Rehabilitation after Motor Vehicle Injuries

Motor vehicle collisions (MVC) are a known cause of poly-trauma in multiple age groups. According to the CDC, MVC claimed the lives of approximately 35,000 Americans in 2015 and account for 2.3 million visits to the hospital yearly. Injuries sustained in MVC can vary based on the mechanism of collision, speed, site of impact as well as other variables including seat belt use, air bag deployment, and others. Due to this, there are many types of injuries that can be sustained in MVC. A common injury seen in the setting of MVC is cervical whiplash injury. This article will discuss the general principles as it pertains to rehabilitation management of cervical whiplash injury. We expect that the general points discussed below can also apply to other MVC injuries.

Whiplash injury from MVC is caused by a sudden change in vehicle velocity causing a flexion/extension movement to the cervical spine. Symptoms of whiplash injury can include prolonged/persistent neck pain, pain with movement, range of motion restriction, headache, and neurological symptoms (weakness, numbness, balance disturbance). It is important to note that symptoms may not present at time of impact. Diagnosis is made with history and physical examination with supporting evidence provided by imaging. Rehabilitation treatment is directed towards reducing pain, improving range of motion, and mitigating disability. Due to the significant psychosocial factors associated with this condition, the goal of therapy is to improve function while also avoiding exacerbation of psychological, social, and legal stressors.

Rehabilitation of cervical whiplash injury is often performed under the coordinated care of a skilled therapist and medical professional (e.g., Rehabilitation Medicine Physician). Initial management is directed towards patient education, postural modification and neck range of motion. The goal of therapy is to educate towards independent practice of learned exercises at home. Most prescriptions for physical therapy are approximately two times per week for four to six weeks. If needed, therapy may be extended if the patient is obtaining benefit from treatment and gains are made.

Therapists will demonstrate and practice exercises including neck rotation, neck tilting and neck bending with the goal of teaching the patient a comprehensive home exercise program. Specific therapies include tissue manipulation. A cervical collar may also be given for comfort however prolonged or continuous use is not recommended. Modalities such as heat, ultrasound and massage may also be employed. Transcutaneous electrical nerve stimulation may also provide benefit. Rest breaks are used to mitigate pain exacerbation and are less frequent as time elapses from initial injury. While cervical traction may be employed, there is no evidence to suggest that traction provides superior management than the above treatments. The patient is educated on symptoms to monitor for and to present for medical evaluation if concerning symptoms arise during therapy and after. As the patient completes the rehabilitation

In conclusion, MVC are associated with a significant number of death and medical evaluations annually. There are many types of injuries associated with MVC due to the mechanism of injury as well as mitigating factors. A common injury seen from MVC is cervical whiplash injury. Rehabilitation of whiplash injury is directed towards reducing pain and improving range of motion with patient education towards an independent home exercise program. The above points highlight the general treatment principles for injury after MVC with cervical whiplash injury used as an example. It is important to determine the specific treatment needs for the injuries sustained and this care should be directed under the watch of a skilled medical professional.


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