Effectiveness of Physiotherapy Following PRP for Chronic Whiplash
Whiplash Injuries, Neck Injuries, Platelet Rich Plasma
About this trial
This is an interventional treatment trial for Whiplash Injuries focused on measuring Physiotherapy
Eligibility Criteria
Inclusion Criteria:
- Individuals with Grade II Whiplash Associated Disorder with > 80% relief of familiar neck pain after dual medial branch blocks
- > 12 weeks since injury and failed to respond to previous (> 6 weeks) conservative treatment
- Neck pain on numerical pain rating scale ≥ 4/10
- Neck Disability Index > 28%
Exclusion Criteria:
- Presence of dizziness symptoms
- Known or suspected serious spinal pathology (e.g. metastatic disease of the spine);
- Confirmed fracture or dislocation at time of injury (i.e., WAD Grade IV)
- Nerve root compromise (i.e., WAD Grade III)
- Spinal surgery in the past 12 months; and
- History of any mental health conditions such as bipolar disorder, psychosis, schizophrenia, anxiety, PTSD or severe depression
- Inability to stop taking anti-inflammatory medications for 3-days prior to, or 10-days following PRP
- Unable to understand +/- complete validated questionnaire items in English
Sites / Locations
- Vivo Cura Health
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
Physiotherapy (PRPt)
Wait and See (PRPu)
The 6-week exercise program (2 sessions in each of weeks 1-4 and 1 session in each of weeks 5 and 6) will comprise specific individually-tailored exercises to improve the movement and control of the neck and shoulder girdle. The exercises will be of a low load nature and designed to be pain free. At the same time, the physiotherapist will provide pragmatic multimodal physiotherapy to facilitate ability to pursue exercises and guide the participant's return to normal activities. This specific treatment program has been described in detail (Jull et al., 2008; Ritchie et al., 2015b) and focuses on activating and improving the coordination and endurance capacity of the neck flexor, extensor and scapular muscles in specific exercises and functional tasks. Participants will also perform the exercises at home, once per day. Written and illustrated exercise instructions will be provided. The exercise program follows Australian guidelines for the management of chronic whiplash (TRACsa, 2008).
Individuals randomized to usual care will be provided with an advice booklet Whiplash Injury Recovery: A Self Help Guide (MAIC, Qld, 2nd edition). It provides information about whiplash; assurance about prognosis; advice to stay active and resume working as well as information on correct posture; pictorial descriptions of specific exercises for the neck and upper limbs and information on resuming functional daily activities. The booklet is based on the recommendations of the current Australian Guidelines for Whiplash Management (SIRA, 2014). Usual care involves a 'wait and see' approach (in combination with provision of home exercises) and will include weekly review appointments with a medical doctor, primarily to review the information in the booklet and progress the 'general' exercises and activity recommendations within the booklet. No hands-on physiotherapy will be provided. Education regarding PRP and associated healing cycles will also be provided during this time period.