Whiplash-associated disorders (WAD) describe a constellation of symptoms that may include pain, stiffness/limited motion, dizziness, headache, depression/anxiety, and brain fog. The condition associates with accelerations/deceleration events like car accidents, sports collisions, or slips and falls. Such injuries are classified into four categories. WAD I (no/minimal complaints/injury) and WAD II (soft-tissue injury – muscle/tendon and/or ligament injury). WAD III (nerve injury and WAD IV (fracture). More than 85% of those involved in a motor vehicle collision (MVC) experience neck pain. About 29-40% recover within a little more than three months and about 23% still not having recovered after one year.
Systematic Review for Neck Pain
In 2016, a systematic review generated treatment guidelines for patients with WAD and/or neck-associated disorders (NAD). For context, both a recent injury and cases in which pain has persisted for longer than three months. Importantly, these guidelines form with input from several types of healthcare providers, including chiropractors, medical doctors, and physical therapists.
For recent-onset neck pain (0-3 months), the authors recommend multiple types of care. These include manipulation or mobilization, range-of-motion home exercise, or multimodal manual therapy (for grades I-II NAD). Adding supervised graded strengthening exercise (grade III NAD), and multimodal care (grade III WAD) if needed.
For persistent neck pain (3+ months), the review recommends multimodal care or stress self-management. This can also include manipulation with soft tissue therapy and high-dose massage. Supervised group exercise, yoga, supervised strengthening exercises, or home exercises (grades I-II NAD) is recommended as well. Multimodal care or practitioner’s advice (grades I-III NAD) and supervised exercise with advice or advice alone (grades I-II WAD). For patients with persistent neck and shoulder pain, evidence support supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD).
The term, “multi-modal care” is defined as a grouping of manipulation, mobilization, and soft tissue techniques, and more. Multi-modal care may incorporate the use of hot or cold packs, assisted stretching, advice to stay active or modify activity, and neck/shoulder exercise training. Chiropractors use a multi-modal approach when treating patients with musculoskeletal pain, including those with whiplash-associated disorders.
