Whiplash Advice

Whiplash is a nonmedical term used to describe neck pain following an injury to the soft tissues of the neck (specifically ligaments, tendons, and muscles).

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It is caused by an abnormal motion or force applied to the neck that causes movement beyond the neck’s normal range of motion. It is usually caused by a flexion-extension motion of the neck that pulls and strains the neck muscles and ligaments.

Helpful tips

  • The sooner you get moving the better. Resting for longer than a day or two does not help and may actually prolong problems

  • Cold packs or ice can be applied to the neck to minimize spasm and pain. Apply ice/cold to the neck area for 15–20 minutes. Repeat every hour, as needed, for the first 48–72 hours after the injury. Precautions include reduced sensation and/or diabetic patients – seek advice.

  • Long term prognosis is good as most whiplashes are not serious

  • The acute pain usually settles within days or a few weeks

  • Analgesia and other medications to control the pain are initially useful to allow you to get going with your exercises.

  • Collars are rarely issued as prolonged use can delay recovery

  • Physiotherapists can help to safely mobilisation strain tissue and joints and show you correct exercises to help restore your motion.

  • If you have had a particularly violent, severe accident and your neck is extremely painful; any difficulty with balance or walking; have disturbed vision; pins and needles or numbness or weakness in your arm or legs; were unconscious then you should seek a medical opinion from your GP or A&E following your accident

Acute Injury Management Advice

When it comes to managing an acute injury many of you will have heard of RICE and some will have seen it progress to PRICE. It stands for Protect Rest Ice Compression and Elevation.

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But a recent study by Bleakley, Glasgow and MacAuley 2012 in the British Journal of Sports Medicine has suggested this needs updating to use the acronym POLICE. So POLICE would be Protect Optimal Loading Ice Compression and Elevation.

So why replace rest with “optimal loading”?

  1. While rest may be helpful in the very short term, continued rest may lead to deconditioning of the tissues – joint stiffness, muscle weakness and tightness and reduced proprioception (control and balance).

  2. Optimal loading will stimulate the healing process as bone, tendon, ligament and muscle all require some loading to stimulate healing.

  3. The right amount of activity can help manage swelling. For example in the ankle, contraction of the calf muscles helps to move swelling up the body against gravity. Complete rest would the prevent this.

The key word here is optimal.

In some cases optimal loading may be no loading. Unstable fractures, complete tendon ruptures etc. are unlikely to benefit from loading and may require casting, bracing or surgical repair. There is no recipe for this, each situation needs to be managed based on the person and their injury and usually under the guidance of a health professional.

Like so many things in health and injury it’s about balance. When it comes to managing acute injuries its recommend you seek medical advice, especially if there is noticeable swelling or any restriction in joint range of movement or a sensation of giving way. Bony tenderness or difficulties weight-bearing are also signs that you should get checked out urgently.

With acute injuries I tend to adopt a policy of weight-bearing as tolerated. Meaning do as much as you feel comfortable to do and don’t push through pain. This usually fits within the idea of optimal loading but as ever comes with the caveat, if in doubt, get it checked out. This also includes exercises, and I encourage people to gently move the joints around the affected area, again listening to the body and not pushing through pain. It’s usually better to do this little and often to prevent stiffness rather than a lot at one sitting which is more likely to cause pain.

Offload taping can also be very useful to support an area when you load it (see kinesiology and taping sections).


You might be surprised to hear that the research behind the use of ice is far from conclusive. There is a real lack of high quality evidence and very little guidance in terms of how ice should be used. Despite this we all tend to reach for the ice pack when nursing an injury and we are right to continue to do so.

Although the research may not be conclusive most of us have seen from personal experience that ice can reduce pain and swelling post injury and aid a quicker return to sport.

There are a few of safety points with ice:

  1. Don’t ice over a numb area or open wound. If the skin is numb you won’t notice if you’re developing an ice burn and ice on an open wound would risk an infection.

  2. Be wary of ice burns – don’t apply ice directly to the skin, wrap an ice pack in a clean, damp tea towel before applying. Avoid prolonged exposure to ice, 10–20 minutes in usually adequate and also be careful applying the ice with too much pressure (e.g. resting your leg on the ice bag).

