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 benefit 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 summarize Dr. Twomey’s summary. I apologize in advance for any errors that I may make, they are inadvertent 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 of non-painful range of motion and other pain-free exercises. Group 3 were left to the care of their physician (almost invariably a general practitioner) who usually prescribed analgesics, a soft collar and some form of self-activation. The accident had to be within forty-eight hours of attendance 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 function by return to work. The subjects were evaluated at 4,6, 12, 26 and 52 weeks.
In every category, 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.
Physical therapist treating a patient with neck pain
This is almost unequivocal 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 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 athlete that we are treating nor is it a sports injury. In any event, an athlete 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 concerned about what is essentially a self-inflict injury, why cannot we be so with some poor shmuck hit in the rear sitting a traffic light.
This content is provided courtesy of Swodeam Institute.
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