Rehabilitation of chronic whiplash: treatment of cervical dysfunctions or chronic pain syndrome?
From: Clin Rheumatol. 2009 Jan 22. [Epub ahead of print]
Chronic whiplash associated disorders remains a challenging condition for clinicians. There is substantial evidence for the presence of various cervical dysfunctions (e.g., increased cervical muscle tone and impaired cervical movement control), but their contribution to the complex clinical picture of subjects with chronic whiplash associated disorders seems rather limited. There is consistent evidence for increased responsiveness of the central nervous system in those with chronic whiplash associated disorders , and central pain processing is likely to play a crucial role in the transition from an acute whiplash trauma towards chronic whiplash associated disorders . The manuscript explains how our current understanding of chronic whiplash associated disorders can be used to steer the content of conservative interventions and how treatment of cervical dysfunctions in patients with chronic whiplash associated disorders should account for the processes involved in chronicity. It is recommended to prevent sensorimotor incongruence, target cognitive-emotional sensitization, and apply a cognitive behavioral therapy-guided exercise program.
