RECOVER researchers and the NHMRC Centre of Research Excellence in Recovery Following Traffic Injuries have combined resources to establish the Whiplash evidence based information resource - a resource providing evidence based information to the general public and health care professionals about whiplash and its management.

The whiplash evidence-based information resource is designed to enhance rehabilitation outcomes for people with whiplash through the provision of high quality information. The resource provides summaries of current evidence for and against specific whiplash treatments compiled by the International Centre for Allied Health Evidence (CAHE) and will be continually updated by research staff to enable best practice outcomes. The information contained in this resource is designed to support, not to replace the relationship between patient and physician.

The resource is endorsed by the Royal Australian College of General Practitioners and Healthdirect Australia.

Rating system

☺☺☺ = Effective    ☺☺ = Useful     = Promising    ʘ = Not effective    Ø = No research

☺☺☺Effective

The treatments are effective. They are consistently supported by scientific evidence.

☺☺ Useful

These treatments are useful. They are supported by some scientific evidence but the evidence is not as consistent as for 3 ticks.

☺ Promising

These treatments are promising and may be useful. They have some evidence to support them, but more evidence is needed to be sure they work.

ʘ Not effective

On the available evidence, these treatments do not seem to be effective.

Ø No research

These treatments have not been properly researched. It is not possible to say whether they are useful or not. 

☺☺ Act as usual

Injury Type: Acute/Chronic

Category: Allied Health Options

While there is some evidence to support advice to act as usual within tolerable levels, especially in the early stages, more research is needed to describe its effect in the long term.

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☺☺ Active treatments

Injury Type: Acute/Chronic

Category: Allied Health Options

While there is some evidence to support the use of active treatments especially in the early stages, more research is needed to describe its effect in the long term.

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☺☺ Exercise

Injury Type: Acute/Chronic

Category: Allied Health Options

Following a whiplash injury you are likely to be better off if you perform some type of exercise, rather than avoiding exercise. Although there does not appear to be one type of exercise more beneficial than another, it is best to seek advice from your doctor or health provider before performing exercises.

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☺☺ Multimodal / Physiotherapy treatment

Injury Type: Acute

Category: Allied Health Options

Treatment consisting of more than one approach, i.e. multimodal, may be more effective than individual treatments provided in isolation. It should consist of at least manipulation and/or mobilisation and some form of exercise. Multimodal treatment should be based on an individual assessment and provided by a qualified professional.

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☺ Acupuncture

Injury Type: Acute

Category: Complementary and Alternative Therapies

The use of acupuncture as an adjunct to other therapy, in treating mechanical neck pain, may be considered for short term relief of pain and disability. However more research is required in order to recommend its use as a sole intervention and to determine its long term effects.

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☺ Education

Injury Type: Acute/Chronic

Category: Allied Health Options

It seems likely that you are more likely to make a speedy recovery if you are provided with the appropriate information, but there is no clear evidence on the best way this should be provided.

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☺ Laser

Injury Type: Acute

Category: Allied Health Options

The use of laser therapy following whiplash may be considered for short term pain relief. More research is required to determine the parameters that can be useful and the long term effectiveness of laser therapy.

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☺ Manipulation

Injury Type: Acute/Chronic

Category: Allied Health Options

Manipulation may be a useful adjunct to other therapies, provided it is performed in a safe manner by a qualified professional. It does not appear to be effective as a sole treatment.

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☺ Medication

Injury Type: Acute/Chronic

Category: Medical Options

The evidence to support these medications is unclear. While it seems that pain relieving medication and anti-inflammatory medications may help in symptom management, especially in the short term after whiplash, more research is needed on long term effects. Usage of medications, especially in combination, should be monitored regularly by a qualified and registered health professional such as medical doctor and/or a pharmacist.

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☺ Mobilisation

Injury Type: Acute

Category: Allied Health Options

Spinal mobilisation may be useful as an adjunct to other treatments (see multimodal care), however its use as an isolated treatment is not warranted based on the current research evidence.

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☺ Psychology (in combination with other rehabilitation)

Injury Type: Acute/Chronic

Category: Allied Health Options

There is some evidence that psychological/psychosocial treatments in conjunction with other rehabilitation treatments are useful for people with chronic whiplash, but more high quality research is needed.

