Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter September 27, 2021

Exercise therapy for whiplash-associated disorders: a systematic review and meta-analysis

Bruno Chrcanovic, Johan Larsson, Eva-Maj Malmström, Hans Westergren ORCID logo and Birgitta Häggman-Henrikson ORCID logo

Abstract

Objectives

Acute as well as chronic pain syndromes are common after whiplash trauma and exercise therapy is proposed as one possible intervention strategy. The aim of the present systematic review was to evaluate the effect of exercise therapy in patients with Whiplash-Associated Disorders for the improvement of neck pain and neck disability, compared with other therapeutic interventions, placebo interventions, no treatment, or waiting list.

Content

The review was registered in Prospero (CRD42017060356) and conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search in PubMed, Scopus and Cochrane from inception until January 13, 2020 was combined with a hand search to identify eligible randomized controlled studies. Abstract screening, full text assessment and risk of bias assessment (Cochrane RoB 2.0) were conducted by two independent reviewers.

Summary

The search identified 4,103 articles. After removal of duplicates, screening of 2,921 abstracts and full text assessment of 100 articles, 27 articles that reported data for 2,127 patients were included. The included articles evaluated the effect of exercise therapy on neck pain, neck disability or other outcome measures and indicated some positive effects from exercise, but many studies lacked control groups not receiving active treatment. Studies on exercise that could be included in the random-effect meta-analysis showed significant short-term effects on neck pain and medium-term effects on neck disability.

Outlook

Despite a large number of articles published in the area of exercise therapy and Whiplash-Associated Disorders, the current evidence base is weak. The results from the present review with meta-analysis suggests that exercise therapy may provide additional effect for improvement of neck pain and disability in patients with Whiplash-Associated Disorders.


Corresponding author: Birgitta Häggman-Henrikson, Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden, E-mail:

Funding source: Folksam Research Foundation

  1. Research funding: The study was supported by grants from the Folksam Research Foundation.

  2. Author contributions: BHH, EMM, HW and JL contributed to the concept and design of the review. BC, BHH and JL conducted the abstract screening and risk of bias assessment. BC, BHH, JL and EMM conducted the full text assessment. BC and JL analyzed the data. and BC performed the meta-analysis. All authors interpreted the results. BC and JL drafted the manuscript. All authors critically reviewed the manuscript and approved the final version.

  3. Competing interests: Authors state no conflict of interest.

  4. Ethical approval: Not applicable.

References

1. Holm, LW, Carroll, LJ, Cassidy, JD, Hogg-Johnson, S, Côté, P, Guzman, J, et al.. The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. J Manip Physiol Ther 2009;32:S61–9. https://doi.org/10.1016/j.jmpt.2008.11.011.Search in Google Scholar PubMed

2. Styrke, J, Stålnacke, BM, Bylund, PO, Sojka, P, Björnstig, U. A 10-year incidence of acute whiplash injuries after road traffic crashes in a defined population in northern Sweden. PM&R 2012;4:739–47. https://doi.org/10.1016/j.pmrj.2012.05.010.Search in Google Scholar PubMed

3. Galasko, C, Murray, P, Stephenson, W. Incidence of whiplash-associated disorder. BC Med J 2002;44:237–40.Search in Google Scholar

4. Carroll, LJ, Holm, LW, Hogg-Johnson, S. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Spine 2011;33:S83–92. https://doi.org/10.1097/BRS.0b013e3181643eb8.Search in Google Scholar PubMed

5. Sterling, M, Hendrikz, J, Kenardy, J. Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: a prospective study. Pain 2010;150:22–8. https://doi.org/10.1016/j.pain.2010.02.013.Search in Google Scholar PubMed

6. Freeman, MD, Croft, AC, Rossignol, AM, Centeno, CJ, Elkins, WL. Chronic neck pain and whiplash: a case-control study of the relationship between acute whiplash injuries and chronic neck pain. Pain Res Manag 2006;11:79–83. https://doi.org/10.1155/2006/304673.Search in Google Scholar PubMed PubMed Central

7. Rosenfeld, M, Seferiadis, A, Gunnarsson, R. Active involvement and intervention in patients exposed to whiplash trauma in automobile crashes reduces costs: a randomized, controlled clinical trial and health economic evaluation. Spine 2006;31:1799–804. https://doi.org/10.1097/01.brs.0000225975.12978.6c.Search in Google Scholar PubMed

8. Wiangkham, T, Duda, J, Haque, S, Madi, M, Rushton, A. The effectiveness of conservative management for acute whiplash associated disorder (WAD) II: a systematic review and meta-analysis of randomised controlled trials. PLoS One 2015;10: e0133415. https://doi.org/10.1371/journal.pone.0133415.Search in Google Scholar PubMed PubMed Central

9. Brody, LT, Hall, CM. Therapeutic exercise: moving toward function. Philadelphia: Lippincott Williams & Wilkins; 2012.Search in Google Scholar

10. Southerst, D, Nordin, MC, Côté, P, Shearer, HM, Varatharajan, S, Yu, H, et al.. Is exercise effective for the management of neck pain and associated disorders or whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Spine J 2016;16:1503–23. https://doi.org/10.1016/j.spinee.2014.02.014.Search in Google Scholar PubMed

11. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, Grp, P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264–9, W64. https://doi.org/10.7326/0003-4819-151-4-200908180-00135.Search in Google Scholar PubMed

