Home 7

Low Back Manipulation

Home 10

Treatment for Shoulder & Neck Pain

Home 9

Acupuncture & Dry Needling

Home 2

State of the Art Prolotherapy Theatre

Home 4

Exercise for Health

Home 6

Pilates Reformer Rehab

Home 8

Sports Injury Treatment

Home 5

Exercise on GP Referral

Whiplash Related Neck Pain

Post Procedure Recovery
The patients should continue with an active rehabilitation programme whilst their pain is improving, the goals being to increase stability, strength and range of motion along with neuromuscular control. Manual therapy may still be required depending upon the progress.

Traction has been shown to be a benefit in several studies and there are useful home traction kits available. Anecdotally this treatment can help where other forms of manual therapy have been ineffective. Traction should be done on a daily basis and consequently traction in an outpatient physiotherapy unit is not cost effective, but home traction units can be extremely useful to provide five minutes of traction twice a day for one to two weeks.

Acupuncture has a role to play in pain relief following whiplash injury and should not be overlooked when considering conservative management in this instance.

Other Approaches
The temporomandibular joint (TMJ) is often considered by osteopaths and chiropractors as being important in neck pain and assessment of this joint can demonstrate asymmetry/dysfunction and malocclusion. It is treated sometimes by occlusal plates from dentists with an interest in this joint. Physiotherapists with an interest in the joint also have several manual and other therapeutic approaches.

Medication
Anti-inflammatory and analgesic medication can be used at any point during the recovery phase and there is a recognised effect of using this form of treatment for pain relief. Gabapentin, Pregabalin and other pain modulating drugs can be useful, especially in neuropathic type pains which may be a consequence of neck injury.

Return to Sport
This is an individual process for sports participants and no specific time frame exists, but the safe return to sport is allowed when the patient can illustrate the full pain free range of motion along with full neuromuscular control and a proper neutral spine posture during and in-between sport specific activities.

Despite extensive literature regarding surgical management of cervical spine injury, there is little information concerning the indication for returning to sport after these procedures and also after non-surgical conditions such as neck strain and “stingers”. Full assessment should be made if ligament injury is suspected. The process of using flexion, extension and neutral radiographs should be used if ligament injury is suspected. If any evidence of ligamentous instability exists the patient must be placed in a rigid collar and further images obtained two to four weeks later. Wryneck or “torticollis” may suggest a severe injury, especially if experienced after trauma and may even suggest subluxation or unilateral dislocation. Neurological status must be assessed thoroughly and an expert opinion sought.

Some specialists recommend a cervical MRI scan if symptoms following a stinger type injury persist for more than a few minutes and an EMG if they last for more than two weeks. As a rule any athlete with permanent neurological signs and deficits should be prohibited from participating in further competition. Athletes without spinal cord injuries and with stable fractures should be allowed to return to their normal daily activities.

Paraesthesia or brachial plexus injury may not prohibit return to play once neurological examination returns to normal, but each of these situations regards careful individual assessment. Even after healing of a severe injury has occurred, the altered biomechanics and loss of motion in the surrounding spinal segments may result in severe or devastating future sports related injuries, so return to play must be considered with due caution.