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☺ Pulsed Electromagnetic Fields (PEMF)

Injury Type: Acute

Category: Allied Health Options

PEMF may be beneficial following whiplash; however more high quality research is required to substantiate current evidence.

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☺ Radiofrequency Neurotomy

Injury Type: Chronic

Category: Medical Options

There is emerging body of evidence to suggest that radiofrequency neurotomy may be beneficial for patients with whiplash injuries whose signs and symptoms are as a result of facet joint problems and of a longstanding nature.

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☺ Vestibular Rehabilitation

Injury Type: Acute

Category: Allied Health Options

While the evidence base for this treatment is limited, the results are promising. More research is needed to strengthen current evidence and also identify if Vestibular Rehabilitation is useful as a stand alone therapy or used in conjunction with other physiotherapy treatments.

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ʘ Botulinum Toxin

Injury Type: Acute

Category: Medical Options

Based on current evidence, Botulinum toxin cannot be recommended as routine treatment for patients with acute or chronic whiplash who are suffering from neck pain and other associated symptoms. While it may be useful in some instances, more research is required to establish this practice as one which produces consistent and sustainable positive outcomes.

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ʘ Collar

Injury Type: Acute

Category: Allied Health Options

The use of a collar is not recommended by research evidence as it may unnecessarily slow recovery.

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ʘ Massage

Injury Type: Acute

Category: Complementary and Alternative Therapies

The current research evidence does not support the use of massage on its own for the management of whiplash. It may be used as an adjunct to other therapies (i.e. multimodal care) in the short term for pain relief.

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ʘ Nerve Root Blocks

Injury Type: Acute

Category: Medical Options

Based on very limited available evidence, it is unclear how useful selective nerve root blocks are for treating patients with whiplash. It is likely to be reserved for people that have not responded to more conservative treatments and have chronic pain.

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ʘ Rest

Injury Type: Acute

Category: Medical Options

Based on available evidence, rest is not recommended as a treatment for whiplash injuries, especially in the long term. The decision of having rest should be made by the health professional (such as a doctor) in consultation with the individual with whiplash.

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ʘ Time off work

Injury Type: Acute

Category: Medical Options

Based on available evidence, time off from work is not recommended as a treatment for whiplash injuries, especially in the long term. The decision of having time off from work should be made by the health professional (a doctor) in consultation with the person with whiplash.

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ʘ Traction

Injury Type: Acute

Category: Allied Health Options

Based on available evidence, there is inconclusive evidence to suggest that traction is a viable treatment option for patients suffering from whiplash injuries. While there is emerging evidence to suggest that intermittent traction may be beneficial for patients suffering from neck pain, more research is needed to guarantee this produces consistent positive benefits for patients suffering from whiplash injuries.

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Ø Alexander Technique

Injury Type: Acute

Category: Complementary and Alternative Therapies

The use of the Alexander technique cannot be recommended following whiplash due to lack of research evidence.

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Ø Cervical Pillow

Injury Type: Acute/Chronic

Category: Life Style Options

The use of cervical pillows cannot be recommended following whiplash based on the lack of research evidence.

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Ø Cold Therapy

Injury Type: Acute

Category: Lifestyle Options

Although there is no direct evidence relating to the effectiveness of cold therapy, recent guidelines suggest that it may be used in conjunction with other manual and physical forms of therapy (i.e. multimodal care) in the first three weeks after whiplash injury.

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Ø Dry needling

Injury Type: Acute/Chronic

Category: Complementary and Alternative Therapies

The effects of dry needling have not been fully evaluated and hence cannot be recommended for whiplash.

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Ø Electrical Muscle Stimulation (EMS)

Injury Type: Acute

Category: Allied Health Options

The use of EMS for whiplash is not recommended due to limited current research evidence.

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Ø Electrical Nerve Stimulation/TENS

Injury Type: Acute

Category: Allied Health Options

The use of TENS for whiplash is not recommended due to limited current research evidence.