12. Spitzer, WO, Skovron, ML, Salmi, LR, Cassidy, JD, Duranceau, J, Suissa, S, et al.. Scientific monograph of the Quebec task force on whiplash-associated disorders: redefining “whiplash” and its management. Spine 1995;20:1s–73s. https://doi.org/10.1097/00007632-199504151-00004.Search in Google Scholar

13. Egger, M, Smith, GD. Principles of and procedures for systematic reviews. In: Egger, M, Smith, GD, Altman, DG, editors. Systematic reviews in health care: meta-analysis in context. London: BMJ Books; 2003:23–42 pp.10.1002/9780470693926.ch2Search in Google Scholar

14. Ahadi, M, Naser, Z, Abolghasemi, J. Vestibular-balance rehabilitation in patients with whiplash-associated disorders. Int Tinnitus J 2019;23:42–6. https://doi.org/10.5935/0946-5448.20190008.Search in Google Scholar PubMed

15. Ardern, CL, Peterson, G, Ludvigsson, ML, Peolsson, A. Satisfaction with the outcome of physical therapist-prescribed exercise in chronic whiplash-associated disorders: secondary analysis of a randomized clinical trial. J Orthop Sports Phys Ther 2016;46:640–9. https://doi.org/10.2519/jospt.2016.6136.Search in Google Scholar PubMed

16. Ask, T, Strand, LI, Skouen, JS. The effect of two exercise regimes; motor control versus endurance/strength training for patients with whiplash-associated disorders: a randomized controlled pilot study. Clin Rehabil 2009;23:812–23. https://doi.org/10.1177/0269215509335639.Search in Google Scholar PubMed

17. Bunketorp, L, Lindh, M, Carlsson, J, Stener-Victorin, E. The effectiveness of a supervised physical training model tailored to the individual needs of patients with whiplash-associated disorders – a randomized controlled trial. Clin Rehabil 2006;20:201–17. https://doi.org/10.1191/0269215506cr934oa.Search in Google Scholar PubMed

18. Crawford, JR, Khan, RJ, Varley, GW. Early management and outcome following soft tissue injuries of the neck-a randomised controlled trial. Injury 2004;35:891–5. https://doi.org/10.1016/j.injury.2004.01.011.Search in Google Scholar PubMed

19. Fitz-Ritson, D. Phasic exercises for cervical rehabilitation after “whiplash” trauma. J Manip Physiol Ther 1995;18:21–4.Search in Google Scholar

20. Hansson, EE, Persson, L, Malmström, EM. Influence of vestibular rehabilitation on neck pain and cervical range of motion among patients with whiplash-associated disorder: a randomized controlled trial. J Rehabil Med 2013;45:906–10. https://doi.org/10.2340/16501977-1197.Search in Google Scholar PubMed

21. Jull, G, Sterling, M, Kenardy, J, Beller, E. Does the presence of sensory hypersensitivity influence outcomes of physical rehabilitation for chronic whiplash? – a preliminary RCT. Pain 2007;129:28–34. https://doi.org/10.1016/j.pain.2006.09.030.Search in Google Scholar PubMed

22. Klobas, L, Axelsson, S, Tegelberg, A. Effect of therapeutic jaw exercise on temporomandibular disorders in individuals with chronic whiplash-associated disorders. Acta Odontol Scand 2006;64:341–7. https://doi.org/10.1080/00016350600825310.Search in Google Scholar PubMed

23. Kongsted, A, Qerama, E, Kasch, H, Bendix, T, Bach, FW, Korsholm, L, et al.. Neck collar, “act-as-usual” or active mobilization for whiplash injury? A randomized parallel-group trial. Spine 2007;32:618–26. https://doi.org/10.1097/01.brs.0000257535.77691.bd.Search in Google Scholar PubMed

24. Landen Ludvigsson, M, Peterson, G, Peolsson, A. The effect of three exercise approaches on health-related quality of life, and factors associated with its improvement in chronic whiplash-associated disorders: analysis of a randomized controlled trial. Qual Life Res 2019;28:357–68. https://doi.org/10.1007/s11136-018-2004-3.Search in Google Scholar

25. Landen Ludvigsson, M, Peterson, G, Widh, S, Peolsson, A. Exercise, headache, and factors associated with headache in chronic whiplash: analysis of a randomized clinical trial. Medicine (Baltim) 2019;98:e18130. https://doi.org/10.1097/md.0000000000018130.Search in Google Scholar

26. Lo, HK, Johnston, V, Landen Ludvigsson, M, Peterson, G, Overmeer, T, David, M, et al.. Factors associated with work ability following exercise interventions for people with chronic whiplash-associated disorders: secondary analysis of a randomized controlled trial. J Rehabil Med 2018;50:828–36. https://doi.org/10.2340/16501977-2374.Search in Google Scholar

27. Ludvigsson, ML, Peterson, G, Dedering, Å, Peolsson, A. One- and two-year follow-up of a randomized trial of neck-specific exercise with or without a behavioural approach compared with prescription of physical activity in chronic whiplash disorder. J Rehabil Med 2016;48:56–64. https://doi.org/10.2340/16501977-2041.Search in Google Scholar

28. Ludvigsson, ML, Peterson, G, O’Leary, S, Dedering, Å, Peolsson, A. The effect of neck-specific exercise with, or without a behavioral approach, on pain, disability, and self-efficacy in chronic whiplash-associated disorders: a randomized clinical trial. Clin J Pain 2015;31:294–303. https://doi.org/10.1097/ajp.0000000000000123.Search in Google Scholar

