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Whiplash: When to Begin Treatment

The science demonstrates unequivocally that whiplash should receive physiotherapy within 96 hours of the injury.1-

More than 50% of patients injured in motor vehicle accidents receive a whiplash diagnosis. Patients with acute neck pain develop chronic neck pain in 15% to 40% of cases.4 Until recently, standard medical treatment for the early phases of whiplash injury consisted of pain control, rest, and a soft-cervical collar.6 However, in this century, the science has suggested a more active approach to the acute phase of whiplash injury.

Mark Rosenfeld, RPT and colleagues published a series of studies on the subject in Spine.1-3 In one of those studies, researchers randomized 100 people with whiplash to three treatment groups. Group 1 received standard care: advice from a doctor, restricted activity, and advice on independent stretching to begin several weeks after the injury. Group 2 received physiotherapy within 96 hours of the whiplash. Group 3 received standard care plus physiotherapy within 14 days of the injury. Even three years after the whiplash, only the group receiving active care within 96 hours of the injury had a neck range of motion that was close to normal. Group 2 was also the fastest to return to work - lessening the economic hardship on those patients. It's important to introduce the right kind of motion into injured tissues early in the healing so that new tissues created by the healing process will lie down in correct patterns.

Whiplash management early in the healing process typically involves slow, gentle, passive movements. Pain inhibits some healing processes. That's why injury treatment at Advanced Physiotherapy emphasizes procedures that are not painful.

When you are injured, especially in an automobile accident, see one of our therapists as soon as possible for advice and evaluation.


  1. Rosenfeld M, Gunnarsson R, Borenstein P. Early intervention in whiplash-associated disorders. Spine, 2000, 25 (14): 1782-87.
  2. Rosenfeld M, Seferiadis A, Carlsson UJ, et al. Active intervention in patients with whiplash associated disorders improves long term prognosis. A randomised controlled clinical trial. Spine 2003, 28, 2491-2498.
  3. Rosenfeld M, Seferiadis, Gunnarsson. Active involvement and intervention in patients exposed to whiplash trauma in automobile pressures reduces costs. A randomised controlled clinical trial and health economic evaluation. Spine 2006, 31, 1799-1804.
  4. Schofferman J, Bogduk N, Slosar P. Chronic whiplash and whiplash associated disorders: an evidence-based approach. J Am Acad Orthop Surg, Vol 15, No 10, October 2007, 596-606.
  5. Vega C. Active Intervention Best for Whiplash (CME). Medscape: November 24, 2003. Available at:


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