Skip to main content

Advertisement

SpringerLink
Log in

The role of non-rigid cervical collar in pain relief and functional restoration after whiplash injury: a systematic review and a pooled analysis of randomized controlled trials

  • Review Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Whiplash injury (WI) represents a common diagnosis at every emergency department. Several investigations have been conducted to compare the different medical managements for non-surgical cases. However, the role of the immobilization with a non-rigid cervical collar (nRCC) for pain management and range of motion (RoM) preservation has not been completely clarified.

Methods

We performed a systematic review of the randomized control trials (RCTs) and a pooled analysis in order to investigate the role of the nRCC for pain management, scored through the visual analogue scale (VAS) and the RoM, by comparing the use of a nRCC (for 1–2 weeks) with a non-immobilization protocols, regardless of the association with physical therapy (PhT). Only patients with whiplash-associated disorders grade I–II were included. Due to a certain heterogeneity across the RCTs, follow-up period time range resetting was necessary in order to pool the data.

Results

A total of 141 papers were reviewed; 6 of them matched the inclusion criteria and were admitted to the final study. Pooled analysis showed that nRCC does not improve the outcome in terms of VAS score and RoM trends along the follow-up. Moreover, VAS and RoM trends seem to further improve at long-term follow-up in non-immobilization associated with PhT group.

Conclusions

This pooled analysis of the available RCTs shows the absence of an advantage of the immobilization protocol with a nRCC after a WI. On the contrary, non-immobilization protocols show an overall better trend of pain relief and neck mobility recovery, regardless of the association of PhT.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Spitzer WO, Skovron ML, Salmi LR et al (1995) Scientific monograph of the Quebec Task Force on whiplash-associated disorders: redefining “whiplash” and its management. Spine 20:1S–73S

    Article  CAS  PubMed  Google Scholar 

  2. Overmeer T, Peterson G, Landén Ludvigsson M, Peolsson A (2016) The effect of neck-specific exercise with or without a behavioral approach on psychological factors in chronic whiplash-associated disorders: a randomized controlled trial with a 2-year follow-up. Med (Baltim) 95:e4430. https://doi.org/10.1097/MD.0000000000004430

    Article  Google Scholar 

  3. Chen H, Yang KH, Wang Z (2009) Biomechanics of whiplash injury. Chin J Traumatol Zhonghua Chuang Shang Za Zhi 12:305–314

    PubMed  Google Scholar 

  4. Björnstig U, Hildingsson C, Toolanen G (1990) Soft-tissue injury of the neck in a hospital based material. Scand J Soc Med 18:263–267

    Article  PubMed  Google Scholar 

  5. Cassidy JD, Carroll LJ, Côté P, Frank J (2007) Does multidisciplinary rehabilitation benefit whiplash recovery?: results of a population-based incidence cohort study. Spine 32:126–131. https://doi.org/10.1097/01.brs.0000249526.76788.e8

    Article  PubMed  Google Scholar 

  6. Sterner Y, Gerdle B (2004) Acute and chronic whiplash disorders—a review. J Rehabil Med 36:193–209 quiz 210

    Article  PubMed  Google Scholar 

  7. Carroll LJ, Hogg-Johnson S, Côté P et al (2008) Course and prognostic factors for neck pain in workers: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Spine 33:S93–100. https://doi.org/10.1097/BRS.0b013e31816445d4

    Article  PubMed  Google Scholar 

  8. Kamper SJ, Rebbeck TJ, Maher CG et al (2008) Course and prognostic factors of whiplash: a systematic review and meta-analysis. Pain 138:617–629. https://doi.org/10.1016/j.pain.2008.02.019

    Article  PubMed  Google Scholar 

  9. Kim K-H, Choi S-H, Kim T-K et al (2005) Cervical facet joint injections in the neck and shoulder pain. J Korean Med Sci 20:659–662. https://doi.org/10.3346/jkms.2005.20.4.659

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lord SM, Barnsley L, Wallis BJ, Bogduk N (1996) Chronic cervical zygapophysial joint pain after whiplash a placebo-controlled prevalence study. Spine 21:1737–1744 discussion 1744-1745

    Article  CAS  PubMed  Google Scholar 

  11. Freeman MD, Croft AC, Rossignol AM (1998) Whiplash associated disorders: redefining whiplash and its management” by the Quebec Task Force. A critical evaluation. Spine 23:1043–1049

