Manipulative Treatment vs Conventional Physiotherapy Treatment in Whiplash Injury

(From the March 2005 The “G”Note)

Fernández-de-las-Peñas C, et al. Manipulative Treatment vs Conventional Physiotherapy Treatment in Whiplash Injury: A Randomized Controlled Trial. Journal of Whiplash & Related Disorders. 2004 3(2):73-90.

ABSTRACT: Introduction: The aim of this clinical trial is to compare the results obtained with manipulative protocol developed by our investigation group with results obtained with a conventional physiotherapy treatment in patients suffering from whiplash injury. No controlled experimental trials have been published documenting the efffects of this manipulative protocol. Design: A randomized controlled trial. Materials and Methods: Three hundred eighty volunteer subjects, 300 men and 80 women, participated in this trial. All patients were diagnosed with acute whiplash injury of less than 3 months duration, and classified in grades II and III according to the Quebec Task Force (QTF). Patients were divided randomly in 2 groups, using a table of random numbers: Group A (experimental group) and Group B (control group). Group A was treated with manipulative protocol which includes “high velocity-low amplitude techniques,” soft tissue manipulation and mobilization techniques. Group B was treated with a conventional physiotherapy treatment which includes active exercises, electrotherapy, ultrasound therapy and diathermy (best evidence). Patients in Group A have received weekly manipulative treatment, whereas Group B have received daily physiotherapy treatment. All subjects signed the required consent sheet before becoming part of the research. The outcome measures were the visual analogue scale (VAS), the cervical range of motion (CROM) in flexion and rotation, and number of sessions needed to complete the treatment. Data were collected pre-treatment, after each 4 sessions in Group A and after each 10 sessions in Group B. Results: Patients of manipulative group needed an average of 9 sessions to complete the treatment, whereas physiotherapy group needed an average of 23 sessions (P=0.002). Results showed that the manipulative group had more benefits than the physiotherapy group in the VAS and CROM, specifically after the first 4 sessions with a decrease of 40% in the VAS (P=0.003) and an improvement of 20 degrees in cervical rotation (P=0.02).

Conclusions: Patients who had received manipulative treatment needed fewer sessions to complete the treatment than patients who had received physiotherapy treatment. The improvement in the manipulative group was achieved with fewer treatment sessions and was greater than the improvement in physiotherapy group. In the future, we plan to analyze if this improvement will be maintained over time by assessing and checking the patients after 6 months and 1 year.

EDITOR’S COMMENT: The study is from an osteopathic school in Madrid, Spain.