Rehabilitation of chronic whiplash: treatment of cervical dysfunctions or chronic pain syndrome?

Chronic whiplash-associated disorders (WAD) remains a challenging condition for clinicians. There is substantial evidence for the presence of various cervical dysfunctions (e.g., increased cervical muscle tone and impaired cervical movement control), but their contribution to the complex clinical picture of subjects with chronic WAD seems rather limited. There is consistent evidence for increased responsiveness of the central nervous system in those with chronic WAD, and central pain processing is likely to play a crucial role in the transition from an acute whiplash trauma towards chronic WAD. The manuscript explains how our current understanding of chronic WAD can be used to steer the content of conservative interventions and how treatment of cervical dysfunctions in patients with chronic WAD should account for the processes involved in chronicity. It is recommended to prevent sensorimotor incongruence, target cognitive-emotional sensitization, and apply a cognitive behavioral therapy-guided exercise program.