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Ø Electromyography (EMG)

Injury Type: Acute

Category: Allied Health Options

The use of EMG cannot be recommended following whiplash due to lack of research evidence.

Ø Feldenkrais

Injury Type: Acute

Category: Complementary and Alternative Therapies

The use of Feldenkrais following whiplash cannot be recommended due to lack of research evidence.

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Ø Galvanic Current

Injury Type: Acute

Category: Allied Health Options

The use of galvanic current for whiplash cannot be recommended based on the current research evidence.

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Ø Heat Therapy

Injury Type: Acute

Category: Lifestyle Options

Although there is no direct evidence relating to the effectiveness of heat therapy, recent guidelines suggest that it may be used in conjunction with other manual and physical forms of therapy (i.e. multimodal care) in the first three weeks after whiplash injury (but avoided for the first 48-72 hours).

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Ø Herbs / Supplements

Injury Type: Acute/Chronic

Category: Allied Health Options

The use of herbs or supplements following whiplash injury cannot be recommended due to a lack of scientific evidence. More research is required.

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Ø Hypnosis

Injury Type: Acute

Category: Complementary and Alternative Therapies

The use of hypnotherapy following whiplash cannot be recommended due to lack of research evidence.

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Ø Injections

Injury Type: Acute

Category: Medical Options

While there is some evidence to suggest that certain injections (such as intravenous methyprednisolone and lidocaine) can work in some instances, there is just not enough research evidence to confidently say that these injections work for all patients with whiplash consistently.

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Ø Magnetic Necklace

Injury Type: Chronic

Category: Life Style Options

The use of magnetic necklaces for whiplash cannot be recommended based on the current research evidence.

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Ø MedEx

Injury Type: Chronic

Category: Life Style Options

The use of MedEx for whiplash cannot be recommended due to a lack of scientific evidence. More research is required.

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Ø Meditation

Injury Type: Chronic

Category: Lifestyle Options

There is presently no evidence that meditation can help with reducing whiplash symptoms, therefore its use cannot be recommended.

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Ø Myofascial Release

Injury Type: Acute

Category: Complementary and Alternative Therapies

Due to the absence of rigorous high quality scientific evidence, myofascial release cannot be recommended for whiplash.

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Ø Pilates

Injury Type: Chronic

Category: Allied Health Options

Pilates cannot be recommended as an effective treatment for whiplash, either in the short or long term, due to the lack of scientific evidence.

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Ø Posture Correction

Injury Type: Acute

Category: Allied Health Options

Although a small study on one patient found CBP to be effective, its routine use cannot be recommended based on this study alone. Learning how to sit and stand correctly may be useful in conjunction with other treatments, especially if there has been no improvement already.

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Ø Prolotherapy

Injury Type: Acute

Category: Medical Options

The use of prolotherapy for whiplash cannot be recommended based on the limited current research evidence.

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Ø Relaxation Techniques

Injury Type: Acute

Category: Life Style Options

The use of relaxation for whiplash cannot be recommended based due to the lack of scientific evidence.

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Ø Rolfing

Injury Type: Acute

Category: Complementary and Alternative Therapies

The use of Rolfing cannot be recommended following whiplash due to lack of high quality rigorous research evidence.

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Ø Shiatsu

Injury Type: Acute

Category: Complementary and Alternative Therapies

The use of Shiatsu cannot be recommended following whiplash due to lack of research evidence.

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Ø Ultra-Reiz Current

Injury Type: Acute

Category: Allied Health Options

As there is very little evidence to support the effectiveness of this treatment, it cannot be recommended for all patients suffering from whiplash.

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Ø Ultrasound

Injury Type: Acute

Category: Allied Health Options

Currently there is no evidence to support the use of ultrasound following whiplash. However it may be used as an adjunct to manual therapy and exercise (i.e. multimodal care) in the first three weeks.

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Ø Work Alteration

Injury Type: Acute

Category: Allied Health Options

Due to the absence of rigorous high quality scientific evidence, work alteration cannot be recommended for whiplash. More research is needed in this area.

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Ø Yoga

Injury Type: Chronic

Category: Life Style Options

The use of yoga following whiplash cannot be recommended due to the lack of scientific evidence.

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