Lynda:
Most of the patients I see that are not trying to exploit the system think that
returning to work is a very high priority for them.
Lynda Bennett wrote:
> I attended several neck pain symposia in Sydney last year. I am disgusted
> with the current attitude towards neck injuries i.e. "ignore it and get on
> with it". You can find or create a research paper to support anything!
> I totally agree with the previous comment re what a different attitude is
> applied to a sprained knee.
> What is not being said is that the research that supports going back to work
> is sponsored by insurance companies. Naturally anything that says 'go back
> to work so we don't have to pay you any sick pay or compensation' will be
> publicised by the monetarily interested parties, including the government
> which is reassured not to even have to pay for x-rays (unless you are nearly
> dead) and the physios/doctors doing the research who are funded by the
> insurance company! This is all in the name of 'if we pay you too much
> attention you will become sick and then you might cost money'.
> The issue is not just collar v. no collar. The real issue is whether or not
> you have time off work. I don't think some people care what treatment is
> offered as long there is minimal time off work!
> I support the RICE ethic for the ankle/ knee/ neck. You may well be back at
> work sooner, even in the collar if appropriate.
> Plus a little bit (not overdone)of TLC and sympathy never hurt anyone in
> pain.
> Lynda
>
> >From: "Anna Lee, Principal" <[log in to unmask]>
> >Reply-To: [log in to unmask]
> >To: <[log in to unmask]>
> >Subject: Re: whiplash patients
> >Date: Tue, 28 Mar 2000 13:11:52 +1000
> >
> >
> >Hello, this may be of interest -
> >
> >Three level II studies (Gennis et al 1996, Borchgrevink et al 1998
> >Gurumoorthy 1999) on 196, 178 and 220 whiplash patients respectively
> >concluded that
> >
> >1. "soft collars do not influence the duration or degree of persistent
> >pain"
> >;
> >2. "...... patients instructed to continue engaging in their normal
> >activities had a better outcome than patients who took sick leave and were
> >immobilised in a soft neck collar in the first 14 days after the accident."
> >3. " ........ early mobilisation followed by defined active exercise
> >programme is the best physical therapy approach to the treatment of acute
> >whiplash injuries"
> >
> >more information available from the APA Neck pain position statement 1999
> >
> >Cheers,
> >
> >Anna.
> >
> >
> >
> >
> >
> >Anna Lee
> >Principal,
> >Work Ready - Industrial Athlete Centre
> >Physiotherapist and Occupational Health Consultant
> >
> >Write to me at [log in to unmask]
> >Visit me at www.workready.com.au
> >
> >Snail mail:
> >Suite 3, 82 Enmore Road,
> >Newtown NSW 2042
> >Australia
> >
> >Tel: (02) 9519 7436
> >Mob: 0412 33 43 98
> >Fax: (02) 9519 7439
> >----- Original Message -----
> >From: "Marc White" <[log in to unmask]>
> >To: <[log in to unmask]>
> >Sent: Tuesday, 28 March 2000 3:03
> >Subject: Re: whiplash patients
> >
> >
> > > The study was presented at the World Congress on Whiplash-Associated
> > > Disorders in Vancouver, February, 1999 and appears to have some
> > > methodological problems. Questions from the floor included discussion of
> > > the high attrition rates. I suggest the study should be thoroughly
> > > reviewed and replicated before recommendations arising from the study be
> > > implemented. Further discussion can be found at the conference website:
> > > www.whiplash99.org
> > >
> > >
> > > At 01:11 AM 3/27/00 -0800, you wrote:
> > > >
> > > >The following piece from Jim Meadows at Manual Therapy Online made me
> > > >think. It certainly presents findings most of us wouldn't have
> > > >predicted. Anyone else seen this work and and want to comment on the
> >findings?
> > > >
> > > >" Last November, I was fortunate enough to attend the 2nd Annual
> >American
> > > >Academy of<?xml:namespace prefix = o ns =
> > > >"urn:schemas-microsoft-com:office:office" />
> > > >
> > > > Orthopedic Manual Physical Therapy (AAOMPT) Conference in Biloxi
> >MS.
> > > > Among the
> > > >
> > > > many fine presentations I heard, Lance Twomey's ranks among the
> >best.
> > > > A highlight of his
> > > >
> > > > presentation was a summary he gave of a student's doctoral thesis
> >on
> > > > the independent
> > > >
> > > > benifit of a cervical collar for recent whiplash patients. The
> > > > student's name was
> > > >
> > > > Gurumoorthy and his thesis earned him a Ph.D. and will be
> >published
> > > > soon in Spine.
