Mixed rehabilitation method improves work capacity

The Journal of Rehabilitation Medicine has an article about the outcome of a treatment method that involves several disciplines: Interdisciplinary rehabilitation after whiplash injury: An observational prospective outcome study. The article examine the change in health and quality of life of patients after whiplash injury, before and after an inpatient interdisciplinary pain management programme.

The programme involved several disciplines; drug adaptation, physical exercise, relaxation therapies, and behavioural therapy. The outcome of the study showed that after rehabilitation, pain improved by effect sizes up to 0.65, function/role performance up to 0.87, vitality up to 0.67 and coping up to 0.41. At the 6-month follow-up, these effects remained and working capacity had improved from 8 h per week to 21 h per week.

Psychological treatment of whiplash pain

A study at Swedish University Hospital Karolinska, Exposure and acceptance in patients with chronic debilitating pain: A behavior therapy model to improve functioning and quality of life, suggest a therapy that promotes acceptance of chronic pain and distress. This type of intervention is aimed at improving functioning and quality of life by increasing the ability to act in alignment with personal values also in the presence of e.g. pain, fear, and negative thoughts.

The study suggests that there is substantial empirical support for treatments based on cognitive behavior therapy (CBT), where a person learns how to cope with e.g. chronic pain. The findings suggest that CBT is an efficient way of getting a new outlook on life if you are suffering from chronic whiplash pain.

What do you think?

Manual therapy and exercise more effective for neck pain

A systematic overview of neck pain treatment research from 1980 to 2006 suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain. For whiplash-associated disorders, there is evidence that mobilization and exercises appear more beneficial than usual care or physical modalities. This overview was published in the Journal of Manipulative Physiological Therapy and was conducted by the Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii.

More information from the PubMed database.

Study shows expectations for recovery important in the prognosis of whiplash injuries

A study at the Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, shows that expectations for recvery seem to be an important factor.

Individuals’ expectations on returning to work after an injury have been shown to predict the duration of time that a person with work-related low back pain will remain on benefits; individuals with lower recovery expectations received benefits for a longer time than those with higher expectations. The role of expectations in recovery from traumatic neck pain, in particular whiplash-associated disorders (WAD), has not been assessed to date to our knowledge. The aim of this study was to investigate if expectations for recovery are a prognostic factor after experiencing a WAD.

Individuals’ expectations for recovery are important in prognosis, even after controlling for symptom severity. Interventions designed to increase patients’ expectations may be beneficial and should be examined further in controlled studies.

Update:

The study was a cooperation with the University of Alberta. One of the researchers, in the School of Public Health, looked at a group of over 6,000 adults with traffic-related whiplash injuries. She found that those that had positive outlooks towards their recovery actually recovered over three times faster than those who did not.

Study suggests that whiplash recovery level off 3 months after the accident

A meta level study, Course and prognostic factors of whiplash: a systematic review and meta-analysis, conducted by The George Institute (University of Sydney in Australia) took a look at previous research on accute whiplash injuries. From the abstract:

These data suggest that recovery occurs for a substantial proportion of subjects in the initial 3 months after the accident but after this time recovery rates level off. Pain and disability symptoms also reduce rapidly in the initial months after the accident but show little improvement after 3 months have elapsed.

Whiplash Injury Recovery – a Guide from the Queensland Government

The Motor Accident Insurance Commission (MAIC) of the Queensland Government (Australia) has published a short booklet with the title The Whiplash Injury Recovery – a Self-Management Guide. It is designed to aid the recovery of people with a whiplash injury and to supplement care being provided by a health professional.

The self-management advice and exercise program in the booklet are based on the results of clinical trials, research into neck disorders and extensive clinical experience in the area of whiplash-associated disorders and other neck pain syndromes. In short, the guide provides the following recommendations:

  • Staying active is important.
  • Continue or resume working.
  • Set goals that are enjoyable to achieve.
  • Maintain flexibility and muscle support of your neck.
  • Be aware of your posture.
  • Perform daily activities in a strain-free way.

The guide also contains some range of motion exercises that can be performed at home. The guide can be downloaded as a PDF document from the Motor Accident Insurance Commission website.

Treatment tips for high blood pressure

Salt crystalAs a short follow-up to the article on the relation between neck injury and high blood pressure, this article summarizes some treatment tips to lower blood pressure. A blood pressure level of 140/90 mmHg or higher is considered high. About two-thirds
of people over age 65 have high blood pressure. There are of course efficient medications as well but these tips focus on what you can do right now and they will also have positive effects on your general condition. The boring thing is that there is no simple solution and most tips revolve around a lifestyle change in diet and exercise.

Eat less salt and sodium

Salt contains sodium. The human requirement for sodium in the diet is about 500 mg per day. Most people consume far more sodium than is physiologically needed. For certain people with salt-sensitive blood pressure, this extra intake may cause a negative effect on health. So, switch to a mineral based salt (which often contain less sodium but still tastes “salty”), be restrictive with extra seasoning in restaurants and pre-canned foods. Eat more fruit and vegetables.

Lower your weight

Being overweight increases your risk of high blood pressure. In fact, your blood pressure rises as your body weight increases. Losing even 10 pounds (4.5 kg) can lower your blood pressure and losing weight has the biggest effect on those who are overweight and already have hypertension. A combination of less calories/carbon hydrates (sugar etc) and exercise is one of the fastest way to loose weight.

Be pysically active

This is of course important in any healthy lifestyle, but may be the hardest to start with for many people, especially if you are overweight. Increase exercise gradually. Start by walking a part of your daily transportation routine. If you are taking the car to work, park two blocks away, if you go by bus, get off on a stop earlier and walk the remainder. Gradually increase walking speed.

