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whiplash how soon how often?
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whiplash how soon how often? - February 24, 2007 10:00:00 AM
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ptadams
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An article in the journal of pain 2006;124:69-76 followed a group of patients for six months. The study group was seen for physcial therapy within 48 hours, and then seen 5 times a week for two weeks. My question to the forum is, how soon do you start therapy. Twenty four hours, one week, or when symptons are less acute(after rest at home with ice and meds)? How often do you treat the patient? Are there any good articles on when to start therapy and how often?
It seems to me that the first 7 days the lesion is too easy to flare and sometime in the second week the patient gains the most benefit. To avoid pro-longed therapy how early should a patient begin P.T.
Any thoughts?
:confused:
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Re: whiplash how soon how often? - February 24, 2007 11:02:00 AM
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jma
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From: NY
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When someone get a whiplash, they don't necessarily feel any signs or symptoms from that moment. It may be 24-48 hours before they begin to feel things going on in the neck. Only then, would one go to their primary PCP, who may then tell them to go for physical therapy. Even those who have come, even from getting a collar from the emergency room and told to go home, eventually went back to their doctor who told them to come to us. It may be a few days to a week until they come to us. Thats based from what I have heard from other therapists I have worked with. Good questions to ask. Will try to look for articles that address this.
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Re: whiplash how soon how often? - February 24, 2007 11:37:00 AM
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PTupdate.com
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Interesting question. In sports medicine, we typically address soft tissue injuries immediately, using cryotherapy and safe ROM to facilitate normal collagen pattern restructuring. There have been quite a few studies with ankle sprains, and I have always used Kenneth Knights Cryokinetics with acute ankle sprains....treating the first three days after injury. Makes me wonder why we have not carried that over to whiplash injuries?
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT
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Re: whiplash how soon how often? - February 24, 2007 12:37:00 PM
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ptadams
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Thanks jma and John, I too use the sports model for ankles, and this model has been sucessful for years. But there does not seem to be much in journals about how soon and how often to treat the acute whiplash patient.
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Re: whiplash how soon how often? - February 24, 2007 12:40:00 PM
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ptadams
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Thanks Steve, I just got your post. I will look at these articles.
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Re: whiplash how soon how often? - February 24, 2007 2:19:00 PM
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ptadams
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Thanks Steve, I just got your post. I will look at these articles.
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Re: whiplash how soon how often? - February 24, 2007 3:20:00 PM
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Karie
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From: Wisconsin
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David,
I have treated a number of cervical whiplash injuries over the last 20+ years and have found in my experience the earlier you get them the better as far as how long you have to treat them to restore normal function. As with anything else you need to get the inflammation undercontrol which restricts motion. I don't like cervical collars because in my experience I theorize that they decrease normal soft tissue/muscular mobility that assists with reduction of inflammation and other normal healing progress. Static motion doesn't allow for the normal physiological activities for fluid exchange etc. Structural instability would be a different story, but in pure soft tissue injury, I don't use them. The longer they splint and don't move (in my opinion) the longer it takes to get them functional, just like any other joint. I have seen many day 1 and day 2 for start. I rarely see them 5x/week, maximum I see them is 3x/week.
Just an opinion to add to the group.
Karie :-)
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Re: whiplash how soon how often? - February 26, 2007 1:17:00 AM
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Sebastian Asselbergs
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From: Barrie, Canada
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Well, I have seen my share and I think that the earliest I can get to them to TEACH them about the inflammation/pain/spasm cycle and the need to move within the painlimits, but often and smooth - the better it is. I don't put hands on too quickly, but for most to hear that the pain is not an accurate measure for tissue damage, and that motion is allowed, can be a real therapeutic experience.
I will use a collar in a rare case. Worn for an hour on - hour off, it can provide the pt with a sense of safety, which can help diminish the elevated neuromuscular responses to any motion. They can still move a bit in the soft collar, and will find "relief". Even a little is sometimes very helpful to reduce the elevated defense system. Motion, motion, motion; but gentle and repetitive and smooth and within the limits.
PS: this all of course, AFTER red flags and fractures and such have been eliminated.....
_____________________________
Mundi vult decipi
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