PATIENT ADVICE Whiplash rehabilitation

SOME HELPFUL TIPS 1. The sooner you get your neck moving the better 2. The long term prognosis is good 3. Most whiplash injuries are not serious 4. If you develop pain a day or two after the accident, that is a sign of a better prognosis

5. The acute pain usually settles within days or a few weeks 6. If the neck pain persists for a long time, that does not necessarily mean that it is serious

7. Resting for more than a day or two usually does not help and may prolong pain and disability

8. The best results are in people who stay active, exercise their neck and get on with life despite the pain

9. X-rays and MRI scans do not normally help in ordinary whiplash injury. If you have a violent accident and your neck is very painful, you should go to Accident & Emergency or see your doc- tor, just to make sure there is no serious damage. That is particularly important if you have:- ■ Been unconscious ■ Disturbed vision ■ Severe muscle spasm and your neck is in an abnormal position

■ Pins and needles, numbness and/or weakness in your arms or legs

■ Any difficulty with balance or walking

10.Painkillers and other treatments can help to control the pain to let you get started on your active management regime. 11.Collars are sometimes given for immediate support but research shows that after the first few days it may delay recovery.

12.Local heat or cold can be used for short term relief or pain and muscle spasm. There is no golden rule - some people will prefer heat and some will prefer cold pack.

13.Most specialists agree that manipulation or mobilisation can help. This is safely done by a qualified osteopath, physiotherapist or chiropractor. You should begin to feel the benefit within a few sessions and there is no value in treatment for months on end.

NECK STRETCHING AND STRENGTHENING EXERCISES 1. Neck stretching You need to stretch in all directions, forwards, backwards and to each side. Also turn your head to the right and left. Move slowly in one direction then in the opposite direction as far as you feel you can. Repeat 10 times each hour (avoid rolling your head round).

2. Shoulder stretching Shrug your shoulders while breathing in and then relax them when breathing out. Circle your arms one at a time, backwards and for- wards, repeat 10 times in each direction every hour.

3. Neck strengthening Put your hand on the side of your head and apply increasing pres- sure. As you resist you will feel your muscles contracting. Maintain force for ten seconds and then gradually release. Repeat other side. Similarly push forwards with both hands on your forehead and then backwards against your clasped hands, behind your head.

4. Neck co-ordination Lie on your back with your head on a thin pillow, push your head backwards into the centre of the pillow whilst still pressing down and looking straight up. Push towards each corner of the pillow in turn without really moving your head - this helps you to learn to control your neck muscles and movements.

If you need extra help, visit a physiotherapist, osteopath or chiro- practor who can show you how to do the exercises properly and give you more advance exercises.

ANXIETY AND STRESS Stress can aggravate or prolong pain. If stress is a problem then you need to recognise this at an early stage and try different manage- ment strategies for it. Learning relaxation exercises can help, along with controlled breathing, muscle relaxation and other techniques. Exercise is also an excellent way of reducing stress and tension.

POSTURAL ADVICE Sitting ■ Choose an ergonomic comfortable chair, get up and stretch regularly

Desk work ■ Adjust the height of your chair to suit your desk ■ Adjust your keyboard and computer screen to comply with ergonomic guidelines

■ Keep the mouse close to you ■ Get up and stretch regularly

Driving ■ Stop regularly for a few minutes break and get out to stretch ■ Make sure your headrest is level with the top of your head, and no more than 2” behind it

■ Make sure the steering wheel is directly in front of you and that you can hold it comfortably

Shopping ■ Carry shopping hugged to the body or split the load between more bags

■ Remember to use a trolley

Daily activities ■ Try to avoid repetitive activity and remember to use your arms at or below shoulder level

Sports ■ Continue with normal sports, as long as it is non impact ■ Reduce intensity if necessary ■ Try varying the stroke pattern if swimming

Sleeping ■ Find the most comfortable pillow, whether it is an orthopaedic pillow or not

■ Take painkillers one hour before going to bed.

The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for special- ist medical advice in each individual case. To the extent permissable by law, the publisher, editors and contributors accept no liability for any loss, injury or damage howsoever incurred (including negli- gence) as a consequence, whether directly or indirectly, of the use of any person of the contents of this article.

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