Tips are based on the recommendation from the National Institutes of Health’s Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

Picture by david.

Virtual Crash Test Dummy to Aid in Whiplash Testing

The development of a virtual dummy is expected to reduce the number of neck injuries received in car accidents.

Peter Ullrich, Crash Safety and Impact Product Manager of developer ESI Group, said: “By using BioRID-II dummies, car manufacturers can enhance seats frame structure so that they absorb more energy and reduce rebound effects, which is decisive in ensuring the safety of car occupants during a crash.”

The new crash-test technology simulates the velocity, force and kinematics experienced by people in car accidents, and its developers believe it will eventually lead to better neck injury protection for drivers and passengers.

Firstly, a solver offers state-of-the-art physics-based models for crash and other impact problems. Secondly, the Visual Environment portfolio is a suite of highly productive CAE process automation products. Finally, there are validated compute models, including crash test dummies, impactors, barriers, and a unique family of human body models (HBM – used to simulate the potential discharge when a human touches an electronic device and characterise the susceptibility of an electronic device to damage from electrostatic discharge).

Insurance industry insiders will be hoping the new technology will significantly reduce the cost of whiplash claims.

The press release has more information.

Better Positioning of Head Restraint Prevents Whiplash Injuries

A publication from ConsumerReports provides interesting information on how better positioning of head restraints can prevent neck injuries. A rear-end crash occurs every 17 seconds in the U.S. But many vehicles offer inadequate protection from the whiplash injuries that can result, according to ConsumerReports.
“Automakers are inconsistent in providing effective head restraints in all seating positions. And auto-safety advocates tend to focus on other concerns, largely because “rear-enders” are rarely life-threatening.”

Many cars provide inadequate protection

Neck injuries are the most commonly reported type of crash-related injury. They can occur at crash speeds as low as 10 mph.

IIHS crash tests suggest why injuries are prevalent. The IIHS is the only organization that conducts dynamic tests of front seats and head restraints, and makes rear-crash-protection ratings available to the public. Of the approximately 175 vehicles for which the institute now has overall ratings, only about one-third are rated Good or Acceptable. Nearly a third are rated Marginal, and more than a third are rated Poor.

The rear seat in many vehicles is still the Wild West of rear-crash protection. Consumer Reports auto-test engineers evaluate rear-seat head restraints on every vehicle they test. Many vehicles also lack head restraints for the center-rear position, which isn’t required by the U.S. government. In Europe, it is required. Of the 2007 vehicles they’ve recently tested, only a little more than half have restraints in the rear outboard positions that are tall enough without adjustment. Only half have any restraints in the rear-center position.

More vehicles are being made with effective, adjustable head restraints in all rear positions. But those can create another problem, making it difficult for the driver to see out the rear windows. To address that, many restraints can be pushed down into a recess in the seatback or can fold out of the way when the rear seat is unoccupied. Some folds forward into the seating area, as in Volvos, because they force rear passengers to put them up before they can get comfortable.

Positioning the head restraint correctly is critical

Whatever car you drive, you’ll get the maximum whiplash protection from a head restraint that’s properly positioned. To work well, the top of the restraint should reach at least as high as the top of your ears and be relatively close to your head.

Progressive Insurance found in a 2002 survey that 40 percent of drivers did not adjust their head restraint when driving a newly purchased vehicle, and 57 percent didn’t adjust them after someone else had driven their vehicle. Only 14 percent of drivers knew the optimal positioning of a head restraint. In 2003, the IIHS did an observational survey in Washington, D.C., and Charlottesville, Va., that revealed that about 56 percent of male drivers and 24 percent of female drivers had head restraints positioned too low.

In 2005 the federal government upgraded the head-restraint rule (Federal Motor Vehicle Safety Standard 202). It becomes mandatory in 2009 for vehicles built on or after Sept. 1, 2008 and will make U.S. rules as strict as those in Europe.

While the law is a step forward, Consumers Union, the nonprofit publisher of Consumer Reports, believes it still falls short. For instance, it doesn’t require vehicles to have rear-seat head restraints.

Neck Pain and High Blood Pressure

This may be of interest to those who suffer from high blood pressure after a whiplash injury. A team from the University of Leeds, led by Professor Jim Deuchars has examined pathways between the neck and the brain to show how the neck muscles play a crucial role in controlling blood pressure.

Update: Also see some tips on how you can lower blood pressure.

Their study, published in the Journal of Neuroscience, provides the first evidence for a role for these connections in influencing brain regions which control body functions that we don’t need to think about, such as breathing and blood pressure.

Chiropractors have long known that tackling neck pain by manipulating the neck can also lower blood pressure, but the reasons were never clear. These new findings clarify how manipulative treatments may work: “Reports from chiropractic journals say that manipulating the neck region helps to reduce blood pressure in some people,” Prof Deuchars explained. “By identifying the pathways we can see why these treatments might work and it could also explain why some people suffering whiplash injuries may experience a change in their blood pressure.”

The findings also contribute to understanding postural hypotension, fainting which can be caused by standing up too fast. The neck muscles could be a part of the system which normally prevents this from happening by sending signals to the brain upon neck movement that posture has changed.

More research is now needed to see which sensory nerve fibres and precisely which cells are involved in the process. The team would now like to know what other brain regions the neck muscle termination site connects to. They believe that there are many malfunctions associated with whiplash injuries to the neck that could be better understood by unravelling these connections. They hope that this knowledge could be used to design more effective treatments for such injuries.

For more information see the Journal of Neuroscience article: The Neurochemically Diverse Intermedius Nucleus of the Medulla as a Source of Excitatory and Inhibitory Synaptic Input to the Nucleus Tractus Solitarii.