Data suggest that, one year after injury, 50% of people with whiplash associated disorder (WAD) still report neck pain. Despite clinical recommendations, there remains no clinical evidence of benefit for many conservative methods of management of chronic WAD, including neck specific exercise. As chronic neck disorders may have symptoms with both physical and psychosocial contributing factors, this study assessed the effects of incorporating a behavioral approach to neck specific exercises.

Subjects were 216 individuals with chronic WAD, with a mean age of 40.5 years. The subjects were randomized to receive either physiotherapist led neck specific exercise (NSE), twice-weekly, aimed at facilitating activity of the deep cervical muscle layers, or similar exercise combined with behavioral intervention. The behavioral treatment included education concerning pain, as well as activities aimed at pain management and problem solving (NSEB). A third group was prescribed physical activity, to be completed outside of the healthcare system (PPA). The primary outcome measure was the Neck Disability Index (NDI). Other outcome variables included self-reported general health, measured with the Euroqol 5-D instrument, and activity level, measured with the International Physical Activity Questionnaire. Pain was recorded with a pain visual analog scale (VAS).

At three months, disability levels were found to have significantly improved in both the NSE (P<0.01) and the NSEB (P<0.001) groups, with no improvement observed in the PPA group. At six months, the proportions of responders, as indicated by changes in scores on the NDI, were 21% in the PPA group, 28% in the NSE group and 54% in the NSEB group. Pain bothersomeness was significantly reduced over time in all three groups. Self-efficacy improved only in the NSE group.

This study of patients with whiplash associated disorder found that supervised, neck specific exercise may have better clinical benefits than a prescription for home exercise, with additional benefits found when combined with a behavioral approach.