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Neck News

Early or Late Treatment for Whiplash Injury?

More cars. More traffic. More accidents. More whiplash injuries. That sums up the state of affairs on roads in Sweden. Physical therapists want to see fewer cases of whiplash. Studying how injury occurs may help find safer car designs and construction. But until whiplash associated disorders (WAD) are a thing of the past, it would be good to know which treatments work best.

Physical therapists from Sweden studied the effects of early or late treatment using two different methods. Patients were divided into two early treatment groups and two late groups. Early treatment groups began therapy within three days of injury. Late treatment began two weeks later. Each of the two groups had either standard treatment or active intervention.

In this study, standard treatments included advice on activities and a pamphlet on how and when to move the neck. Movements involved raising up the shoulders, pulling the shoulders back, and all neck motions. Active treatment is usually based on early and repeated movements. A group of patients matched by sex and age, but without accident or injury, was used to compare to the whiplash patients.

Patients in all four groups were followed for three years. Pain level, neck range of motion, and sick leave were used as measurements. The authors report faster recovery for patients in the active treatment group. These patients used less sick leave, and their pain was reduced more than in the standard group.

The authors conclude that if active treatment is given, it should be done early rather than late. Standard treatment is better received later. They think early intervention may even prevent delayed symptoms common with WAD. This information will help physical therapists plan the best program and timing for patients with WAD.


Mark Rosenfeld, RPT, et al. Active Intervention in Patients with Whiplash Associated Disorders Improves Long-Term Prognosis. In Spine. November 15, 2003. Vol. 28. No. 22. Pp. 2491-2498.

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