29. Michaleff, ZA, Maher, CG, Lin, CW, Rebbeck, T, Jull, G, Latimer, J, et al.. Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial. Lancet 2014;384:133–41. https://doi.org/10.1016/s0140-6736(14)60457-8.Search in Google Scholar

30. Overmeer, T, Peterson, G, Landen Ludvigsson, M, Peolsson, A. The effect of neck-specific exercise with or without a behavioral approach on psychological factors in chronic whiplash-associated disorders: a randomized controlled trial with a 2-year follow-up. Medicine (Baltim) 2016;95:e4430. https://doi.org/10.1097/md.0000000000004430.Search in Google Scholar PubMed PubMed Central

31. Peolsson, A, Landén Ludvigsson, M, Tigerfors, AM, Peterson, G. Effects of neck-specific exercises compared to waiting list for individuals with chronic whiplash-associated disorders: a prospective, randomized controlled study. Arch Phys Med Rehabil 2016;97:189–95. https://doi.org/10.1016/j.apmr.2015.10.087.Search in Google Scholar PubMed

32. Picelli, A, Ledro, G, Turrina, A, Stecco, C, Santilli, V, Smania, N. Effects of myofascial technique in patients with subacute whiplash associated disorders: a pilot study. Eur J Phys Rehabil Med 2011;47:561–8.Search in Google Scholar

33. Rosenfeld, M, Seferiadis, A, Carlsson, J, Gunnarsson, R. Active intervention in patients with whiplash-associated disorders improves long-term prognosis: a randomized controlled clinical trial. Spine 2003;28:2491–8. https://doi.org/10.1097/01.brs.0000090822.96814.13.Search in Google Scholar

34. Schnabel, M, Ferrari, R, Vassiliou, T, Kaluza, G. Randomised, controlled outcome study of active mobilisation compared with collar therapy for whiplash injury. Emerg Med J 2004;21:306–10. https://doi.org/10.1136/emj.2003.010165.Search in Google Scholar PubMed PubMed Central

35. Scholten-Peeters, GG, Neeleman-van der Steen, CW, van der Windt, DA, Hendriks, EJ, Verhagen, AP, Oostendorp, RA. Education by general practitioners or education and exercises by physiotherapists for patients with whiplash-associated disorders? A randomized clinical trial. Spine 2006;31:723–31. https://doi.org/10.1097/01.brs.0000206381.15224.0f.Search in Google Scholar PubMed

36. Seferiadis, A, Ohlin, P, Billhult, A, Gunnarsson, R. Basic body awareness therapy or exercise therapy for the treatment of chronic whiplash associated disorders: a randomized comparative clinical trial. Disabil Rehabil 2016;38:442–51. https://doi.org/10.3109/09638288.2015.1044036.Search in Google Scholar PubMed

37. Sterling, M, Smeets, R, Keijzers, G, Warren, J, Kenardy, J. Physiotherapist-delivered stress inoculation training integrated with exercise versus physiotherapy exercise alone for acute whiplash-associated disorder (StressModex): a randomised controlled trial of a combined psychological/physical intervention. Br J Sports Med 2019;53:1240–7. https://doi.org/10.1136/bjsports-2018-100139.Search in Google Scholar PubMed

38. Stewart, MJ, Maher, CG, Refshauge, KM, Herbert, RD, Bogduk, N, Nicholas, M. Randomized controlled trial of exercise for chronic whiplash-associated disorders. Pain 2007;128:59–68. https://doi.org/10.1016/j.pain.2006.08.030.Search in Google Scholar PubMed

39. Söderlund, A, Olerud, C, Lindberg, P. Acute whiplash-associated disorders (WAD): the effects of early mobilization and prognostic factors in long-term symptomatology. Clin Rehabil 2000;14:457–67. https://doi.org/10.1191/0269215500cr348oa.Search in Google Scholar PubMed

40. Landen Ludvigsson, M, Peolsson, A, Peterson, G, Dedering, A, Johansson, G, Bernfort, L. Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders: analyses of a randomized clinical trial. Medicine (Baltim) 2017;96:e7274. https://doi.org/10.1097/md.0000000000007274.Search in Google Scholar PubMed PubMed Central

41. Landén Ludvigsson, M, Peterson, G, Dedering, Å, Falla, D, Peolsson, A. Factors associated with symptom reduction following different exercise interventions in chronic whiplash associated disorders. A randomized clinical trial. Physiotherapy 2015;101:e819. https://doi.org/10.1016/j.physio.2015.03.3707.Search in Google Scholar

42. Landen Ludvigsson, M, Peterson, G, Peolsson, A. Neck-specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash – analyses of a randomized clinical trial. Sci Rep 2018;8:12409. https://doi.org/10.1038/s41598-018-30556-w.Search in Google Scholar PubMed PubMed Central

43. Ludvigsson, ML, Peolsson, A, Peterson, G, Dedering, Å, Johansson, G, Bernfort, L. Cost-effectiveness of neck-specific exercise in the treatment of chronic whiplash associated disorders. Man Ther 2016;25:e33. https://doi.org/10.1016/j.math.2016.05.026.Search in Google Scholar

44. Ludvigsson, ML, Peterson, G, Dedering, Å, Peolsson, A. Two-year follow up of a randomized clinical trial of pain and disability following neck-specific exercise in chronic whiplash associated disorders. Man Ther 2016;25:e34. https://doi.org/10.1016/j.math.2016.05.028.Search in Google Scholar

