07.19.12

Does Early Management of Whiplash-Associated Disorders Assist or Impede Recovery?

Posted in Guidelines for Treatment, Injury, Truths About Back & Neck Pain at 2:23 PM by Dr. Greathouse

Commentary

What this abstract is telling us is that it’s probably best to wait a period of time before letting a physical therapist or a chiropractor  begin exercise or manual therapy on one’s neck after a motor vehicle accident! Too much too soon is bad. Additionally, if you’re not getting better after at least four weeks of care, something needs to change. That means different care or another opinion. I’ve done enough independent medical exams over the years to tell you that both disciplines (chiros and PT’s) can get a bit too over zealous in their attempts to make you better with too much too soon.

This review indicates not only does care too early delay your recovery it can lead to the development of chronic  pain and iatrogenic disability!  Iatrogenic means caused by the healthcare provider.

Typically  injuries are most painful for 3 to 10 days and will progressively lessen as inflammation reduces and repair begins. The PRICE Rule should be in effect at this time (Protect, Rest, Ice, Compress and elevate an extremity joint). Inflammatory cells and by-products, which are the source of chemically mediated pain, decrease significantly in numbers until the third week (Enwemeka 1989). Gradually, at the end of the acute inflammatory phase, functional range movements can begin.

Treating too long typically isn’t helpful either!

Treating over 8 to 12 weeks will not likely provide further remedial therapeutic benefit (won’t make you better). It may be palliative in nature (makes you feel good short term) but experts feel it leads to dependency on care. Kind of like the classical conditioning of  Pavlov’s dog, I hurt a little, therefore I need care. The goals of care should be to abolish/reduce pain, improve physical and functional capacity (as clinically indicated) and wean from care. Most long term therapeutic needs can be achieved with well prescribed exercises you can do at home. If you have exacerbations, then you return to care, but not on a regular basis after the natural history of healing.

For more info on soft tissue healing and management go to http://www.greathousechiropractic.com/physical_therapy__rehabilitation

Feel free to call me with questions: 725-6314

Does Early Management of Whiplash-Associated Disorders Assist or Impede Recovery?

Pierre Côté , DC, PhD , * and Sophie Soklaridis , PhD †

Study Design. Narrative review of the literature and commentary.

Objective. To discuss from an epidemiological and sociological

perspective whether the early clinical management of whiplashassociated

disorders can lead to iatrogenic disability.

Summary of Background Data. There is a lack of evidence

supporting the effectiveness of early rehabilitation care for whiplashassociated

disorders.

Methods. We describe the epidemiological evidence on the

effectiveness of early rehabilitation on health outcomes for patients

with whiplash-associated disorders and analyze from a sociological

perspective how the medicalization of this condition may have

contributed to increasing its burden on disability.

Results. The evidence from randomized clinical trials suggests

that education, exercise, and mobilization are effective modalities

to treat whiplash-associated disorders. However, the evidence from

large population-based cohort studies and a pragmatic randomized

trial suggests that too much health care and rehabilitation too early

after the injury can be associated with delayed recovery and the

development of chronic pain and disability. These fi ndings suggest

that clinicians may be inadvertently contributing to the development

of iatrogenic disability. The epidemiological evidence is supported

by the sociological concepts of medicalization, iatrogenesis, and

moral hazard.

Conclusion. The current evidence suggests that too much health

care too early after the injury is associated with delayed recovery.

Clinicians need to be educated about the risk of iatrogenic disability.

Key words: whiplash-associated disorders , rehabilitation , prognosis ,

iatrogenesis , chronic pain , disability . Spine 2011 ; 36 : S275 – S279

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