FEATURED TOPIC - COLLARS AND THE ACUTE WHIPLASH PATIENT (NECK PAIN)

This 'Featured Topic' is Neck Pain: Whiplash and Neck Sprains / Strains. Whether the neck pain is due to whiplash in a motor vehicle accident (MVA) or a congenital condition, it is a common complaint heard by the physical therapist in a clinical orthopedic setting. This week we feature two articles from one of our content partners. On this page you will find Article 2 - Collars and the Acute Whiplash Patient

ARTICLE 2: COLLARS AND THE ACUTE WHIPLASH PATIENT

by Jim Meadows

I was fortunate enough to attend the 2nd Annual American Academy of Orthopedic Manual Physical Therapy (AAOMPT) Conference in Biloxi MS. Among the many fine presentations I heard, Lance Twomey's ranks among the best. A highlight of his presentation was a summary he gave of a student's doctoral thesis on the independent benifit of a cervical collar for recent whiplash patients. The student's name was Gurumoorthy and his thesis earned him a Ph.D. and will be published soon in spine. However, the information is so useful and for most therapists so radical that I thought that it would be appropriate to summarise Dr. Twomey's summary. I apologise in advance for any errors that I may make, they are inadverdent and caused by galloping senility.

220 post whiplash victims were randomly divided into three groups the first being asked to wear a Philadelphia cervical collar for one month and then to discard it. These subjects were then put into group two. Group two subjects were assigned an active program from day 1 which consisted on non-painful range of motion and other painfree exercises. Group 3 were left to the care of their physician (almost invariably a general practitioner) who usually prescribed analgesis, a soft collar and some form of self activation. The accident had to be within forty eight hours of attendence for the patient to be included as a subject. The subjects were tested by blinded assessors for pain, range of motion, strength and function. Pain was evaluated on a visual analogue scale, isometric strength by dynamometer, range of motion by goniometry and funtion by return to work. The subjects were evaluated at 4,6, 12, 26 and 52 weeks.

In every catagory, the collared subjects did better than those in the other two groups. Perhaps one the most clear cut findings was in return to function. 50% of the subjects in the collared group were back at full function by the 26th week assessment. This figure was not achieved in either of the other two groups.

This is almost unequivocable evidence of the value of a collar in the early stages of post-whiplash. The most amazing thing about the study is that it should have had to be carried out in the first place except as a means of confirming an established and obvious practice. With even a little thought is is obvious that an acutely injured neck requires the same care as an acute knee injury. That is rest while the inflammation subsides. In the knee patient we would have no trouble understanding the need to have the patient non-weight bearing, using a compression bandage, applying ice and generally resting it. But in the whiplash patient, there seems to be a lack of common sense by many health care providers from all disciplines. The sports medicine model is often applied indiscriminately with no thought to the fact that it is not an athelete that we are treating nor is it a sport injury. In any event, an athelete with an acute knee would be rested until the effusion had subsided and if this did not occur in a timely fashion, considerable expense and time would be spent investigating the reason for delayed recovery. If we (the combined health care professions) can be this concered about what is essenially a self inflicte injury, why cannot we be so with some poor smuck hit in the rear sitting a traffic light.

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