45. Westergren, H, Larsson, J, Freeman, M, Carlsson, A, Joud, A, Malmstrom, EM. Sex-based differences in pain distribution in a cohort of patients with persistent post-traumatic neck pain. Disabil Rehabil 2018;40:1085–91. https://doi.org/10.1080/09638288.2017.1280543.Search in Google Scholar

46. Barnsley, L, Lord, S, Bogduk, N. Whiplash injury. Pain 1994;58:283–307. https://doi.org/10.1016/0304-3959(94)90123-6.Search in Google Scholar

47. Borchgrevink, GE, Kaasa, A, McDonagh, D, Stiles, TC, Haraldseth, O, Lereim, I. Acute treatment of whiplash neck sprain injuries. A randomized trial of treatment during the first 14 days after a car accident. Spine 1998;23:25–31. https://doi.org/10.1097/00007632-199801010-00006.Search in Google Scholar

48. Maimaris, C, Barnes, MR, Allen, MJ. ‘Whiplash injuries’ of the neck: a retrospective study. Injury 1988;19:393–6. https://doi.org/10.1016/0020-1383(88)90131-3.Search in Google Scholar

49. Kamper, SJ, Rebbeck, TJ, Maher, CG, McAuley, JH, Sterling, M. Course and prognostic factors of whiplash: a systematic review and meta-analysis. Pain 2008;138:617–29. https://doi.org/10.1016/j.pain.2008.02.019.Search in Google Scholar

50. Sterling, M, Jull, G, Vicenzino, B, Kenardy, J. Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery. Pain 2003;104:509–17. https://doi.org/10.1016/s0304-3959(03)00078-2.Search in Google Scholar

51. Sterling, M, Jull, G, Vicenzino, B, Kenardy, J, Darnell, R. Development of motor system dysfunction following whiplash injury. Pain 2003;103:65–73. https://doi.org/10.1016/s0304-3959(02)00420-7.Search in Google Scholar

52. Sterling, M, Kenardy, J, Jull, G, Vicenzino, B. The development of psychological changes following whiplash injury. Pain 2003;106:481–9. https://doi.org/10.1016/j.pain.2003.09.013.Search in Google Scholar PubMed

53. Chen, K, Andersen, T, Carroll, L, Connelly, L, Côté, P, Curatolo, M, et al.. Recommendations for core outcome domain set for whiplash-associated disorders (CATWAD). Clin J Pain 2019;35:727–36. https://doi.org/10.1097/ajp.0000000000000735.Search in Google Scholar

54. Juul, T, Søgaard, K, Davis, AM, Roos, EM. Psychometric properties of the Neck OutcOme Score, Neck Disability Index, and Short Form-36 were evaluated in patients with neck pain. J Clin Epidemiol 2016;79:31–40. https://doi.org/10.1016/j.jclinepi.2016.03.015.Search in Google Scholar PubMed

55. Pink, J, Petrou, S, Williamson, E, Williams, M, Lamb, SE. Economic and health-related quality of life outcomes of whiplash associated disorders. Spine 2016;41:1378–86. https://doi.org/10.1097/brs.0000000000001512.Search in Google Scholar

56. Gennis, P, Miller, L, Gallagher, EJ, Giglio, J, Carter, W, Nathanson, N. The effect of soft cervical collars on persistent neck pain in patients with whiplash injury. Acad Emerg Med 1996;3:568–73. https://doi.org/10.1111/j.1553-2712.1996.tb03466.x.Search in Google Scholar

57. Buitenhuis, J, de Jong, PJ, Jaspers, JP, Groothoff, JW. Work disability after whiplash: a prospective cohort study. Spine 2009;34:262–7. https://doi.org/10.1097/brs.0b013e3181913d07.Search in Google Scholar

58. Ravn, SL, Sterling, M, Lahav, Y, Andersen, TE. Reciprocal associations of pain and post-traumatic stress symptoms after whiplash injury: a longitudinal, cross-lagged study. Eur J Pain 2018;22:926–34. https://doi.org/10.1002/ejp.1178.Search in Google Scholar

59. Campbell, L, Smith, A, McGregor, L, Sterling, M. Psychological factors and the development of chronic whiplash-associated disorder(s): a systematic review. Clin J Pain 2018;34:755–68. https://doi.org/10.1097/ajp.0000000000000597.Search in Google Scholar

60. Sarrami, P, Armstrong, E, Naylor, JM, Harris, IA. Factors predicting outcome in whiplash injury: a systematic meta-review of prognostic factors. J Orthop Traumatol 2017;18:9–16. https://doi.org/10.1007/s10195-016-0431-x.Search in Google Scholar

61. Ris, I, Juul-Kristensen, B, Boyle, E, Kongsted, A, Manniche, C, Søgaard, K. Chronic neck pain patients with traumatic or non-traumatic onset: differences in characteristics. A cross-sectional study. Scand J Pain 2017;14:1–8. https://doi.org/10.1016/j.sjpain.2016.08.008.Search in Google Scholar

62. Cote, P, Boyle, E, Shearer, HM, Stupar, M, Jacobs, C, Cassidy, JD, et al.. Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial. BMJ Open 2019;9:e021283. https://doi.org/10.1136/bmjopen-2017-021283.Search in Google Scholar

63. Scholten-Peeters, GG, Verhagen, AP, Neeleman-van der Steen, CW, Hurkmans, JC, Wams, RW, Oostendorp, RA. Randomized clinical trial of conservative treatment for patients with whiplash-associated disorders: considerations for the design and dynamic treatment protocol. J Manip Physiol Ther 2003;26:412–20. https://doi.org/10.1016/s0161-4754(03)00092-7.Search in Google Scholar

