The Importance of Advice in the Treatment of Chronic Neck Conditions

There is evidence that physiotherapy is effective for the management of acute whiplash-associated disorders (WAD). It is unknown however if this is the case for chronic whiplash-associated disorders.


Michaleff et al (2014) has undertaken a recent study, which examined 172 participants with a chronic (>3 months and <5 years) grade 1 or 2 whiplash-associated disorder. Grade 1 WAD includes a complaint of neck pain, stiffness or tenderness only without physical sign(s). Grade 2 involves a neck complaint and musculoskeletal sign(s). The participants received one of either a comprehensive exercise programme (20 sessions) or advice (one session and telephone support) with the aim of assessing the primary outcome of pain intensity. Outcomes were measured at baseline, 14 weeks, 6 months, and 12 months.


The study found that the addition of a comprehensive exercise program was not more effective than advice alone in reducing pain: at 14 weeks the treatment. The authors advised that the study reinforced that the comprehensive exercise program provided no additional benefit to a single physiotherapy advice session supplemented with telephone support.


The authors concluded that this study adds to a growing body of literature which suggests that there is a need to reconfigure the way in which WAD is treated and move away from long, extensive treatment regimes to shorter treatment programmes where the patient is actively involved. Physiotherapists are ideally positioned to empower patients to self-manage their condition through the provision of advice, reassurance and a gentle exercise program aimed at graded return to normal function.


A limitation of the study is that it did not review the additional potential impact of education on work-related outcome measures. There also remains a high level of conjecture as to any firm relationship between pain and activity.Whiplash photo


Workplace Physiotherapy incorporates education, advice, reassurance and development of self-management strategies into their management practices.


2014 Jul 12;384(9938):133-41.

Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial.

Michaleff ZA, Maher CG,Lin CW,Rebbeck T,Jull G,Latimer J,Connelly L, Sterling M.

Cochrane Database Syst Rev. 2015 Jan 28;1:CD004250.



The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of WorkCover NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.


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