> > > >
> > > > However, the information is so useful and for most therapists so
> > > > radical that I thought that
> > > >
> > > > it would be appropriate to summarise Dr. Twomey's summary. I
> > > > apologise in advance for
> > > >
> > > > any errors that I may make, they are inadvertent and caused by
> > > > galloping senility.
> > > >
> > > >
> > > >
> > > > 220 post whiplash victims were randomly divided into three groups
> >the
> > > > first being asked
> > > >
> > > > to wear a Philadelphia cervical collar for one month and then to
> > > > discard it. These subjects
> > > >
> > > > were then put into group two. Group two subjects were assigned an
> > > > active program from
> > > >
> > > > day 1 which consisted on non-painful range of motion and other
> > > > painfree exercises. Group
> > > >
> > > > 3 were left to the care of their physician (almost invariably a
> > > > general practitioner) who
> > > >
> > > > usually prescribed analgesics, a soft collar and some form of self
> > > > activation. The accident
> > > >
> > > > had to be within forty eight hours of attendence for the patient
> >to
> > > > be included as a subject.
> > > >
> > > > The subjects were tested by blinded assessors for pain, range of
> > > > motion, strength and
> > > >
> > > > function. Pain was evaluated on a visual analogue scale, isometric
> > > > strength by
> > > >
> > > > dynamometer, range of motion by goniometry and funtion by return
> >to
> >
> > > > work. The subjects
> > > >
> > > > were evaluated at 4,6, 12, 26 and 52 weeks.
> > > >
> > > >
> > > >
> > > > In every category, the collared subjects did better than those in
> >the
> > > > other two groups.
> > > >
> > > > Perhaps one the most clear cut findings was in return to function.
> > > > 50% of the subjects in
> > > >
> > > > the collared group were back at full function by the 26th week
> > > > assessment. This figure
> > > >
> > > > was not achieved in either of the other two groups.
> > > >
> > > >
> > > >
> > > > This is almost unequivocal evidence of the value of a collar in
> >the
> > > > early stages of
> > > >
> > > > post-whiplash. The most amazing thing about the study is that it
> > > > should have had to be
> > > >
> > > > carried out in the first place except as a means of confirming an
> > > > established and obvious
> > > >
> > > > practice. With even a little thought is is obvious that an acutely
> > > > injured neck requires the
> > > >
> > > > same care as an acute knee injury. That is rest while the
> > > > inflammation subsides. In the
> > > >
> > > > knee patient we would have no trouble understanding the need to
> >have
> > > > the patient
> > > >
> > > > non-weight bearing, using a compression bandage, applying ice and
> > > > generally resting it.
> > > >
> > > > But in the whiplash patient, there seems to be a lack of common
> >sense
> > > > by many health
> > > >
> > > > care providers from all disciplines. The sports medicine model is
> > > > often applied
> > > >
> > > > indiscriminately with no thought to the fact that it is not an
> > > > athlete that we are treating nor
> > > >
> > > > is it a sport injury. In any event, an athlete with an acute knee
> > > > would be rested until the
> > > >
> > > > effusion had subsided and if this did not occur in a timely
> >fashion,
> > > > considerable expense
> > > >
> > > > and time would be spent investigating the reason for delayed
> > > > recovery. If we (the
> > > >
> > > > combined health care professions) can be this concered about what
> >is
> > > > essenially a
> > > >
> > > > self-inflicted injury, why cannot we be so with some poor soul hit
> >in
> > > > the rear sitting at a
> > > >
> > > > traffic light. " Jim Meadows -Manual Therapy Online
> > >
> > > Marc White, Executive Director
> > > Physical Medicine Research Foundation
> > > Suite 510, 207 West Hastings St.,
> > > Vancouver, B.C. V6B 1H7
> > > Tel: In North America +800 872-3105
> > > Elsewhere +1 604 684-4148 Fax: +1 604 684-6247
> > > Website: www.icpro.org
> > > Related Sites: www.whiplash99.org,
> > > www.health-sciences.ubc.ca/whiplash.bc/home.html
> >
>
> ______________________________________________________
> Get Your Private, Free Email at http://www.hotmail.com
--
Douglas M. White, PT, OCS
Physical Therapist, Consultant
191 Blue Hills Parkway
Milton, MA USA 02186
P: 617.696.1974
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