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Multimodal Care for Whiplash Associated Disorders

Multimodal Care for Whiplash Associated Disorders
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The term whiplash associated disorders (WAD) is used to describe the constellation of symptoms that can arise from the sudden acceleration and deceleration of the head and neck during an automobile collision, slip and fall, sports injury, etc. This process can injure several ligaments, tendons, muscles, and joints in the region, giving rise to symptoms that include neck and upper back pain and stiffness, headache, dizziness, ear ringing, cognitive fog, fatigue, jaw pain, and more. Because each WAD case is unique, there’s no consensus on what single type of treatment may work best. Rather, the common practice for managing WAD is to take a multimodal approach.

Simply put, a multimodal approach combines one or more therapies, which may include multiple providers, in hopes of producing greater overall improvement in pain and disability than a single therapy on its own. The Bone and Joint Decade 2000-2010 Task Force on WAD and NAD (Neck Associated Disorders) investigated the existing literature to identify which treatments were well supported and which looked promising but required more studies before firm recommendations could be made. The initial paper cited evidence for manual therapies, passive physical modalities, and acupuncture. An updated review published in 2016 added mobilization, manipulation, and clinical massage—all of which are commonly delivered in a chiropractic setting. Clinical guidelines such as the Ontario Protocol for Traffic Injury Management Collaboration often recommend a multimodal approach that combines these therapies as well as specific exercise and patient education, among others, for managing WAD cases of a variety of severities.

This can be observed in practice by looking at a case study that focused on a 30-year-old woman who began experiencing truncal tremors (a neurological disorder) following a motor vehicle collision. The initial physical examination conducted by a chiropractor revealed an increase in the truncal tremor during cervical compression testing by flexing the trunk during passive cervical flexion, limited cervical range of motion, and swaying during balance testing. This led to a multi-discipline management strategy including neurological consults and the diagnosis of functional truncal tremors. Multi-modal chiropractic management included spinal manipulative therapy, whole-body vibration therapy, and acupuncture as well as concurrent co-management by the neurologist that included pharmacology, as well as behavioral care. This included stress reduction techniques, caffeine elimination, and 30 minutes of daily yoga exercises. The patient was released after twelve chiropractic visits, reaching maximum improvement 95 days post-MVC with truncal tremors described as barely noticeable.

This case study represents an important point that multimodal care often results in superior outcomes. While many WAD patients experience satisfactory results from chiropractic care alone, more complex cases may require working with allied healthcare providers. As with other musculoskeletal conditions, recovery may be swifter the earlier the patient seeks care, so if you’ve sustained a whiplash injury, contact your doctor of chiropractic sooner rather than later. 

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