Whiplash is an injury to the neck muscles and ligaments caused by sudden distortion or trauma, usually from motor vehicle collisions. Symptoms include neck pain and stiffness, headaches, shoulder pain, dizziness, and restricted range of motion.
Treatments consist of rest, pain medication, physical therapy, and chiropractic care[1]Wong JJ, Shearer HM, Mior S, Jacobs C, Côté P, Randhawa K, Yu H, Southerst D, Varatharajan S, Sutton D, van der Velde G. Are manual therapies, passive physical modalities, or acupuncture effective … Continue reading. Massage is sometimes utilized as an adjunct therapy for whiplash injuries.
The neck contains delicate structures including vertebrae, discs, nerves, muscles, and ligaments that can be damaged during whiplash. Conventional medical care focuses on rest, pain relief, and restoring mobility.
Research suggests massage may also help improve circulation, relax muscles, increase range of motion, and reduce whiplash-related pain. This article reviews the evidence surrounding massage as a complementary treatment option for acute and chronic whiplash injuries[2]Ezzo J, Haraldsson BG, Gross AR, Myers CD, Morien A, Goldsmith CH, Bronfort G, Peloso PM, Cervical Overview Group. Massage for mechanical neck disorders: a systematic review. Spine. 2007 Feb … Continue reading.
Anatomy of the Cervical Spine
The cervical spine consists of seven vertebrae named C1 to C7. C1 is called the atlas, and C2 is the axis. Along with discs between each vertebral segment, key structures include:
- Facet joints that allow flexibility
- Nerves that transmit signals to the body
- Ligaments that connect and stabilize vertebrae
- Muscles that support the neck
During whiplash, these tissues can become strained, compressed, or torn, resulting in pain, inflammation, and dysfunction.
- Cervical collar to immobilize the neck
- Rest and avoiding activities that aggravate symptoms
- Over-the-counter anti-inflammatory medications like NSAIDs to control pain and swelling
- Muscle relaxants to relieve muscle spasms
- Physical therapy exercises to improve mobility and strengthen muscles
- Chiropractic manipulations and modalities to improve joint alignment and reduce pain
- Corticosteroid injections for persistent symptoms
Most acute whiplash cases resolve with conservative care within 3-6 months. However, some patients develop chronic neck pain or disability lasting more than a year post-injury.
How Massage Therapy May Help
As an adjunct therapy, massage may help whiplash injuries by:
- Increasing circulation and delivering oxygenated blood to injured tissues
- Reducing localized muscle spasm and tension
- Releasing natural pain-relieving endorphins
- Gently stretching tight muscles to improve cervical range of motion
Massage techniques tailored for whiplash aim to relax strained muscles, reduce inflammation, and restore normal motion to the neck. This may speed recovery and facilitate a return to normal activity[3]Bussieres AE, Stewart G, Al-Zoubi F, Decina P, Descarreaux M, Hayden J, Hendrickson B, Hincapie C, Page I, Passmore S, Srbely J. The treatment of neck pain–associated disorders and … Continue reading.
Tretment Strategies
Acute Whiplash (0-3 months)
- Multimodal care combining manual therapy, exercise, education, and self-management advice is recommended. This may include spinal mobilization, soft tissue techniques, range of motion exercises, advice on maintaining activity.
- Structured patient education providing information on the condition, reassurance, posture, exercises, and encouragement to resume normal activities.
- Avoiding immobilization with collars and emphasizing early return to activity.
Acute Neck Pain (0-3 months)
- Manipulation or mobilization based on patient preference and response.
- Multimodal manual therapy using manipulation/mobilization, massage, hot/cold therapy, assisted stretching, and advice to stay active.
- Home range of motion exercises with advice on self-care and posture.
- For grade III neck pain, supervised graded strengthening and stability exercises.
Persistent Whiplash (>3 months)
- Supervised general exercises combined with advice and education. May involve manual therapy, range of motion exercises, stretching, stabilization.
- Advice focused on posture, staying active, and resuming normal activities.
Persistent Neck Pain (>3 months)
- Multimodal care using manual therapy, exercise, self-management advice, stress management based on patient factors.
- Supervised strengthening exercises or home exercises.
- High dose massage for grades I-II neck pain.
- Supervised yoga or group exercises like qigong.
- Workplace exercise programs focusing on strengthening for workers.
- Manipulation paired with soft tissue massage for grades I-II neck pain.
Key Points:
- Treatment strategies evolve from multimodal care in acute phase to emphasis on exercise and self-management in persistent phase.
- Advice on maintaining activity and range of motion is consistent across durations.
- Individual patient preferences and access to modalities help guide tailored treatment plans.
- Regular reassessment of treatment effectiveness and progress is essential.
