Chronic Whiplash and Neck Muscle Endurance

Whiplash-associated disorders (WAD) is an umbrella term used to characterize the
myriad symptoms that can occur when soft tissues are injured during rapid acceleration and
deceleration of the head and neck in a whiplash event, such as a rear-end automobile collision.
Despite advances in the understanding and treatment of WAD, it is estimated that nearly half of
whiplash patients continue to experience ongoing pain and disability for a year or longer. Recent
studies have identified reduced neck muscle endurance as a risk factor for chronic WAD, but
what happens in a real-world setting when neck muscle strengthening is included as part of
treatment?
To explore this question, a May 2025 study recruited 140 patients with chronic WAD
who completed pre-intervention assessments of neck pain, neck-related disability, neck function,
and psychosocial factors. Participants were then assigned to one of two treatment groups: athome exercises delivered through Internet-based instruction or in-office exercises facilitated by a
physiotherapist. Treatment frequency ranged from two to four sessions per week over a twelveweek period. Participants completed the same assessments three months and fifteen months
following the conclusion of care.
The results demonstrated that both in-person and at-home exercise approaches produced
similar improvements in neck pain, disability, and function, and these improvements were
associated with increased neck muscle endurance. While this finding provides important
confirmation that addressing impaired neck muscle endurance may help reduce persistent WAD
symptoms, the results related to psychosocial factors—how a person perceives, responds to, and
recovers from neck pain and injury—were particularly noteworthy. The data showed significant
post-treatment improvements in self-efficacy, fear-avoidance beliefs, depressive symptoms, and
catastrophizing. This is especially meaningful, as these factors are known to be present early
after injury and are strongly associated with the development of chronic WAD.
While further research is needed to confirm these findings and better understand the
underlying mechanisms involved, the results suggest that assessment of neck muscle endurance
should be included as part of the initial clinical evaluation, with targeted exercises prescribed for
patients to perform between in-person visits with their chiropractor or other healthcare provider,
if needed. Beyond the personal and family-level benefits associated with successful WAD
recovery, any intervention that reduces the risk of chronic WAD may also offer substantial
macroeconomic benefits, including improved productivity and reduced litigation-related costs,
which could ultimately contribute to lower automobile insurance expenses.
Brent Binder, D.C. 4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

Tags: mechanicsburg pa chiropractor, whiplash