Box 83 Therapeutic options for acute and chronic whiplash

Acute whiplash

Likely to be effective

Early exercise or mobilization

Unknown effectiveness

Early return to normal activities

Early home exercise

Pulsed electromagnetic field therapy

Multimodal therapy

Drug treatments

Chronic whiplash

Unknown effectiveness Percutaneous radiofrequency neurotomy Multimodal therapy Physical therapies reviews with be mentioned, but with data mainly from the higher quality RCTs.

Most neck pain appears to respond to conservative measures, although the effect size is often quite small, and the optimal therapeutic approach for uncomplicated neck pain has yet to be established. Even where an initial benefit is shown, this advantage is not sustained. Few modalities of treatment have been assessed in high-quality randomized studies, but I will try to present the best available evidence for the most commonly used modalities. The evidence is often contradictory because of the poor quality of many of the studies, use of interventions in combination, and diverse patient groups. The lack of consistency in study design makes it difficult to identify which intervention may be of use in which type of patients.

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