Research on Massage for Whiplash
A number of studies have investigated massage therapy for whiplash injuries:
- A 2016 review found massage effective for reducing whiplash-associated pain and disability
- A 2015 study reported 10 massage sessions reduced neck pain and increased range of motion
- A 2011 clinical trial concluded massage was superior to relaxation therapy for improving whiplash symptoms
While early research shows promise, the studies have had relatively small sample sizes. Larger, more rigorous randomized controlled trials are still needed.
Treatment Modalities
Active Modalities
- Exercise – Supervised or home exercise programs incorporating strength training, range of motion, flexibility, and stabilization exercises are recommended, especially as part of a multimodal approach. Different types of exercise like yoga, qigong, and workplace exercise programs can be beneficial.
- Self-management – Advice focused on staying active, maintaining range of motion, and resuming normal activities is suggested. Stress self-management programs incorporating relaxation, body awareness, and pain coping strategies may also help some patients.
- Patient education – Providing education on the condition, treatment options, and self-care can empower patients. This is recommended in combination with other active modalities.
Passive Modalities
- Manual therapy – Spinal manipulation and mobilization techniques are recommended, especially when combined with active modalities in a multimodal approach. Soft tissue massage may also be helpful.
- Modalities – Passive physical modalities like hot/cold packs may be used as adjuncts but are not well supported as standalone treatments. Other modalities like traction, TENS, laser, ultrasound lack evidence currently.
- Medication – For acute neck pain, over-the-counter analgesics or prescription anti-inflammatories may provide temporary relief. Long-term opioids are not recommended.
Proper Massage Techniques
Massage therapists should use gentle techniques for whiplash patients including:
- Superficial Swedish massage strokes – effleurage, petrissage, friction
- Post-isometric relaxation to relax muscles
- Myofascial release to ease trigger points
- Gentle neck and shoulder stretching
Deep tissue massage should be avoided in acute or severe cases, as it may exacerbate inflammation and pain. Massage pressure should be tolerated without discomfort.
Massage is often most effective when incorporated with other therapies under a physical therapist or chiropractor’s care.
Multimodal Care
- Involves combining multiple distinct treatment modalities and disciplines[4]Sutton DA, Cote P, Wong JJ, Varatharajan S, Randhawa KA, Yu H, Southerst D, Shearer HM, van der Velde GM, Nordin MC, Carroll LJ. Is multimodal care effective for the management of patients with … Continue reading.
- May include manual therapy, exercise, education, self-management advice, stress management strategies.
- Allows complementary effects of different treatments and caters to bio-psycho-social factors.
- Treatment components can be tailored to individual patient needs and presentation.
- Requires coordination between disciplines for optimal timing, sequencing, and dosage of treatments.
Exercise
- Exercises help strengthen muscles, restore range of motion, improve flexibility and function.
- Can be supervised in a clinical setting or prescribed as a home program.
- Often incorporates stretching, resistance training, aerobic conditioning, proprioception, and stabilization.
- Should be gradually progressed in intensity based on patient response.
- Proper form and technique is emphasized to prevent injury or aggravation.
- Supervised programs allow monitoring and individual adjustments.
- Adherence may be better with group programs offering accountability.
Manual Therapy
- Involves hands-on techniques aimed at joints and soft tissues.
- Spinal manipulation delivers a high-velocity low-amplitude thrust.
- Spinal mobilization uses lower velocity oscillatory movements.
- Often targets restricted vertebral segments and aims to restore mobility.
- Soft tissue massage techniques like effleurage and petrissage relax muscles.
- Myofascial release and trigger point therapy also used.
- Force, duration, frequency should be adapted to patient response.
- Precautions taken in acute inflammation, osteoporosis, instability.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.
References
| ↑1 | Wong JJ, Shearer HM, Mior S, Jacobs C, Côté P, Randhawa K, Yu H, Southerst D, Varatharajan S, Sutton D, van der Velde G. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. The Spine Journal. 2016 Dec 1;16(12):1598-630. |
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| ↑2 | Ezzo J, Haraldsson BG, Gross AR, Myers CD, Morien A, Goldsmith CH, Bronfort G, Peloso PM, Cervical Overview Group. Massage for mechanical neck disorders: a systematic review. Spine. 2007 Feb 1;32(3):353-62. |
| ↑3 | Bussieres AE, Stewart G, Al-Zoubi F, Decina P, Descarreaux M, Hayden J, Hendrickson B, Hincapie C, Page I, Passmore S, Srbely J. The treatment of neck pain–associated disorders and whiplash-associated disorders: a clinical practice guideline. Journal of manipulative and physiological therapeutics. 2016 Oct 1;39(8):523-64. |
| ↑4 | Sutton DA, Cote P, Wong JJ, Varatharajan S, Randhawa KA, Yu H, Southerst D, Shearer HM, van der Velde GM, Nordin MC, Carroll LJ. Is multimodal care effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. The Spine Journal. 2016 Dec 1;16(12):1541-65. |