64. Slade, SC, Dionne, CE, Underwood, M, Buchbinder, R, Beck, B, Bennell, K, et al.. Consensus on exercise reporting template (CERT): modified delphi study. Phys Ther 2016;96:1514–24. https://doi.org/10.2522/ptj.20150668.Search in Google Scholar PubMed

65. Amirfeyz, R, Cook, J, Gargan, M, Bannister, G. The role of physiotherapy in the treatment of whiplash associated disorders: a prospective study. Arch Orthop Trauma Surg 2009;129:973–7. https://doi.org/10.1007/s00402-008-0803-7.Search in Google Scholar PubMed

66. Armstrong, BS, McNair, PJ, Williams, M. Head and neck position sense in whiplash patients and healthy individuals and the effect of the cranio-cervical flexion action. Clin Biomech 2005;20:675–84. https://doi.org/10.1016/j.clinbiomech.2005.03.009.Search in Google Scholar PubMed

67. Castaldo, M, Catena, A, Chiarotto, A, Fernandez-de-Las-Penas, C, Arendt-Nielsen, L. Do subjects with whiplash-associated disorders respond differently in the short-term to manual therapy and exercise than those with mechanical neck pain? Pain Med 2017;18:791–803. https://doi.org/10.1093/pm/pnw266.Search in Google Scholar PubMed

68. Florio, A, Ceruti, R, Sguazzini-Viscontini, G, Cisari, C. The sequelae of cervical whiplash injury. Static posturography for evaluating disability and the efficacy of rehabilitation (mesotherapy versus physiotherapy). Eur Medicophys 1999;35:171–6.Search in Google Scholar

69. Goodman, R, Frew, L. Effectiveness of progressive strength resistance training for whiplash: a pilot study. Physiother Can 2000;52:211–4.Search in Google Scholar

70. Pennie, BH, Agambar, LJ. Whiplash injuries. A trial of early management. J Bone Joint Surg Br 1990;72:277–9. https://doi.org/10.1302/0301-620x.72b2.2312568.Search in Google Scholar

71. Peolsson, A, Landén Ludvigsson, M, Overmeer, T, Dedering, Å, Bernfort, L, Johansson, G, et al.. Effects of neck-specific exercise with or without a behavioural approach in addition to prescribed physical activity for individuals with chronic whiplash-associated disorders: a prospective randomised study. BMC Muscoskel Disord 2013;14:311. https://doi.org/10.1186/1471-2474-14-311.Search in Google Scholar PubMed PubMed Central

72. Peolsson, A, Landén Ludvigsson, M, Peterson, G. Neck-specific exercises reduce disability and improve health-related quality of life in individuals with chronic whiplash-associated disorders compared to being on a waiting list for physiotherapy. Man Ther 2016;25:e102–3. https://doi.org/10.1016/j.math.2016.05.181.Search in Google Scholar

73. Rosenfeld, M, Gunnarsson, R, Borenstein, P. An active exercise and posture protocol reduced pain in acute whiplash injuries. Evid Base Med 2001;6:76.10.1136/ebm.6.3.76Search in Google Scholar

74. Rushton, A, Wiangkham, T, Duda, J, Haque, S, Price, J. Prospective cluster-randomised double-blind pilot and feasibility trial of an active behavioural physiotherapy intervention for acute whiplash associated disorder (WAD)II. Physiotherapy 2017;103:e119. https://doi.org/10.1016/j.physio.2017.11.101.Search in Google Scholar

75. Ryan, JM. Reducing pain and disability for whiplash victims: a double-blind randomised controlled trial. In: Road safety research, policing and education conference proceedings 2002. Adelaide, Australia: Plevin and Associates; 2002:219–27 pp.Search in Google Scholar

76. Sterling, M. Kinaesthetic exercise does not improve outcome (or kinaesthesia) in patients with acute whiplash. Aust J Physiother 2001;47:67.Search in Google Scholar

77. Sterling, M, Valentin, S, Vicenzino, B, Souvlis, T, Connelly, LB. Dry needling and exercise for chronic whiplash – a randomised controlled trial. BMC Muscoskel Disord 2009;10:160. https://doi.org/10.1186/1471-2474-10-160.Search in Google Scholar PubMed PubMed Central

78. Sterner, Y, Löfgren, M, Nyberg, V, Karlsson, AK, Bergström, M, Gerdle, B. Early interdisciplinary rehabilitation programme for whiplash associated disorders. Disabil Rehabil 2001;23:422–9. https://doi.org/10.1080/09638280010008852.Search in Google Scholar PubMed

79. Söderlund, A, Lindberg, P. An integrated physiotherapy/cognitive-behavioural approach to the analysis and treatment of chronic whiplash associated disorders, WAD. Disabil Rehabil 2001;23:436–47. https://doi.org/10.1080/09638280010008870.Search in Google Scholar PubMed

80. Söderlund, A, Lindberg, P. Cognitive behavioural components in physiotherapy management of chronic whiplash associated disorders (WAD) – a randomised group study. Physiother Theory Pract 2001;17:229–38. https://doi.org/10.1080/095939801753385735.Search in Google Scholar

81. Turk, DC. Chronic pain and whiplash associated disorders: rehabilitation and secondary prevention. Pain Res Manag 2003;8:40–3. https://doi.org/10.1155/2003/437163.Search in Google Scholar PubMed

