McKinney M B
Altnagelvin Area Hospital, Londonderry, Northern Ireland.
Orthopade. 1994 Aug;23(4):287-90.
It is estimated that between 15 and 30% of car occupants will suffer neck pain after accidents, and many will remain symptomatic for a prolonged period. This has often been attributed to the effect of associated litigation as a financial deterrent to recovery. Conventional treatment uses an old orthopaedic principle of rest until the symptoms resolve and analgesia is widely accepted, although its use is unlikely to influence the ultimate outcome. Mobilization programmes have become popular, particularly with physiotherapists, but they are often based upon personal experience and are largely scientifically untested. An improvement in both the cervical range of movement and a reduction in the severity of neck pain was claimed in a study in 1986 using early mobilization. In an attempt to identify which features of physiotherapeutic practice appeared to correspond with improved outcome, I studied the outcomes of differing treatment regimens in acute whiplash patients in three randomized groups and showed that after 1 and 2 months there was a significant improvement in cervical movements and in the patients' perception of their neck pain severity, in actively mobilized patients, including those who were instructed about postural correlation and mobilization techniques. The benefit conferred on this group was still evident 2 years post injury. It therefore seems that self-reliance with exercises used when symptoms are troublesome and postural advice can play a significant role in the recovery process.
据估计，15%至30%的汽车乘客在事故后会出现颈部疼痛，许多人会长期有症状。这通常归因于相关诉讼的影响，作为康复的经济阻碍。传统治疗采用旧的骨科原则，即休息直到症状缓解，镇痛方法被广泛接受，尽管其使用不太可能影响最终结果。动员方案已经流行起来，尤其是在物理治疗师中，但它们往往基于个人经验，在很大程度上未经科学检验。1986年的一项研究使用早期动员，声称颈椎活动范围有所改善，颈部疼痛严重程度有所降低。为了确定物理治疗实践的哪些特征似乎与改善的结果相对应，我研究了三个随机分组的急性挥鞭伤患者不同治疗方案的结果，结果显示，在1个月和2个月后，积极动员的患者，包括那些接受了姿势相关性和动员技术指导的患者，颈椎活动和患者对颈部疼痛严重程度的感知有显著改善。受伤2年后，这组患者获得的益处仍然明显。因此，在症状困扰时使用锻炼和姿势建议的自我护理似乎可以在康复过程中发挥重要作用。
