Physical therapy and active exercises - An adequate treatment for prevention of late whiplash syndrome? Randomized controlled trial in 200 patients

The aim of this study was to compare the effect of a physical therapy regimen including active exercises with the current standard treatment on reduction of pain 6 weeks and 6 months after whiplash injury caused by motor vehicle collision. Two hundred patients were enrolled in a prospective randomized controlled trial. In the standard group, treatment consisted of immobilization with a soft collar over 7 days. In the physical therapy group, patients were scheduled for 10 physical therapy appointments including active exercises within 14 days after enrollment. Pain intensity was rated by all patients daily during the first week, the sixth week, and 6 months after recruitment, using a numeric rating scale (0-10). Data analyses were performed by comparing the mean (over 1 week) pain scores between the two different treatment groups. Ninety-seven patients were randomly assigned to the standard treatment group and 103 to the physical therapy group. During the first week, there was no significant difference in mean pain intensity between the standard treatment group (4.76 +/- 2.15) and the physical therapy group (4.36 +/- 2.14). However, after 6 weeks, mean pain intensity was significantly (p = 0.002) lower in the physical therapy group (1.49 +/- 2.26 versus 2.7 +/- 2.78). Similarly, after 6 months, significantly (p < 0.00 1) less pain was reported in the physical therapy group (1.17 +/- 2.13) than the standard treatment group (2.33 +/- 2.56). We conclude that a physical therapy regimen which includes active exercises is superior in reducing pain 6 weeks and 6 months after whiplash injury compared to the current standard treatment with a soft collar. (c) 2006 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.