82. Williams, MA, Williamson, EM, Gates, S, Mt-Isa, S, Castelnuovo, E, Ashby, D, et al.. A randomised controlled trial of physiotherapy treatments for patients with acute whiplash associated disorders. Physiotherapy 2015;101:e816. https://doi.org/10.1016/j.physio.2015.03.3703.Search in Google Scholar

83. Williamson, E, Williams, M, Hansen, Z, Joseph, S, Lamb, SE. Development and delivery of a physiotherapy intervention for the early management of whiplash injuries: the Managing Injuries of Neck Trial (MINT) Intervention. Physiotherapy 2009;95:15–23. https://doi.org/10.1016/j.physio.2008.11.001.Search in Google Scholar PubMed

84. Conforti, M, Fachinetti, GP. High power laser therapy treatment compared to simple segmental physical rehabilitation in whiplash injuries (1 degrees and 2 degrees grade of the Quebec Task Force classification) involving muscles and ligaments. Muscles Ligaments Tendons J 2013;3:106–11. https://doi.org/10.11138/mltj/2013.3.2.106.Search in Google Scholar PubMed PubMed Central

85. Nyström, B, Svensson, E, Larsson, S, Schillberg, B, Mork, A, Taube, A. A small group Whiplash-Associated-Disorders (WAD) patients with central neck pain and movement induced stabbing pain, the painful segment determined by mechanical provocation: fusion surgery was superior to multimodal rehabilitation in a randomized trial. Scand J Pain 2016;12:33–42. https://doi.org/10.1016/j.sjpain.2016.03.003.Search in Google Scholar PubMed

86. Faux, SG, Kohler, F, Mozer, R, Klein, LA, Courtenay, S, D’Amours, SK, et al.. The ROARI project – Road Accident Acute Rehabilitation Initiative: a randomised clinical trial of two targeted early interventions for road-related trauma. Clin Rehabil 2015;29:639–52. https://doi.org/10.1177/0269215514552083.Search in Google Scholar PubMed

87. Humphreys, BK, Irgens, PM. The effect of a rehabilitation exercise program on head repositioning accuracy and reported levels of pain in chronic neck pain subjects. J Whiplash Relat Disord 2002;1:99–112. https://doi.org/10.3109/j180v01n01_09.Search in Google Scholar

88. Häkkinen, A, Salo, P, Tarvainen, U, Wiren, K, Ylinen, J. Effect of manual therapy and stretching on neck muscle strength and mobility in chronic neck pain. J Rehabil Med 2007;39:575–9. https://doi.org/10.2340/16501977-0094.Search in Google Scholar PubMed

89. Lange, B, Toft, P, Myburgh, C, Sjøgaard, G. Effect of targeted strength, endurance, and coordination exercise on neck and shoulder pain among fighter pilots: a randomized-controlled trial. Clin J Pain 2013;29:50–9. https://doi.org/10.1097/ajp.0b013e3182478678.Search in Google Scholar PubMed

90. Park, SD, Kim, SY. Clinical feasibility of cervical exercise to improve neck pain, body function, and psychosocial factors in patients with post-traumatic stress disorder: a randomized controlled trial. J Phys Ther Sci 2015;27:1369–72. https://doi.org/10.1589/jpts.27.1369.Search in Google Scholar PubMed PubMed Central

91. Suni, JH, Rinne, M, Tokola, K, Manttari, A, Vasankari, T. Effectiveness of a standardised exercise programme for recurrent neck and low back pain: a multicentre, randomised, two-arm, parallel group trial across 34 fitness clubs in Finland. BMJ Open Sport Exerc Med 2017;3:e000233. https://doi.org/10.1136/bmjsem-2017-000233.Search in Google Scholar PubMed PubMed Central

92. Brison, RJ, Hartling, L, Dostaler, S, Leger, A, Rowe, BH, Stiell, I, et al.. A randomized controlled trial of an educational intervention to prevent the chronic pain of whiplash associated disorders following rear-end motor vehicle collisions. Spine 2005;30:1799–807. https://doi.org/10.1097/01.brs.0000174115.58954.17.Search in Google Scholar PubMed

93. Ehrenborg, C, Archenholtz, B. Is surface EMG biofeedback an effective training method for persons with neck and shoulder complaints after whiplash-associated disorders concerning activities of daily living and pain – a randomized controlled trial. Clin Rehabil 2010;24:715–26. https://doi.org/10.1177/0269215510362325.Search in Google Scholar PubMed

94. Pena-Salinas, M, Oliva-Pascual-Vaca, J, Heredia-Rizo, AM, Rodriguez-Blanco, C, Ricard, F, Oliva-Pascual-Vaca, A. No immediate changes on neural and muscular mechanosensitivity after first rib manipulation in subjects with cervical whiplash: a randomized controlled trial. J Back Musculoskelet Rehabil 2017;30:921–8. https://doi.org/10.3233/bmr-160645.Search in Google Scholar

95. Rydman, E, Ottosson, C, Ponzer, S, Dahl, A, Eneqvist, T, Jarnbert-Pettersson, H, et al.. Intervention with an educational video after a whiplash trauma – a randomised controlled clinical trial. Scand J Pain 2020;20:273–81. https://doi.org/10.1515/sjpain-2019-0097.Search in Google Scholar PubMed

96. Svensson, E, Nystrom, B, Goldie, I, Landro, NI, Siden, A, Staff, P, et al.. Superior outcomes following cervical fusion vs. multimodal rehabilitation in a subgroup of randomized Whiplash-Associated-Disorders (WAD) patients indicating somatic pain origin-comparison of outcome assessments made by four examiners from different disciplines. Scand J Pain 2018;18:175–86. https://doi.org/10.1515/sjpain-2017-0180.Search in Google Scholar PubMed

