Exercise
Injury type: Acute/Chronic
Category: Allied Health Options
Rating: Useful
What is it?
Exercise is the activity of exerting your muscles in various ways to improve or maintain physical fitness. Exercises for whiplash or neck pain may include specific neck exercises, shoulder exercises, active exercise, stretching, strengthening, postural, functional, kinaesthetic, eye-fixation and proprioception exercises (the last two exercises help with balance and control of movement). Exercises may be performed in a structured supervised format or may involve unsupervised sessions in a variety of settings. Exercise can also be performed individually or in a group. Exercise typically has effects on the cardiovascular, musculoskeletal and neurological systems of our body.
How does it work?
It is thought that exercise can help improve pain, range of movement/flexibility, function, physical fitness, reduce/maintain body weight, increase/maintain muscle strength and endurance, coordination, balance, control, improve patient satisfaction and quality of life via its effect on the musculoskeletal, cardiovascular and neurological systems. Exercise is also thought to promote the production of endorphins, naturally occurring opioid hormones by the brain that can help with pain control.
Is it effective?
The short answer is that doing some form of exercise is probably more effective than not doing any exercise following a whiplash injury. What is not known is the type of exercise that is most beneficial, or whether exercise is better than any other form of treatment. A systematic review1 updating evidence on the effectiveness of exercise for neck pain and whiplash identified that while supervised exercise programs including qigong, Iyengar yoga, and combined range of motion, strengthening and flexibility exercises are more effective than wait list or advice, there is no evidence to suggest that one modality of exercise is superior to another. There is also some evidence from this review to suggest that home exercises tend to produce similar outcomes, when compared to manual therapy or medication for patients with recent neck pain (not specifically whiplash). A clinical commentary2 which synthesised evidence from relevant research studies and international clinical practice guidelines indicated that there was currently lack of evidence to suggest that one type of exercise was better than another. This clinical commentary further highlighted two important factors to consider when selecting exercise approaches for whiplash, including determination of the presence of specific physical impairment(s) and consideration of symptom responsiveness.
A rapid review3 synthesising evidence from highest level of primary studies, systematic reviews, and well-conducted clinical practice guidelines reported that exercise is widely recommended for the initial treatment of whiplash. This despite the type of exercise varied from general aerobic, functional and strengthening exercising to specific range of motion movements, stretching and proprioceptive training amongst the body of evidence. Another review4 recommended that health professionals should use exercise approaches (e.g. strengthening, endurance, flexibility, postural, coordination, aerobic and functional exercises) in combination with manual mobilisation techniques (i.e. a multimodal care) for patients with acute whiplash, who experience a moderate to slow recovery with persistent impairments. This recommendation was substantiated by a moderate level of evidence in this review.
Several high level research studies have investigated evidence on the effectiveness of exercise for the management of chronic whiplash. A recent narrative review5 identified several randomised controlled trials examining the effect of exercise for chronic whiplash. This review concluded that exercise interventions targeting the cervical spine (including strength, endurance, flexibility, postural control) seem to be effective in improving pain and disability for chronic whiplash. Another systematic review6 also reported that neck-specific strengthening exercise is more effective in reducing pain and disability than an individualised aerobic physical activity program. However, when the neck-specific strengthening exercise was combined with cognitive therapy, the combined intervention was not more effective than the neck-specific strengthening exercise alone. Similarly, a review4 found a weak level of evidence associated with an individualised, progressive submaximal exercise program (including cervicothoracic strengthening, endurance, flexibility and coordination), when used in conjunction with mobilisation.
Are there any disadvantages?
While some side effects were reported in a small number of studies, these were not severe nor long-lasting. Side effects have been reported as headaches, arm pain, pins and needles, dizziness and worsening of symptoms (likely to be temporary).
Usually exercise is quite safe, but you should always seek advice from your doctor or health professional regarding exercise following a whiplash injury.
Where do you get it?
Specific exercises may be prescribed to you by your doctor or treating therapist. You may perform exercises under their direct supervision, at home, or in a class. You may also join an exercise group with other people in the wider community. Exercises can be performed just about anywhere – gyms, clinics, home, outdoors, pools etc.
Recommendations
Following a whiplash injury you are likely to be better off if you perform some type of exercise, rather than avoiding it. 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 these activities.