In the initial stages of whiplash injury, when the pain is acute and movement very limited, there is little a manual therapist can do directly to treat the person’s neck as the pain is too irritable and easily worsened. Advice and explanation is the main treatment here and the physiotherapist will emphasise the mostly non-serious nature of these injuries, likening them perhaps to a sprained ankle, which will gradually improve until the neck is normal again. A reduction in activity is appropriate but a long period of resting or withdrawal from activity should be avoided.
Once the pain is improved the physiotherapist will examine the neck for range of movement, areas of pain and altered sensation, muscle power or reflex loss in the arms and general day to day function. If the pain is still significant the physio will encourage range of movement neck exercises in lying to reduce the stresses through the neck, progressing to neck exercises sitting up as the patient is able. Massage to the neck, shoulder and upper thoracic region can be very beneficial, inducing relaxation and putting mechanical stimulation into the nervous system which can help reduce pain transmission.
Physiotherapists will teach postural awareness to minimise the forward poking chin posture and encourage correct sitting, with limited periods of activity interspersed with regular short rest periods. Pacing activity to avoid doing one activity or maintaining one position for too long is very important in limiting aggravation of symptoms. As the pain settles the physiotherapist will be able to manually examine the neck more closely, performing mobilisation techniques on the individual spinal joints to look for pain and restricted movement at particular spinal levels. Once a particular spinal level has be identified as suffering from a movement limitation the physio can performing repeated mobilisation techniques to those joints to loosen them up.
Simple neck exercises continue with the physio progressing the ranges of movement regularly and perhaps combining movements which are limited to restore the full function of the neck joints. Exercises for the shoulders, shoulder girdle and upper thorax will have been included all along and the exercise programme will now be focused on functional activities and return to normal daily living. The physiotherapist will encourage the patient to confront their symptoms in a controlled manner and return to normal daily activity as soon as possible as this carries with it the highest chances of a full recovery.