Whiplash: Treatment and Recovery
Conservative treatment includes immobilizing the patient's neck in a well-fitting soft cervical collar; use of pain, anti-inflammatory, and muscle relaxant medications; and physical therapy.
Physical therapy (PT) helps to reduce muscle spasms, increase circulation, and promote healing. PT may include the following modalities: moist heat, ice, ultrasound, electrical stimulation, and exercise to restore range of motion and build strength.
If symptoms persist, cervical traction may be incorporated into the treatment plan. A portable cervical traction device can be used at home or office. Trigger point injections containing a local anesthetic may help alleviate pain and tenderness.
If symptoms continue more than 6 weeks, or new symptoms appear the patient's condition is re-evaluated. Severe extension injuries can damage the intervertebral discs involved. When an intervertebral disc is affected, surgical intervention may in rare instances be required.
Surgery Rarely Needed
Rarely does the treatment of whiplash require surgery. Surgical intervention is considered in severe cases such as those presenting persistent neck, scapular or shoulder pain. The pain may indicate a tear in an intervertebral disc. When intervertebral disc removal is necessary, one of the following procedures may be performed:
Discectomy is the surgical removal of part or the entire offending intervertebral disc.
Microdiscectomy incorporates the use of a microscope to magnify the surgical field during disc removal.
Percutaneous surgical procedures enable disc removal through a small incision in the back. These are generally not used in the cervical spine (neck) but have been used in the low back. Automated Percutaneous Discectomy is performed under radiologic control while a cannula (hollow tube) with a rotating blade breaks up the disc. The disc fragments are then removed by aspiration.
Once the target disc is removed, Spinal Instrumentation and Fusion provides permanent stability to the spinal column. These procedures join and solidify the level where an intervertebral disc has been damaged or removed. Instrumentation, the use of medically designed hardware such as rods and screws, can be combined with Spinal fusion (arthrodesis) to permanently join two or more vertebrae.
During the recovery phase, the goal is to help the patient resume normal activities at their pre-injury level.
The guidelines set forth by the spinal physician and/or physical therapist should be closely followed. A home exercise program customized by the physical therapist is a key to rebuilding strength and increasing range of motion. It may be necessary to continue physical therapy and modalities (e.g. moist heat) for a period of time.
Post-operative pain and/or discomfort should be expected. Patient Controlled Analgesia (PCA) enables the patient to control their pain without hospital staff assistance. PCA is eventually replaced by oral medication.
The patient may be encouraged to get up and walk the following day. Activity enhances circulation and healing.
Physical therapy is added post-operatively enabling the patient to build strength, flexibility, and increase range of motion. Physical therapy is usually continued on an outpatient basis for a period of time. Additionally, the therapist provides the patient with a customized home exercise program.
Prior to release from the hospital, the patient is given written instructions and prescriptions for necessary medication. The patient's care continues during follow-up visits with their spinal surgeon.
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