When discussing the topic of whiplash injury recovery, prompt assessment, treatment, education, reassurance, and advice can be VERY EFFECTIVE in helping the injured crash victim improve during the acute stage of the injury (the first three months). But after three months, when the condition becomes more chronic, which interventions are the most beneficial? More specifically, what is the role of having a “positive outlook” on the outcome of care?
We can “classify” injuries associated with whiplash into three primary categories: Type I WAD (Whiplash Associated Disorders)—soft tissue injury without range of motion loss; Type II WAD—soft tissue injury with cervical or neck motion loss; and Type III WAD—the above PLUS neurological findings (numbness, tingling, and/or muscle weakness). Statistically, patients with Type I and II WAD generally have good treatment results with plans that include exercise and group therapy. At six months, 65% are able to return to work, 92% are able to return to work on at least a part-time basis, and 81% report that no further care is needed. Coordination exercises are also reported to be helpful and are recommended to be included in treatment plans.
In those with chronic WAD (more than three months of symptoms), patients with negative thoughts tend to do worse than those who are not afraid to perform tasks and who are less emotional in stressful situations. Most importantly, negative thoughts and increased pain behavior can be IMPROVED using a structured treatment approach that includes education about the neurophysiology of pain and how to overcome the fear factor associated with chronic pain behavior. In fact, the MOST important predictor of persistent disability in patients with chronic WAD is how well the injured patient believes he/she CAN perform a task and their emotional reaction to stressful situations. So, how is this done?
As stated above, an improved knowledge about pain and how the nervous system is “wired”—from the tip of the finger hitting a hot stove to the central processing center in the brain—REALLY HELPS. When this process is understood, it reduces much of the “fear of the unknown” that chronic WAD patients experience. When you think about it, pain is actually a good thing, as it warns us when to slow down or stop AND tells us when it’s OK to continue with tasks or desired activities. It helps define boundaries within which we can SAFELY FUNCTION by forewarning us to SLOW DOWN or modify. Exercise and staying active are some of the most important factors for success in managing almost ALL musculoskeletal conditions, and knowing the difference between “safe” vs. “harm” when it comes to interpreting pain can result in a lower risk for chronic pain problems.
Once this “knowledge” is understood and appreciated, the injured whiplash patient literally “proves” to him/herself that they are in CONTROL of their condition and can begin to return towards more normal function. The success of this approach centers on introducing the WAD patient to a step-by-step activity re-integration process through structured exercises and careful guidance. For example, muscles can become weak and shrink within 24-48 hours of being inactive. After days, weeks, months, and/or years of modified or stopped activity, this kind of weakness becomes obvious and the whiplash patient may gradually become more and more afraid of performing an activity/exercise in fear that doing so could make the problem worse. This negative thought is a HUGE HURDLE to overcome but must be dwelt with systematically to gain success in returning to life’s required and desired ADLs. Your doctor of chiropractic can guide you in this learning process. When needed, her or she will often work with other healthcare professionals as a team to reach this goal. Remember, THE POWER OF POSITIVE THINKING can make or break a successful outcome!