The information on this page is based on recommendations outlined in the Australian Guidelines for the management of acute whiplash-associated disorders for health professionals.
Management of a whiplash injury aims to facilitate rapid and complete recovery. It is important to remember that every injury is different. Each patient may recover at a different rate and therefore, require a different management approach, but all patients can expect to achieve a good quality of living and return to maximum function.
In cases where recovery is slow, management should be evidence-based, focus on empowering the patient to independently manage their injury, and should assist them in restoring function and participation in usual activities and roles.
To complement your management, patients are able to access Australian Guideline-based information and exercises. You may also choose to customise exercises from this section for your patient using the Whiplash Navigator Exercise Dosage Chart.
Frontline treatments
The frontline treatment recommended for whiplash are:
- reassurance and advice to stay active
- resumption of usual activities
- exercise
- analgesic medication.
Managing patients with a low risk
Managing whiplash patients with a low risk
People with a low risk whiplash injury are more likely to recover well and generally require minimal care over up to 3 sessions with their health care professional. They do not require specialised treatment interventions.
The main management goal for low-risk patients is to support self-management.
Treatment should include:
- Explain the nature of the injury including classification of the injury based on the QTF Classification of WAD and positive prognostic signs.
- Avoid specific anatomical explanations or catastrophic language.
- Avoid imaging unless there are specific indications (Canadian C-spine rule).
- Address any specific questions and concerns.
- Include analgesic medications if required.
Care should be guideline-based and consist of standard assessment, the provision of advice and instructions for self-directed exercises.
Managing patients with a medium to high risk
Managing patients with a medium to high risk
People with a medium to high risk whiplash injury experience greater functional or psychological impact as a result of whiplash, but can still expect to achieve maximum function and a good quality of life.
The main management goals for medium to high risk patients are to support self-directed symptom management, and to reduce disability.
Treatment should include:
- Frontline treatments as for low risk.
- Specific advice that is focused on reducing distress and encouraging coping.
- Training in symptom management, management of flare-ups, activity pacing, understanding chronic pain.
- Specific goals for physical therapy, with defined timeframes and end points.
Treatment should include:
- specific physical therapies e.g. manual therapy, specific exercises
- referral to specialist for a more detailed assessment of the physical and psychological factors associated with whiplash injury
Treatment outcomes should be carefully monitored.
Other treatments
Other treatments
There are other treatments for whiplash where the evidence of benefit or harm has not been conclusively established. If using these treatments, it is important that:
- the frontline treatments are not neglected
- the purpose of the treatment is clearly defined
- the treatments relate to goals that focus on improving self-management and function
- the timeframe for the course of treatment is clearly defined
- treatment outcomes are closely monitored.
Other treatments include:
| Low-level evidence of benefit | No evidence of benefit or harm |
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Can be used for limited periods in conjunction with first line treatments |
Can be used for limited periods in conjunction with first line treatments |
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Not recommended
Other treatments for acute whiplash are NOT recommended because there is evidence that they are ineffective or harmful. These include:
- Reduction of usual activities for more than 4 days
- Immobilisation collars
- Pharmacology: anti-convulsants and anti-depressants, muscle relaxants, botulinum toxin type A, intra-articular and intrathecal steroid injections,
- Pulsed Electromagnetic Treatment (PEMT).
Source: NSW State Insurance Regulatory Authority. Quick reference guide for the management of acute whiplash associated disorders, 2015.