Prospective, randomized, controlled study of activity versus collar, and the natural history for whiplash injury, in Germany

Objectives: To examine the rate of recovery in groups of acute whiplash injury patients subjected to two different treatments, an activity program, or collar use. Methods: A prospective randomized study of 97 consecutive accident victims of rear-end collisions was carried out utilizing a control group of 50 healthy, age and sex-matched subjects. Symptoms recorded included presence and intensity of neck pain, neck stiffness, headache, shoulder pain, arm pain, and neck range of motion at 1, 2, 3, 6, and 12 weeks. There were 47 patients in the active therapy group [group 1], receiving active and passive mobilization in combination with postural exercises and advice over three weeks. The other 50 accident victims [CT] had a collar only for three weeks. Results: At three weeks, group 1 [active therapy] had significantly less pain and improved neck range of motion than CT [collar]. Symptom prevalence was no different at six weeks between group 1 and healthy controls. At 12 weeks, CT did not differ from healthy controls in these measures. Conclusion: The study confirms that active therapy, compared to use of a collar and rest results in a significant difference in rate of recovery. The Quebec Task Force recommendation for active therapy and avoidance of collars appears justified. It would also appear that in Germany, the natural history of the acute whiplash injury shows recovery in weeks.