    Article  CAS  PubMed  Google Scholar 

  12. Rydman E, Ponzer S, Brisson R et al (2018) Long-term follow-up of whiplash injuries reported to insurance companies: a cohort study on patient-reported outcomes and impact of financial compensation. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 27:1255–1261. https://doi.org/10.1007/s00586-018-5507-2

    Article  Google Scholar 

  13. Teasell RW, McClure JA, Walton D et al (2010) A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): part 2—interventions for acute WAD. Pain Res Manag 15:295–304

    Article  PubMed  PubMed Central  Google Scholar 

  14. Griffin A, Leaver A, Moloney N (2017) General exercise does not improve long-term pain and disability in individuals with whiplash-associated disorders: a systematic review. J Orthop Sports Phys Ther 47:472–480. https://doi.org/10.2519/jospt.2017.7081

    Article  PubMed  Google Scholar 

  15. Holla M, Hannink G, Eggen TGE et al (2017) Restriction of cervical intervertebral movement with different types of external immobilizers: a cadaveric 3D analysis study. Spine 42:E1182–E1189. https://doi.org/10.1097/BRS.0000000000002107

    Article  PubMed  Google Scholar 

  16. Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  17. McKinney LA (1989) Early mobilisation and outcome in acute sprains of the neck. BMJ 299:1006–1008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. McKinney LA, Dornan JO, Ryan M (1989) The role of physiotherapy in the management of acute neck sprains following road-traffic accidents. Arch Emerg Med 6:27–33

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135. https://doi.org/10.1186/1471-2288-14-135

    Article  PubMed  PubMed Central  Google Scholar 

  20. DerSimonian R, Kacker R (2007) Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials 28:105–114. https://doi.org/10.1016/j.cct.2006.04.004

    Article  PubMed  Google Scholar 

  21. Borchgrevink GE, Kaasa A, McDonagh D et al (1998) Acute treatment of whiplash neck sprain injuries. A randomized trial of treatment during the first 14 days after a car accident. Spine 23:25–31

    Article  CAS  PubMed  Google Scholar 

  22. Kongsted A, Qerama E, Kasch H et al (2007) Neck collar, “act-as-usual” or active mobilization for whiplash injury? A randomized parallel-group trial. Spine 32:618–626. https://doi.org/10.1097/01.brs.0000257535.77691.bd

    Article  PubMed  Google Scholar 

  23. Mealy K, Brennan H, Fenelon GC (1986) Early mobilization of acute whiplash injuries. Br Med J Clin Res Ed 292:656–657

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Schnabel M, Ferrari R, Vassiliou T, Kaluza G (2004) Randomised, controlled outcome study of active mobilisation compared with collar therapy for whiplash injury. Emerg Med J EMJ 21:306–310

    Article  CAS  PubMed  Google Scholar 

  25. Vassiliou T, Kaluza G, Putzke C et al (2006) Physical therapy and active exercises—an adequate treatment for prevention of late whiplash syndrome? Randomized controlled trial in 200 patients. Pain 124:69–76. https://doi.org/10.1016/j.pain.2006.03.017

    Article  PubMed  Google Scholar 

  26. Wiangkham T, Duda J, Haque S et al (2015) The effectiveness of conservative management for acute whiplash associated disorder (WAD) II: a systematic review and meta-analysis of randomised controlled trials. PLoS ONE 10:e0133415. https://doi.org/10.1371/journal.pone.0133415

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Rushton A, Wright C, Heneghan N et al (2011) Physiotherapy rehabilitation for whiplash associated disorder II: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 1:e000265. https://doi.org/10.1136/bmjopen-2011-000265

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy

    Luca Ricciardi, Vito Stifano, Filippo Maria Polli, Alessandro Olivi & Carmelo Lucio Sturiale

  2. Departments of Anaesthesiology and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy

    Sonia D’Arrigo

  3. Department of Neurosurgery, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy

    Luca Ricciardi, Vito Stifano & Alessandro Olivi

Authors
  1. Luca Ricciardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vito Stifano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sonia D’Arrigo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Filippo Maria Polli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alessandro Olivi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carmelo Lucio Sturiale
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luca Ricciardi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 161 kb)

Supplementary material 2 (DOCX 18 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ricciardi, L., Stifano, V., D’Arrigo, S. et al. The role of non-rigid cervical collar in pain relief and functional restoration after whiplash injury: a systematic review and a pooled analysis of randomized controlled trials. Eur Spine J 28, 1821–1828 (2019). https://doi.org/10.1007/s00586-019-06035-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-019-06035-9

Keywords

Search

Navigation