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SOMATIC RESEARCH HOW TO BEST TREAT WAD Acknowledge clients' conditions. Explain how, even without visible signs of trauma, they can be experiencing symptoms beyond what they might have expected if damage to the car was minor or the collision occurred at low speeds. Calm their nervous system. Nonrestorative sleep is detrimental to healing. Retrain their nervous system. The purpose of treatment should be not only to relieve pain but also to allow for proper proprioception.24 There are a host of resistive movement techniques, positional release techniques, and subtle movement techniques that will reset proprioception and invite alternative movement options. Reduce inflammation. Fibrosis of repair complicates healing and increases the potential for chronic pain. Use ice, topical analgesics and anti-inflammatories, and manual lymph drainage techniques. Utilize massage. Various types of massage, trigger-point therapy, and structural integration have been found to reduce pain, reduce cervicogenic headaches, reduce nervous system hypersensitivity, decrease electromyogram amplitude, increase range of motion, improve movement and postural stability, reduce muscle stiffness, and reduce anxiety in people with WAD and MND.25 Address TMJ. Not only are TMJ disorders common with whiplash injuries, treatment of the temporomandibular region has been found to significantly reduce the intensity of headaches and increase neck function.26 These improvements persist in the short term and long term.27 Focus on regaining function. Combine passive, soothing care with active movement techniques and exercise. Mobilization, manipulation, and soft-tissue techniques decrease pain and improve satisfaction. When musculoskeletal treatment strategies were combined with exercise, even greater improvements were achieved.28 Teach self-care. Education and referring effective products for self- care can help ensure healing continues between sessions. Manual therapies are more effective when combined with cervical pillow supports.29 Ice therapy is more effective when combined with topical menthol for relieving pain.30 SUMMARY Whiplash is not just a pain in the neck. Understanding the complexity of WAD and its long-term consequences can give clients peace of mind and therapists better command of successful treatment planning. 1984, Diana L. Thompson has created a varied and interesting career out of massage: from specializing in presurgical and postsurgical lymph drainage to teaching, writing, consulting, and volunteering. Her consulting includes assisting insurance carriers on integrating massage into insurance plans and educating researchers on massage therapy theory and practice to ensure research projects and protocols are designed to match how we practice. Contact her at soapsage@comcast.net. A licensed massage practitioner since NOTES 1. R. Myran et al., "Headache and Musculoskeletal Complaints Among Subjects with Self Reported Whiplash Injury. The HUNT-2 study," BMC Musculoskeletal Disorders 12, no. 1 (June 8, 2011): 129. 2. A. Berglund et al., "The Association Between Exposure to a Rear-End Collision and Future Health Complaints," Journal of Clinical Epidemiology 54, no. 8 (August 2001): 851–6. 3. M. Curatolo, L. Arendt-Nielsen, S. Petersen- Felix, "Central Hypersensitivity in Chronic Pain: Mechanisms and Clinical Implications," Physical Medicine & Rehabilitation Clinics of North America 17, no. 2. (May 2006): 287–302. 4. R. Myran, "Headache and Musculoskeletal Complaints Among Subjects with Self Reported Whiplash Injury. The HUNT-2 study." 5. A. Woodhouse, O. Stavdahl, O. Vasseljen. "Irregular Head Movement Patterns in Whiplash Patients During a Trajectory Task," Experimental Brain Research 201, no. 2 (March 2010): 261–70; J. Nijs, J. Van Oosterwijck, W. De Hertogh, "Rehabilitation of Chronic Whiplash: Treatment of Cervical Dysfunctions or Chronic Pain Syndrome?" Clinical Rheumatology 28, no. 3, (March 2009): 243–51; D. Scott, G. Jull, M. Sterling, "Widespread Sensory Hypersensitivity is a Feature of Chronic Whiplash-Associated Disorder but not Chronic Idiopathic Neck Pain," The Clinical Journal of Pain 21, no. 2 (March–April 2005): 175–81. 6. US Department of Transportation National Highway Traffic Safety Administration Traffic Safety Facts, Research Note (August 2010). 7. J. Schofferma, N. Bogduk, P. Slosar, "Chronic Whiplash and Whiplash-Associated Disorders: An Evidence-Based Approach," Journal of the American Academy of Orthopaedic Surgeons 15, no. 10 (October 2007): 596–606. 8. J.H. Coert, A.L. Dellon, "Peripheral Nerve Entrapment Caused by Motor Vehicle Crashes," The Journal of Trauma 37, no. 2 (August 1994): 191–4. 9. Ibid. 10. H.B. Chen, K.H. Yang, Z.G. Wang, "Biomechanics of Whiplash Injury," Chinese Journal of Traumology 12, no. 5 (October2009): 305–14. 11. Ibid. 12. Ibid. 13. G.P. Siegmund et al., "The Anatomy and Biomechanics of Acute and Chronic Whiplash Injury," Traffic Injury Prevention 10, no. 2 (April 2009): 101–12. 14. J. Nijs, J. Van Oosterwijck, W. De Hertogh, "Rehabilitation of Chronic Whiplash: Treatment of Cervical Dysfunctions or Chronic Pain Syndrome?" 15. R. Garcia, J.A. Arrington, "The Relationship Between Cervical Whiplash and Temporomandibular Joint Injuries, An MRI Study," Cranio 14, no. 3 (July 1996): 233–9. 16. L. Hartling, W. Pickett, R.J. Brison, "Derivation of a Clinical Decision Rule for Whiplash Associated Disorders Among Individuals Involved in Rear-End Collisions," Accident Analysis & Prevention 34, no. 4 (July 2002): 531–9. 120 massage & bodywork september/october 2011