97. Ventegodt, S, Merrick, J, Andersen, NJ, Bendix, T. A combination of gestalt therapy, Rosen Body Work, and Cranio Sacral therapy did not help in chronic whiplash-associated disorders (WAD) – results of a randomized clinical trial. ScientificWorldJournal 2004;4:1055–68. https://doi.org/10.1100/tsw.2004.132.Search in Google Scholar PubMed PubMed Central

98. Wicksell, RK, Ahlqvist, J, Bring, A, Melin, L, Olsson, GL. Can exposure and acceptance strategies improve functioning and life satisfaction in people with chronic pain and whiplash-associated disorders (WAD)? A randomized controlled trial. Cognit Behav Ther 2008;37:169–82. https://doi.org/10.1080/16506070802078970.Search in Google Scholar PubMed

99. Wicksell, RK, Olsson, GL, Hayes, SC. Psychological flexibility as a mediator of improvement in Acceptance and Commitment Therapy for patients with chronic pain following whiplash. Eur J Pain 2010;14:1059.e1–11. https://doi.org/10.1016/j.ejpain.2010.05.001.Search in Google Scholar

100. Antolinos-Campillo, PJ, Oliva-Pascual-Vaca, A, Rodriguez-Blanco, C, Heredia-Rizo, AM, Espi-Lopez, GV, Ricard, F. Short-term changes in median nerve neural tension after a suboccipital muscle inhibition technique in subjects with cervical whiplash: a randomised controlled trial. Physiotherapy 2014;100:249–55. https://doi.org/10.1016/j.physio.2013.09.005.Search in Google Scholar

101. Bonk, AD, Ferrari, R, Giebel, GD, Edelmann, M, Huser, R. Prospective, randomized, controlled study of activity versus collar, and the natural history for whiplash injury, in Germany. J Muscoskel Pain 2000;8:123–32. https://doi.org/10.1300/j094v08n01_10.Search in Google Scholar

102. Bring, A, Åsenlöf, P, Söderlund, A. What is the comparative effectiveness of current standard treatment, against an individually tailored behavioural programme delivered either on the Internet or face-to-face for people with acute whiplash associated disorder? A randomized controlled trial. Clin Rehabil 2016;30:441–53. https://doi.org/10.1177/0269215515581503.Search in Google Scholar

103. Dehner, C, Elbel, M, Strobel, P, Scheich, M, Schneider, F, Krischak, G, et al.. Grade II whiplash injuries to the neck: what is the benefit for patients treated by different physical therapy modalities? Patient Saf Surg 2009;3:2. https://doi.org/10.1186/1754-9493-3-2.Search in Google Scholar

104. Fernández-De-Las-Peñas, C, Fernández-Carnero, J, Palomeque Del Cerro, L, Miangolarra-Page, JC. Manipulative treatment vs. conventional physiotherapy treatment in whiplash injury: a randomized controlled trial. J Whiplash Relat Disord 2004;3:73–90. https://doi.org/10.3109/j180v03n02_06.Search in Google Scholar

105. Jull, G, Kenardy, J, Hendrikz, J, Cohen, M, Sterling, M. Management of acute whiplash: a randomized controlled trial of multidisciplinary stratified treatments. Pain 2013;154:1798–806. https://doi.org/10.1016/j.pain.2013.05.041.Search in Google Scholar

106. Lamb, SE, Gates, S, Williams, MA, Williamson, EM, Mt-Isa, S, Withers, EJ, et al.. Emergency department treatments and physiotherapy for acute whiplash: a pragmatic, two-step, randomised controlled trial. Lancet 2013;381:546–56. https://doi.org/10.1016/s0140-6736(12)61304-x.Search in Google Scholar

107. McKinney, LA. Early mobilisation and outcome in acute sprains of the neck. BMJ 1989;299:1006–8. https://doi.org/10.1136/bmj.299.6706.1006.Search in Google Scholar PubMed PubMed Central

108. Mealy, K, Brennan, H, Fenelon, GC. Early mobilization of acute whiplash injuries. Br Med J 1986;292:656–7. https://doi.org/10.1136/bmj.292.6521.656.Search in Google Scholar PubMed PubMed Central

109. Pato, U, Di Stefano, G, Fravi, N, Arnold, M, Curatolo, M, Radanov, BP, et al.. Comparison of randomized treatments for late whiplash. Neurology 2010;74:1223–30. https://doi.org/10.1212/wnl.0b013e3181d8ffe0.Search in Google Scholar

110. Provinciali, L, Baroni, M, Illuminati, L, Ceravolo, MG. Multimodal treatment to prevent the late whiplash syndrome. Scand J Rehabil Med 1996;28:105–11.Search in Google Scholar

111. Vassiliou, T, Kaluza, G, Putzke, C, Wulf, H, Schnabel, M. Physical therapy and active exercises – an adequate treatment for prevention of late whiplash syndrome? Randomized controlled trial in 200 patients. Pain 2006;124:69–76. https://doi.org/10.1016/j.pain.2006.03.017.Search in Google Scholar

112. Wiangkham, T, Duda, J, Haque, MS, Price, J, Rushton, A. A cluster randomised, double-blind pilot and feasibility trial of an active behavioural physiotherapy intervention for acute whiplash-associated disorder (WAD)II. PLoS One 2019;14:e0215803. https://doi.org/10.1371/journal.pone.0215803.Search in Google Scholar

