Protocol: Neck Pain/Strain/Whiplash

This describes the various treatment procedures the physical therapist may select, as indicated by patient evaluation, re-evaluation, treatment responses.

ACUTE INTERVENTION:

1. Pain control modalities, as needed and used in concert with restorative procedures to facilitate treatment tolerance and control disabling pain.

Ice, heat, electric Stim (Microcurrent, TNS, Neuroprobe, Russian, Interferential).

Corrective-protective rest positioning; relaxation training.

2. Initial patient education on problem, treatment, self-care.

3. Posture stress correction; daytime, nighttime, workplace, auto

4. Manual, mechanical, positional traction-distraction

5. Gentle, remedial low-grade articular and-or soft tissue manual therapy and mobilization

6. Physician specialty referrals as indicated

SUB-ACUTE RECOVERY:

1. Exercise progression of range of motion, flexibility, stability, strengthening exercises at the neck and related upper body regions (emphasizing home exercises).

2. Manual therapy progression: articular and soft tissue mobilization:

Cervical, upper thoracic, subcranial, TMJ contributing structures as indicated;

Myofascial release, strain counterstrain, craniosacral technique, massage.

3. Manual, positional, mechanical traction in clinic; home units.

4. Address contributory stresses at shoulder girdle, upper back, thoracic outlet and TMJ with manual therapies, electrotherapies, corrective exercises

5. Advanced patient education; risk factor education.

6. Ergonomic job evaluation and modification; job coaching.

7. Return-to-work plan; restricted duty recommendations; employer education.

8. Reconditioning exercise plan; home and gym

Clinic treatment typically 2-3 visits per week for 2-5 weeks

GOALS:

Establish self-care skills and participation to minimize dependence on providers

Safe, early return to work

Pain control; pain relief

Reduce inflammation and spasm

Restore posture, flexibility, mobility, strength at upper body

Correct derangements, impingements, entrapments

Restore ADL and occupational functions, tolerances, abilities

Prevent recurrence.