Whiplash – Which Treatment Method Is Best?

Whiplash, or better termed, cervical acceleration-deceleration disorder (CAD) is primarily an injury to the soft tissues of the neck – that is, the muscles, their tendon insertions, and the ligaments that hold the joints firmly together. Neck pain is a very common health problem that affects between 10–15% of the population and drives people to all types of healthcare providers. We have previously discussed the reasons why whiplash /CAD injuries occur, the examination process and the prognosis aspects but the argument continues as to what treatment methods work the best when managing patients with CAD.

In the May 21, 2002 issue of the Annals of Internal Medicine, a group of medical doctors and PhD’s reported on neck pain treatment comparing traditional medical and physical therapy approaches verses spinal manipulation. In the study, they compared three common neck pain treatment approaches in a group of 183 patients with chronic neck pain (patients who had neck pain for more than 3 months). The 3 methods included traditional medical care which included medication utilization and rest, manual therapy (chiropractic adjustments) and physical therapy (active exercise training). After 7 weeks of treatment, the percentage of patients who felt either totally resolved (cured) or much improved were 68.3% receiving manual therapy / chiropractic care, 50.8% receiving physical therapy, and 35.9% receiving medical care.

The author, Jan Lucas Hoving, PhD reports that manual therapy / chiropractic was found to be more effective than the other 2 methods “…on almost all outcome measures,” not just a few! Further, although PT scored better than traditional medical care, “…most of the differences were not statistically significant,” meaning, not that much better. The authors appropriately reported that further study was needed to better understand the differences between methods.

In 2008, the “Decade Task Force” reviewed 10 years of studies on the treatment of neck pain and found similar results and referenced many studies that indicated spinal manipulation for neck pain, headaches, whiplash, and other neck related conditions was one of the most effective methods and that patients with neck pain should be given the option of receiving manual therapy / chiropractic before other approaches as it was found to be less expensive, faster in obtaining satisfying results (shorter course of disability), and most effective in terms of long-term benefits. This comparison discussion is by no means meant to minimize the importance of medical and PT care.

However, there appears to be a bias among patients with neck pain to seek medical care first when the studies clearly show chiropractic care is the preferred method. Hence, the purpose of this article is to educate the reader that their choice in treatment for neck pain should favor chiropractic care FIRST, not last. In fact, the sooner manipulation can be applied to the injured joints of the neck, typically the faster the results. For example, long term disability and chronic neck pain can occur from prolonged use of a cervical collar as the structures tighten and stiffen up from being immobile - unable to move because of the collar. Unless there is some unstable condition to the neck (fracture, grade 3 ligament tear, progressive neurological loss, etc.), studies support manipulation / early mobilization of the neck joints after injuries like whiplash verses wearing a cervical collar and rest.