ROM and Strengthening Exercises as a Treatment Option
There are multiple kinds of exercise that could be beneficial in treating acute whiplash. Literature shows exercises such as a McKenzie treatment, postural training exercise, endurance strengthening and motor control, eye fixation, isometric exercises, and resistive exercises. In reviewing the literature, these exercises were combined with other treatment strategies such as modalities or mobilization to get the most effective outcome. Also, at this point although there is a large amount of research done on treatment of whiplash injury, the conclusions that are made from this literature conflict each other. However, there is a consensus that excessive treatment of whiplash associated disorder may be counterproductive in the acute stages of injury. (Cochrane review) The evidence does not support episodes of care that last longer than 6-8 weeks with any one or combination of noninvasive interventions. If the intervention that is being attempted at that time is unsuccessful, it is then recommended that a different intervention be attempted. (Cochrane review) Based on this information, if active ROM and strengthening exercises are to be used, the intensity and frequency should be monitored closely to avoid increased injury. In comparing the effectiveness of these exercises, many studies compared them to periods of “standard care”. Standard Care included rest, analgesia, and general advice on gradual mobilization after a short period of rest.
McKenzie treatment is based on the principle of centralization of pain and the use of exercises to reduce the stress on the surrounding neck musculature. For acute WAD patient’s, the goal is to stretch and decrease the tightness of the cervical extensor muscles, which may be overly contracted in this patient population. A common exercise to accomplish this is the chin tuck, where the patient retracts their chin and repeats this activity for a given number of repetitions. In a study by McKinney et al, three groups of patients with WAD were placed in 3 treatment categories and compared by outcome measures. The treatment categories included a home mobilization group who were instructed in postural correction, analgesia, collar, muscle relaxation and mobilization exercises. The second group was a group who received outpatient physiotherapy, including; McKenzie treatment, heat, cold, diathermy, traction, Maitland mobilization, postural correction and home exercise. The final group compared in this study received standard care as defined above. (Seferiadis, European spine journal) All treatments were given over a period of 6 weeks for 24 visits, with the follow up visits at 2 weeks. (Cochrane review- exercises for mechanical neck disorders) Patients who received outpatient physiotherapy, including McKenzie treatment demonstrated improved cervical ROM and pain intensity in comparison to the treatment group receiving standard care. However, there was no difference in effectiveness between the outpatient physiotherapy group and home mobilization group. In a second study by Rosenfeld et al, the standard treatment for WAD was compared to active intervention that included McKenzie treatment and active cervical ROM. The group receiving active intervention demonstrated the most benefit when treatment was provided within 96 hours of initial injury. This group also demonstrated lower pain intensity and amount of sick leave, as well as improved cervical ROM in comparison to the standard care group. These outcomes were maintained at a 6 month and 3 year follow up (Seferiadis, European spine journal). Based on this literature and the results of the studies, McKenzie exercises have shown to be beneficial in reducing pain in patients with WAD.
Postural training exercises as defined by a systematic review by Drescher et al, includes any correction, exercise or advice with the aim of improving posture. (Drescher) Postural training would be...
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