113. Vikne, J, Oedegaard, A, Laerum, E, Ihlebaek, C, Kirkesola, G. A randomized study of new sling exercise treatment vs traditional physiotherapy for patients with chronic whiplash-associated disorders with unsettled compensation claims. J Rehabil Med 2007;39:252–9. https://doi.org/10.2340/16501977-0049.Search in Google Scholar

114. Sterling, M, Vicenzino, B, Souvlis, T, Connelly, LB. Dry-needling and exercise for chronic whiplash-associated disorders: a randomized single-blind placebo-controlled trial. Pain 2015;156:635–43. https://doi.org/10.1097/01.j.pain.0000460359.40116.c1.Search in Google Scholar

115. Rebbeck, T, Maher, CG, Refshauge, KM. Evaluating two implementation strategies for whiplash guidelines in physiotherapy: a cluster randomised trial. Aust J Physiother 2006;52:165–74. https://doi.org/10.1016/s0004-9514(06)70025-3.Search in Google Scholar

116. Stewart, MJ, Maher, CG, Refshauge, KM, Herbert, RD, Nicholas, MK. Patient and clinician treatment preferences do not moderate the effect of exercise treatment in chronic whiplash-associated disorders. Eur J Pain 2008;12:879–85. https://doi.org/10.1016/j.ejpain.2007.12.009.Search in Google Scholar PubMed

117. Ekvall Hansson, E, Månsson, NO, Ringsberg, KA, Hakansson, A. Dizziness among patients with whiplash-associated disorder: a randomized controlled trial. J Rehabil Med 2006;38:387–90. https://doi.org/10.1080/16501970600768992.Search in Google Scholar PubMed

118. Lamb, SE, Williams, MA, Williamson, EM, Gates, S, Withers, EJ, Mt-Isa, S, et al.. Managing Injuries of the Neck Trial (MINT): a randomised controlled trial of treatments for whiplash injuries. Health Technol Assess 2012;16:iii–iv, 1–141. https://doi.org/10.3310/hta16490.Search in Google Scholar PubMed

119. Ludvigsson, ML, Peterson, G, Dedering, Å, Falla, D, Peolsson, A. Factors associated with pain and disability reduction following exercise interventions in chronic whiplash. Eur J Pain 2016;20:307–15. https://doi.org/10.1002/ejp.729.Search in Google Scholar PubMed

120. McKinney, LA, Dornan, JO, Ryan, M. The role of physiotherapy in the management of acute neck sprains following road-traffic accidents. Arch Emerg Med 1989;6:27–33. https://doi.org/10.1136/emj.6.1.27.Search in Google Scholar PubMed PubMed Central

121. Peterson, G, Nilsson, D, Trygg, J, Peolsson, A. Neck-specific exercise improves impaired interactions between ventral neck muscles in chronic whiplash: a randomized controlled ultrasound study. Sci Rep 2018;8:9649. https://doi.org/10.1038/s41598-018-27685-7.Search in Google Scholar PubMed PubMed Central

122. Peterson, GE, Landén Ludvigsson, MH, O’Leary, SP, Dedering, ÅM, Wallman, T, Jönsson, MI, et al.. The effect of 3 different exercise approaches on neck muscle endurance, kinesiophobia, exercise compliance, and patient satisfaction in chronic whiplash. J Manip Physiol Ther 2015;38:465–76.e4. https://doi.org/10.1016/j.jmpt.2015.06.011.Search in Google Scholar PubMed

123. Rosenfeld, M, Gunnarsson, R, Borenstein, P. Early intervention in whiplash-associated disorders: a comparison of two treatment protocols. Spine 2000;25:1782–7. https://doi.org/10.1097/00007632-200007150-00008.Search in Google Scholar PubMed

124. Scholten-Peeters, W, Neeleman-Van Der Steen, K, Van Der Windt, D, Hendriks, E, Verhagen, A, Oostendorp, R. The effectiveness of the treatment of general practitioners and of physiotherapy in patients with whiplash: a randomized clinical study. Huisarts Wet 2006;49:7–14. https://doi.org/10.1007/bf03084594.Search in Google Scholar

125. Treleaven, J, Peterson, G, Ludvigsson, ML, Kammerlind, AS, Peolsson, A. Balance, dizziness and proprioception in patients with chronic whiplash associated disorders complaining of dizziness: a prospective randomized study comparing three exercise programs. Man Ther 2016;22:122–30. https://doi.org/10.1016/j.math.2015.10.017.Search in Google Scholar PubMed

126. Gálvez-Hernández, CL, Rodríguez-Ortiz, MD, Del Río-Portilla, Y. Biofeedback treatment for acute whiplash patients. Rev Med Inst Mex Seguro Soc 2016;54:480–9.Search in Google Scholar

127. Giebel, GD, Edelmann, M, Huser, R. Sprain of the cervical spine: early functional vs. immobilization treatment. Zentralbl Chir 1997;122:517–21.Search in Google Scholar

128. McKinney, MB. Treatment of cervical-spine distortions in whiplash injuries. Orthopade 1994;23:287–90.Search in Google Scholar

129. Schnabel, M, Vassiliou, T, Schmidt, T, Basler, HD, Gotzen, L, Junge, A, et al.. Results of early mobilisation of acute whiplash injuries. Schmerz 2002;16:15–21. https://doi.org/10.1007/s004820100087.Search in Google Scholar PubMed

Received: 2021-03-31
Accepted: 2021-09-02
Published Online: 2021-09-27
Published in Print: 2022-04-26

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Scroll Up Arrow