Does Early Management of Whiplash-Associated Disorders Assist or Impede Recovery?

Study Design. Narrative review of the literature and commentary. Objective. To discuss from an epidemiological and sociological perspective whether the early clinical management of whiplash-associated disorders can lead to iatrogenic disability. Summary of Background Data. There is a lack of evidence supporting the effectiveness of early rehabilitation care for whiplash-associated disorders. Methods. We describe the epidemiological evidence on the effectiveness of early rehabilitation on health outcomes for patients with whiplash-associated disorders and analyze from a sociological perspective how the medicalization of this condition may have contributed to increasing its burden on disability. Results. The evidence from randomized clinical trials suggests that education, exercise, and mobilization are effective modalities to treat whiplash-associated disorders. However, the evidence from large population-based cohort studies and a pragmatic randomized trial suggests that too much health care and rehabilitation too early after the injury can be associated with delayed recovery and the development of chronic pain and disability. These findings suggest that clinicians may be inadvertently contributing to the development of iatrogenic disability. The epidemiological evidence is supported by the sociological concepts of medicalization, iatrogenesis, and moral hazard. Conclusion. The current evidence suggests that too much health care too early after the injury is associated with delayed recovery. Clinicians need to be educated about the risk of iatrogenic disability.