Physical therapy may not help whiplash pain
NEW YORK (Reuters Health) - Whiplash injuries can be enduring and painful, but new research finds that counseling on how to manage the disorder - along with a list of optional exercises - reduces pain as effectively as an intensive physical therapy program.
The results contradict a "strong biological and theoretical rationale" for the benefits of physical therapy seen in past studies, said Zoe Michaleff, the study's lead author and a doctoral candidate at The George Institute for Global Health in Sydney, Australia.
"We were therefore really quite surprised with our results when we did not find a difference," she told Reuters Health in an email.
Whiplash injury is a broad term covering symptoms caused by damage to joints, muscles, ligaments and nerves in the spine following a rapid deceleration.
Previous research has found that more than half of victims will still be feeling pain six months after the initial accident and up to 30 percent have moderate to severe disability as a result.
The new study, published in The Lancet, involved 150 participants in Australia recruited between September 2009 and 2012.
All were between the ages of 18 and 65 and had suffered from whiplash-related pain for at least three months but not more than five years. All had experienced at least moderate pain or were moderately disabled because of the pain and had not received treatment for their whiplash.
Every participant received educational materials about coping with and treating whiplash, as well as instructions for basic exercises they could try at home.
Then participants were divided into two groups, with half assigned to attend 20 intense one-hour one-on-one exercise sessions with a physical therapist for 12 weeks. During these sessions, therapists led the participants through exercises that aimed to improve neck and spinal flexibility, posture, balance and other factors.
The rest of the participants had one half-hour meeting with a physical therapist to read through the booklet, ask any questions about the advice it contained and to run through the exercises with minimal guidance. They were also able to contact the therapist by phone twice if further clarification or information was needed.
The researchers used a scale of 0 to 10, with 10 being the worst pain imaginable, to gauge participants' pain levels at the beginning of the study, and again after 14 weeks, six months and one year.
Each time they checked in, the researchers also asked participants for their own views of their recovery and how disabled they were by their injury as well as measuring each person's spinal range of motion.
Michaleff and her colleagues found that at the beginning of the study, patients randomized to the physical therapy group rated their pain, on average, as 5.5 out of 10; those in the advice group rated it 4.9 out of 10.
One year later, these numbers had dropped to 3.7 and 4.4, respectively. The difference in the changes between groups was too small to have been significant. The participants' self-rated recovery and functional ability were slightly in favor of the exercise program, but there too, the difference between the advice and the exercise groups was so small that the effects were not clinically meaningful, Michaleff said.
The authors said the results should encourage clinicians and therapists to reexamine how whiplash injuries are currently treated.
"The results of our study add to the growing body of literature that suggests we need to rethink how we deliver treatment to people with a chronic whiplash injury, and that perhaps for these people intensive treatment is not required," Michaleff said.
Joseph Ciacci, a neurosurgeon at the University of California, San Diego, was not surprised that a single meeting with a physical therapist was as effective as longer-term therapy.
Ciacci, who was not involved in the study, said he has even recommended such a strategy to some of his patients in the past.
"If I were a whiplash patient, I would be pleased by the results of the study knowing that I could have more control over my treatment, such as when I do it, as opposed to going to the physical therapist's office multiple times a week," Ciacci told Reuters Health.
"I'd also be relieved to know that I am not shortchanging myself if I don't have the time and money" to participate in so many therapy sessions, he said.
Michaleff cautioned, however, that the findings "should not be interpreted as encouragement to abandon exercise or physical therapy in these patients."
Instead, they should encourage therapists to think strategically about the right combination of exercise and practical functional advice for their patients.
There is a potential cost benefit in that approach as well, she noted.
"The fact that we found a brief, single session physiotherapy program to be as effective for chronic whiplash as a more intensive program will ultimately help stretch the health dollar further," Michaleff said.
SOURCE: bit.ly/1kkD5wb The Lancet, online April 4, 2014.
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