Injury type: Acute/Chronic

Category: Allied Health Options

Rating: Useful

What is it?

Active treatments are based on the principles that early and repeated movements of neck within the pain free range ensure that normality is maintained and encouraged. These active treatments can be in the form of light, repetitive exercises of the neck, posture advice and education, and may even include specific philosophies of management (such as McKenzie). These strategies can be conducted under the supervision of a health professional and/or at home.

How does it work?

Active treatments aim to maintain and enhance available movements in the spine. This results in minimised pain, stiffness and loss of movement which can occur if the spine is immobilised for long periods of time. By encouraging regular movement of the spine in the initial stages and gradually increasing movements with active exercises, while still respecting pain, ensures that normal movement is maintained during the recovery period.

Is it effective?

There are high level research studies which have investigated the effectiveness of active treatments, particularly in the acute stage of whiplash. The findings from these studies are mixed.

A systematic review and meta-analysis of randomised controlled trials1 revealed that active intervention is more effective than passive intervention on pain alleviation for acute grade II whiplash at six months and one to three years. However, there were no significant differences in terms of improvement in cervical mobility and days of sick leave between the two types of interventions. Taking the quality of evidence into consideration, the authors of this systematic review concluded that active treatments (encompassing range of movement, mobilising exercises, and strengthening of the neck and scapular muscles) may be useful for pain reduction in the medium-long term.

A variety of active exercise approaches used for the management of acute and chronic whiplash, such as active cervical range of motion exercises and exercises based on McKenzie method were evaluated in a clinical commentary2. While these approaches are commonly included as part of the recommended exercise interventions across multiple clinical practice guidelines, high-quality trials and/ or evaluation of independent effect are still lacking. There is also no clear evidence to suggest that one approach is better than another. Another systematic review of existing clinical practice guidelines3 also revealed that neck exercises are widely recommended for the management of acute whiplash in all relevant guidelines. 

Are there any disadvantages?

While there were no reported disadvantages or side effects from active treatments, these treatments should be prescribed and monitored by a health professional at regular intervals. If patients’ symptoms are not improving with these treatments, health professionals need to review their management regime.

Where do you get it?

Active treatments can be provided by any qualified health professional. This may include doctors, physiotherapists and chiropractors.


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.