Musculoskeletal Physiotherapy Consultants

Whiplash – how long to recover?

By on June 6, 2018 in General with 0 Comments

Wet weather after a series of sunny days made the roads quite slippery this morning and I was witness to a motor vehicle crash which undoubtedly would have led to the common, often disabling and costly condition known as whiplash associated disorder (WAD) for at least one person involved.

Whiplash is probably the most controversial of all musculoskeletal conditions, partly because of the compensable nature of the injury but also because a precise pathoanatomical diagnosis remains elusive. Nevertheless, evidence over recent years has emerged that WAD is a complex and varied condition with diverse physical and psychological clinical features. Of concern for patients, clinicians and insurers is the fact that about half of the people who sustain a whiplash injury will continue to experience pain and disability one year after the injury.

Studies have demonstrated that symptoms normally decrease in the first 2-3 months with some patients making a full recovery during this time, while others experience a plateau in recovery after this point. Research has identified three recovery pathways following whiplash injury:

  1. 45% of patients who have initial mild levels of pain-related disability are predicted to have a good recovery
  2. 39% of patients who have initial moderate to severe pain-related disability are predicted to have moderate levels of disability at 1 year post-injury
  3. 16% of patients who have initial severe pain-related disability are predicted to have moderate or severe disability at 1 year post-injury

As specialist musculoskeletal physiotherapists, we are often asked, “how long should this case take to get better?” Although this can be a difficult question to answer, the research does give us some pointers. A recent systematic review showed that the following factors were consistent predictors of poor recovery:

  • Initial pain levels >5.5/10
  • Neck Disability Index (NDI) score  >29%
  • Symptoms of post-traumatic stress
  • Negative expectations of recovery
  • High pain catastrophizing
  • Cold hyperalgesia

We also have clinical prediction rules (CPR) which try to identify the best combination of signs, symptoms, and other findings in predicting the probability of a specific disease or outcome. Recently a CPR for whiplash was developed and validated. This predicted 2 recovery pathways following an acute whiplash injury:

  1. Ongoing moderate/severe pain and disability in the presence of baseline NDI scores of 40% or greater, age of 35 years or older, and a hyperarousal subscale symptom score on the Post-traumatic Stress Diagnostic Scale of 6 or greater.
  2. Full recovery in individuals less than 35 years of age with a baseline NDI score of 32% or less

Although further studies are needed to comprehensively validate this CPR, results to date estimate that where the above criteria are met, the probability of ongoing moderate/severe pain and disability is 90%, and of full recovery is 80%. It must also be noted that these studies included only patients with grade II WAD (Quebec Task Force Classification) who had musculoskeletal signs including decreased range of movement and point tenderness but not patients with neurological signs or fracture/dislocation.

These studies are not only of clinical interest but may assist in allocating health resources appropriately, and may help researchers develop targeted therapies to better match patient subgroups.

Please email us if you want further information or have any questions, or if you would like a specialist musculoskeletal physiotherapy opinion on this topic.

In the meantime, take care when driving in wet conditions! Remember to drive slowly to avoid aquaplaning and skidding, and double your stopping time so that you travel at least 4 seconds behind the vehicle in front.


  • Casey, Petrina P., Anne Marie Feyer, and Ian D. Cameron. “Course of Recovery for Whiplash Associated Disorders in a Compensation Setting.” Injury 46, no. 11 (November 2015): 2118–29.
  • Michaleff, Z. A., and M. L. Ferreira. “Physiotherapy Rehabilitation for Whiplash Associated Disorder II: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.” British Journal of Sports Medicine 46, no. 9 (July 1, 2012): 662–63.
  • Ritchie, Carrie, Joan Hendrikz, Gwendolen Jull, James Elliott, and Michele Sterling. “External Validation of a Clinical Prediction Rule to Predict Full Recovery and Ongoing Moderate/Severe Disability Following Acute Whiplash Injury.” Journal of Orthopaedic & Sports Physical Therapy 45, no. 4 (April 2015): 242–50.
  • Sterling, Michele. “Physiotherapy Management of Whiplash-Associated Disorders (WAD).” Journal of Physiotherapy 60, no. 1 (March 2014): 5–12.


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