Injuries associated with motor vehicle accidents are one of the most inconsistently treated conditions within medical and conservative treatment programs. In my professional experience I have seen treatment plans range from weeks to years with many different therapies being utilized depending on the health care practitioner.
With the exception of instances where fracture, dislocation or any other red flag situations are involved, the most common primary diagnosis results in cervical sprain/strain. In the absence of these more severe injuries, the most up-to- date research recognizes conservative therapy as the most effective in terms of both patient response as well as lowest overall cost. However, there tends to be discrepancies between practitioners in the treatment plans that are implemented in order to achieve pre-accident status.
Initially following the motor vehicle accident the injured patient can present with a variety of symptoms typically resulting from injuries to the cervical joints, ligaments and muscles. Ultimately the most common presentation occurs with varied acute pain and inflammation. Upon the patient’s presentation to the office a complete history and examination is necessary to determine the extent of the injury as well as the differential diagnosis in order to create a proper treatment plan. Subjective outcome assessment forms should also be utilized within these examinations in order to properly document subjective treatment progress.
Inflammation can cause false positive findings during this initial examination. An initial treatment plan, utilizing therapies to decrease pain and inflammation while increasing active range of motion, is essential for the first two to four weeks. These therapies are typically passive in nature and include and are not limited to chiropractic manipulative therapy, cryotherapy, electrical muscle stimulation, ultrasound, traction and passive stretching techniques. Following this initial trial of therapy a reexamination would be necessary to assess the progress of the patient while ensuring the treatment plan and differential diagnoses are properly documented.
The typical course of healing through this acute stage tends to range between two to six weeks depending on the severity of the injury. Following the acute stage of the injury the healing process moves into the remodeling stage. Once objective functional improvement is noted, the treatment plan requires an alteration to reduce and eliminate the passive care modalities being utilized within the treatment plan in favor of active care and a home exercise program. As the typical motor vehicle injury results in a sprain/ strain complex, improving strength and stability of the injured area is imperative.
Common therapy utilized within this phase may include spinal stability exercises, core activation, proprioceptive exercises, manual manipulation and mobilization, as well as manual soft tissue therapy. This is also the time period where, if the patient is not improving or they are worsening, an alteration in the treatment program is necessary. Therapies within the chiropractic office may be altered, or may also include referral for imaging (especially in the case of radiating symptoms or other red flags) or to other medical providers in order to decrease symptoms and transition into the active rehabilitation portion of treatment.
This remodeling stage of healing can be lengthy, up to a year time frame; however that is not to say that supervised treatment is at all necessary throughout this total time period. Throughout this time frame, reexaminations need to be performed periodically to monitor objective functional improvement and a consistent reduction in the frequency of treatment should also be noted. Subjective outcome assessment evaluations should also be utilized throughout each examination in order to determine reduction of symptoms and effectiveness of care.
Passive modalities should only be added back into the treatment program upon exacerbation of the original injury. As long as a home exercise program is implemented, the patient can easily be released from active care and continue their physical improvement by following the implemented home program.
Even when following the active therapy protocols, there are always other lifestyle factors such as age, smoking, obesity, age and treatment compliance that will affect total outcome. Within the cases that I have reviewed, conservative care treatment is entirely too passive in nature. Research dictates that extended passive care, although typically providing temporary relief, tends to lead toward practitioner dependency as well as the potential for chronicity of symptoms. In order to counteract these potential issues, active rehabilitation is necessary within the treatment plan to ensure progression throughout the healing process.