Cervical Strain (Whiplash) Treatment & Management

Updated: Dec 02, 2019
  • Author: Warren Magnus, DO; Chief Editor: Trevor John Mills, MD, MPH  more...
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Treatment

Emergency Department Care

All persons involved in motor vehicle accidents who sustain neck injuries should, at a minimum, receive cervical collars prior to transport. Many emergency medical service (EMS) protocols require these patients to be placed on a backboard in full spinal precautions. Because MVAs often involve enough force to seriously injure the cervical spine, such precautions are essential to prevent further injury.

In the ED, apply ice to acute strain injuries, and administer analgesia and pain control, as well as muscle relaxants. Outpatient medications should include acetaminophen or an NSAID. Muscle relaxant medications may be considered adjunctive care.

Soft collars are commonly used but have not been proven effective. [19, 1, 2, 20]

A single-blind study with 6-month follow-up conducted by Borchgrevink et al found that patients who received "usual care," with early mobilization and pain control, fared better than similarly treated patients placed in soft collars. [21] This was reinforced by Kongsted et al. [22]

There have been various calls for early multidisciplinary management, including aggressive early physical therapy and other modalities. Current consensus, however, shows that consultations are rarely required for strain injuries; however, follow-up with a physician familiar with rehabilitation therapies is essential for longer-term management, particularly for patients who have experienced an occupational injury.

Follow-up with a primary care physician is strongly recommended in cervical strain injuries to facilitate further care. For patients involved in occupational injuries, appropriate referral for follow-up is particularly important.

The cohort study by Pape et al in the European Journal of Pain, suggests that initial conservative management is associated with a better long-term outcome than overly aggressive, multidisciplinary approaches. [23]  Therefore, limiting follow-up to primary care referral only and avoiding other interventions such as chiropractic care my be most appropriate.

If additional treatments are to be considered, therapeutic massage appears to have little benefit in the management of strain injuries. [24, 25] Strain/counterstrain manual medicine techniques have been shown to relieve pain in cervical injuries when compared with sham techniques and may be adjunctive in the management of cervical strain. [26, 27]

Regardless of whether the patient is referred, vigilance for decreased function secondary to disuse or long-standing injury should be maintained to prevent long-term sequelae from the strain injury.

Long-term complications of strain injuries are typically related to decreased function secondary to disuse.

Patients who fail to recover experience diffuse somatic, musculoskeletal, and anxiety symptoms. An awareness of these factors can assist in identifying and planning appropriate treatment for these individuals. [28]

Patients with cervical strain injuries who are compliant with recommended therapy, including rest, ice, and physical therapy or exercise programs, often make full, rapid recoveries.  However, only 50% of individuals experience full recovery; approximately 25% continue to experience persistent moderate to severe pain and disability; and 25% have milder levels of pain and disability. [29]

A meta-analysis found predictors of poor outcome after acute whiplash injury are early pain, postinjury anxiety, and catastrophizing, whereas physical factors such as imaging findings and motor dysfunctions are not associated with the outcome of acute whiplash. [3]

Prior to discharge from the ED, patients should be made aware of the potential for long-term injury due to noncompliance.

Patients should be advised of the benefits of ice versus heat in acute injuries.

Patient education in basic exercises can enhance mobility and minimize discomfort during the recovery period.

During follow-up visits, referral to a physical therapist for patients with markedly decreased range of motion or long-standing injury prior to presentation can be significantly beneficial in regaining range of motion as well as strengthening cervical musculature. [30]