Effect of intensive inpatient physical therapy on whole-body indefinite symptoms in patients with whiplash-associated disorders

Abstract

Background A considerable number of patients with whiplash-associated disorders (WAD) report variable and indefinite symptoms involving the whole body, despite there being no evidence of direct injuries to organs other than the neck. However, little is known about their management or underlying mechanism. This study examined the effect of intensive physical therapy at the cervical muscles in patients with WAD reporting whole-body indefinite symptoms. Methods A total of 194 hospitalized patients with WAD who were resistant to outpatient care by reporting whole-body indefinite symptoms between May 2006 and May 2017 were enrolled in this observational study. All patients underwent daily physical therapies by low-frequency electric stimulation therapy and far-infrared irradiation to the cervical muscles during hospitalization. Self-rated records in the medical interview sheets on 22 representative whole-body symptoms at admission and discharge were compared. Results The number of symptoms was markedly decreased by the physical therapies during hospitalization. Almost all symptoms showed recovery rates of more than 80% at discharge as compared to those at admission. Although the percentage of patients reporting at least four of the 22 representative indefinite symptoms was 99.0% at admission, it decreased to 7.7% at discharge. Sixteen percent of patients recovered completely without any residual symptoms. The mean number of symptoms significantly decreased from 13.1 at admission to 2.0 at discharge. Notably, symptoms other than those in the neck or shoulder recovered to a greater extent than those in the neck or shoulder. Conclusions This study, for the first time, examined the management of whole-body indefinite symptoms in patients with WAD. The intensive physical therapy markedly improved the symptoms, suggesting the involvement of cervical muscles in the pathogenesis. Trial registration UMIN000035435 (Retrospectively registered on Jan 3, 2019). Electronic supplementary material The online version of this article (10.1186/s12891-019-2621-1) contains supplementary material, which is available to authorized users.

Possible involvement of the autonomic nervous system in cervical muscles of patients with myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS)

“…Among the physical therapies, low-frequency electrical stimulation [ 18 , 19 ] and far-infrared irradiation [ 20 ] are reportedly effective at treating stiffness of the cervical muscles. A previous study of patients with whiplash-associated disorders showed that the combined application of these two physical therapies to the cervical muscles ameliorated not only local symptoms in the neck and shoulder, but also indefinite symptoms in the whole body [ 21 ]. Furthermore, a recent study of 1863 patients showed that therapies applied to the cervical muscles significantly improved the indefinite whole-body symptoms including headache, cervical pain or stiffness, vertigo or dizziness, palpitation, dazzling, nausea or stomachache, fever of unknown etiology, and depression [ 22 ].…”

Involvement of Cervical Muscle Lesions and Autonomic Nervous System in Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS)

“…Among physical therapies, low-frequency electrical stimulation [20,21] and far-infrared irradiation [22] are reportedly effective at recovering muscle stiffness of the neck and shoulders. In fact, our previous study of patients with WAD showed that the combined application of these two physical therapies to the cervical muscles recovered not only local symptoms in the neck and shoulder, but also inde nite symptoms in the whole body [23]. Furthermore, our recent study of 1,863 patients with inde nite whole-body symptoms showed that therapies applied to the cervical muscles signi cantly improved signs and symptoms such as headache, cervical pain or stiffness, vertigo or dizziness, palpitation, dazzling, nausea or stomachache, fever of unknown etiology, and depression [24].…”

Cervical muscle stiffness and parasympathetic nervous system improvements for treatment-resistant depression

“…The previous study showed that the combined application of these two physical therapies to the cervical muscles significantly decreased the number of indefinite whole-body disorders [ 14 ]. Also, our studies disclosed that the physical therapies to the cervical muscles were effective in patients with whiplash-associated disorders [ 18 ] and myalgic encephalomyelitis/chronic fatigue syndrome [ 19 ].…”