Whiplash

Pain Res Manag. 2005 Spring;10(1):21-32.

Treatment of whiplash-associated disorders–part I: Non-invasive interventions.

Conlin A, Bhogal S, Sequeira K, Teasell R.

St Joseph’s Health Centre, Parkwood Hospital, London, Canada.

BACKGROUND: A whiplash-associated disorder (WAD) is an injury due to an acceleration-deceleration mechanism at the neck. WAD represents a very common and costly condition, both economically and socially. In 1995, the Quebec Task Force published a report that contained evidence-based recommendations regarding the treatment of WAD based on studies completed before 1993 and consensus-based recommendations.

OBJECTIVE: The objective of the present article–the first installment of a two-part series on interventions for WAD–is to provide a systematic review of the literature published between January 1993 and July 2003 on noninvasive interventions for WAD using meta-analytical techniques.

METHODS OF THE REVIEW: Three medical literature databases were searched for identification of all studies on the treatment of WAD. Randomized controlled trials (RCTs) and epidemiological studies were categorized by treatment modality and analyzed by outcome measure. The methodological quality of the RCTs was assessed. When possible, pooled analyses of the RCTs were completed for meta-analyses of the data. The results of all the studies were compiled and systematically reviewed.

RESULTS: Studies were categorized as exercise alone, multimodal intervention with exercise, mobilization, strength training, pulsed magnetic field treatment and chiropractic manipulation. A total of eight RCTs and 10 non-RCTs were evaluated. The mean score of methodological quality of the RCTs was five out of 10. Pooled analyses were completed across all treatment modalities and outcome measures. The outcomes of each study were summarized in tables.

CONCLUSIONS: There exists consistent evidence (published in two RCTs) in support of mobilization as an effective noninvasive intervention for acute WAD. Two RCTs also reported consistent evidence that exercise alone does not improve range of motion in patients with acute WAD. One RCT reported improvements in pain and range of motion in patients with WAD of undefined duration who underwent pulsed electromagnetic field treatment. Conflicting evidence in two RCTs exists regarding the effectiveness of multimodal intervention with exercise. Limited evidence, in the form of three non-RCTs, exists in support of chiropractic manipulation. Future research should be directed toward clarifying the role of exercise and manipulation in the treatment of WAD, and supporting or refuting the benefit of pulsed electromagnetic field treatment. Mobilization is recommended for the treatment of pain and compromised cervical range of motion in the acute WAD patient.

Neurorehabilitation
Issue: Volume 17, Number 1 / 2002
Pages: 63 – 67

Evaluation of electromagnetic fields in the treatment of pain in patients with lumbar radiculopathy or the whiplash syndrome.

Ch. Thuile A1 and M. Walzl A2

A1 International Society of Energy Medicine, Vienna, Austria
A2 State Clinic of Neurology and Psychiatry, Graz, Austria

Abstract:

Back pain and the whiplash syndrome are very common diseases involving tremendous costs and extensive medical effort. A quick and effective reduction of symptoms, especially pain, is required. In two prospective randomized studies, patients with either lumbar radiculopathy in the segments L5/S1 or the whiplash syndrome were investigated. Inclusion criteria were as follows: either clinically verified painful lumbar radiculopathy in the segments L5/S1 and a Laségue’s sign of 30 degrees (or more), or typical signs of the whiplash syndrome such as painful restriction of rotation and flexion/extension. Exclusion criteria were prolapsed intervertebral discs, systemic neurological diseases, epilepsy, and pregnancy. A total of 100 patients with lumbar radiculopathy and 92 with the whiplash syndrome were selected and entered in the study following a 1:1 ratio. Both groups (magnetic field treatment and controls) received standard medication consisting of diclofenac and tizanidine, while the magnetic field was only applied in group 1, twice a day, for a period of two weeks. In patients suffering from radiculopathy, the average time until pain relief and painless walking was 8.2 – 0.5 days in the magnetic field group, and 11.7 – 0.5 days in controls p < 0.04). In patients with the whiplash syndrome, pain was measured on a ten-point scale. Pain in the head was on average 4.6 before and 2.1 after treatment in those receiving magnetic field treatment, and 4.2/3.5 in controls. Neck pain was on average 6.3/1.9 as opposed to 5.3/4.6, and pain in the shoulder/arm was 2.4/0.8 as opposed to 2.8/2.2 (p < 0.03 for all regions). Hence, magnetic fields appear to have a considerable and statistically significant potential for reducing pain in cases of lumbar radiculopathy and the whiplash syndrome.

References:

  1. G.B.J. Andersson, The Epidemiology of Spinal Disorder, in: The Adult Spine: Principles and Practice, J.W. Frymoyer, ed., Raven Press, New York, 1991.
  2. V. Grosser, K. Seide and D. Wolter, Berufliche Belastungen und bandscheibenbedingte Erkrankungen der LWS: Derzeit-iger Kausalwissenstand in der Literatur? in: Berufskrankheit 2108: Kausalit¨at und Abgrenzungskriterien, D. Wolter and K. Seide, eds., Springer, Berlin, 1995, pp. 26-38.

Best Pract Res Clin Rheumatol. 2007 Feb;21(1):93-108.

Straqtegies for prevention and mangagement of musculoskeletal conditions. Neck pain.

Jensen I, Harms-Ringdahl K.

Department of Clinical Neuroscience, Section of Personal Injury Prevention, Karolinska Institutet, and Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden. irene.jensen@ki.se

The aim of this article was to summarise the existing evidence concerning interventions for non-specific neck pain. Neck-and-shoulder pain is commonly experienced by both adolescents and adults. Although the prevalence appears to vary among different nations, the situation is essentially the same, at least in the industrialised nations. Explanations for the wide variation in incidence and prevalence include various methodological issues. Back and neck disorders represent one of the most common causes for both short- and long-term sick leave and disability pension. Evidenced risk factors for the onset and maintenance of non-specific neck and back pain include both individual and work-related psychosocial factors. Based on the existing evidence different forms of exercise can be strongly recommended for at-risk populations, as well as for the acute and chronic non-specific neck pain patient. Furthermore, for symptom relief this condition can be treated with transcutaneous electric nerve stimulation, low level laser therapy, pulse electromagnetic treatment or radiofrequency denervation.

Scand J Rehabil Med. 1992;24(1):51-9.

Low energy high frequency pulsed electromagnetic therapy for acute whiplash injuries.  A double blind randomized controlled stuy.

Foley-Nolan D. et.al. Mater Hospital, Dublin, Ireland.

The standard treatment of acute whiplash injuries (soft collar and analgesia) is frequently unsuccessful. Pulsed electromagnetic therapy PEMT has been shown to have pro-healing and anti-inflammatory effects. This study examines the effect of PEMT on the acute whiplash syndrome. PEMT as described is safe for domiciliary use and this study suggests that PEMT has a beneficial effect in the management of the acute whiplash injury.