Q: I've seen my regular doctor, a physiotherapist, and a chiropractor for a whiplash injury I got three months ago. I'm still no better and in pain every day. I don't know what to do next. What do you advise?

A: After all you have been through, this may sound a bit odd but studies show it may be possible to get too much medical help too soon after a whiplash injury. A recent review examining the results of early treatment for whiplash may be of interest to you. The researchers showed a surprising amount of evidence that iatrogenic disability is possible.

Iatrogenic disability refers to the development of problems caused by the treatment. Chronic pain is one of those problems. Studies consistently showed that too much treatment too soon actually increases the risk of chronic pain and disability. How do they explain this finding? And what kind of "treatment" are they talking about?

First, let's look at the types of treatment studied. Fitness training, chiropractic care, and physiotherapy during the early stages of recovery from whiplash were linked with slower recovery. The reason? Possibly too much attention creates illness behaviors. Calling the problem a "whiplash" injury instead of a "neck strain" may be a way health care providers cause or extend the sick-role. Not enough focus on self-care may encourage passive coping behaviors.

These findings prompt the next most logical question: how should whiplash injuries be handled early on? Efforts are made to help reduce patient's pain and improve their function towards a goal of preventing chronic whiplash-associated disorders (WADs).

There is plenty of evidence that education, home exercise, and returning to normal activities as soon as possible is the most successful approach to this problem. Reducing patients' fear and anxiety about their condition seems to be a big help (and more successful than other hands-on treatments).

Today's view of whiplash is that it is a fairly benign problem that requires prevention management. Education, reassurance, and encouragement to get back to normal daily living is the number one effective approach to whiplash injuries. Once a patient has developed a chronic pain pattern, then the approach becomes a bit more complicated.

There is still a need to consider fear-avoidance movement patterns and behaviors. Patients become so afraid that a particular movement is going to increase the pain that they stop engaging in movements or activities that "might" aggravate their symptoms.

Here's where a physiotherapist could help you -- not by using electrical or heal modalities but by guiding you through restricted neck motions and helping you regain your confidence. You may want to ask your therapist to evaluate you for "fear-avoidance behaviors" (FABs). You will probably surprise him or her with the question but at three months post-injury, the time for this question is right.

You may want to pursue other methods of breaking the pain-spasm cycle and get back to movement. For example, some patients add in massages and/or acupuncture along with slow moving exercise such as Tai Chi or QiGong or gentle yoga.

Reference: Pierre Côté, DC, PhD, and Sophie Soklaridis, PhD. Does Early Management of Whiplash-Associated Disorders Assist or Impede Recovery? In Spine. December 1, 2011. Vol. 36. No. 25S. Pp. S275-279.