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Hello Ross, My apologies - good spotting. that should read 3. ....early IMMOBILISATION followed by ...... 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: "crm3a" <[log in to unmask]> To: <[log in to unmask]> Sent: Wednesday, 29 March 2000 15:52 Subject: Re: whiplash patients > Can you clarify your source for the Guromorthy article? I thought that he > was the one that found a Philadelphia collar was most effective? > > Cheers, Ross > > ----- Original Message ----- > From: Anna Lee, Principal <[log in to unmask]> > To: <[log in to unmask]> > Sent: Monday, March 27, 2000 7:11 PM > Subject: Re: whiplash patients > > > > > > 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 > > > > %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%