Practical details in the use of ice :

Having read several reviews of the use of ice in the literature it’s very hard to make an evidence based recommendation for use of ice in terms of how long to apply it and how frequently. There is some evidence that as little as 10 minutes can be effective to create tissue cooling and that, although fairly rare, ice burn can occur after just 20–30 minutes. Baring that in mind, and in the spirit of getting the most benefit with the smallest risk of harm I’d recommend the following very general guide;

  1. Apply ice wrapped in a damp towel for 10–20 minutes 2–3 times per day for the first 5–7 days post injury.

  2. Stop applying ice if there are any negative effects such as increase in pain or swelling or skin soreness.


Similar to ice the research behind compression is far from conclusive. From personal experience I find compression very useful in managing swelling. A simple tubigrip bandage can be used, especially good for ankles and knees. The area should feel compressed but not uncomfortable or painful. Ensure there is good circulation distal to the bandage (I.e. in the toes if the ankle is compressed). Its recommended to remove the bandage at night for comfort when sleeping and also because swelling is usually fairly well controlled when we are lying down.


Elevation can be very effective in reducing swelling and pain. You can combine it with gentle exercises that aid circulation such as moving the ankle up and down or tightening the thigh muscles to straighten the knee. Obviously this will depend on your injury and the guidance you get from your health professional.


Protection is part of optimal loading and involves the use of crutches, casts, braces to help protect the area as it heals. Think of it as a tool to prevent excessive loading in the early stages and it’s especially useful if you are struggling to weight bear and need some extra help (in which case you need to make sure you’ve had your injury checked out).

This is only general advice and it is strongly advised that you get the injury assessed by a health care professional as investigations maybe required. If you have any questions regarding a recent injury or would like to book an appointment call 07557760623 or complete contact form.

Clinic News

Kinesio Taping Coming Soon to the Practice

In May 2013 Pure Balance Physiotherapy clinic will be able to offer Kinesio taping for management and prevention of musculoskeletal injury. It is recommended that Kinesio tape should be only applied under the guidance or advice of a Kinesio Practitioner.

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What is Kinesiology Taping

Kinesiology taping is a new therapeutic taping method that uses flexible tape for the treatment of disorders and dysfunctions of the musculoskeletal system (joints, muscles, ligaments). It has a multitude of uses including: pain relief, reduction of swelling and inflammation, protection and support of joints and muscles and enhanced sports performance.

How Kinesio Tape Was Developed?

Kinesiology taping has been around since the 1970’s. Originally developed by Dr Kenzo Kase as “Kinesio-tape” it has found popularity more recently, particularly since the Beijing Olympic Games when media recognition picked up on high profile athletes wearing it. There are now many brand names that use this form of taping principle (Kinesio-tape, Rock-tape, K-tape, Flexotape, Kindmax) to name a few. The tape is much more elastic that sports tape you may already be familiar with. Its flexibility is supposed to be akin to that of normal skin, particularly along its length. It therefore allows normal movement of joints and muscles when it is applied.

How Does Kinesio Tape Work?

The Kinesio Tape method facilitates the body’s natural healing process, while stabilising muscles and joints without hindering their range of motion.

In embryology there are three major germ-cell layers; the outermost layer ectoderm, the middle layer mesoderm and deepest layer endoderm. As we develop, these three layers from our major organs of the body. The Kinesio Tape method works on the basis that these three layers are still connected and it is possible to treat the body from the outside in.

The skin is the largest sensory organ of the body and contains a huge sensory network. Kinesio Taping works by lifting the skin microscopically which forms convolutions creating an institial space. This space allows for greater lymph drainage and enhanced cardiovascular circulation which reduces pressure on sensory and mechanical receptors within the skin. These combined affects alleviate pain, aid biofeedback to muscles and aid lymphatic drainage which helps to reduce joint or tissue swelling and lymphedema; and have a connective tissue massage effect.

How Kinesio Tape Influences Fascia?

Fascia is a strong continuous connective tissue with the human body. It surrounds the muscles, joints, organs and nerves. Following trauma, fascia will change from its usual healthy pattern of linear collagen fibres and become disarrayed and knotted. Applying Kinesio Tape helps to these painful areas helps to restore their natural linear pattern which in turn increases range of motion, makes muscular contractions more efficient and helps relieve pain.

What can be treated with Kinesio Tape?

Kinesio Taping is not just for high performance athletes. It is now used by practitioners around the world in the treatment of orthopaedic, neurological, neuromuscular and medical conditions.

Kinesio Tape can be used to treat many conditions including soft tissue injuries such as whiplash or a hamstring strain to removing excess lymph in cancer patients following a lymphadenectomy; new uses for this truly outstanding tape are still being discovered.

It is recommended that the tape is left in-situ for 3–5days. This is easily achieved as long as the skin is clean and dry when the tape is applied and the tape is left to “set” (i.e. rubbed after application and do not get it wet for the first hour until the adhesive has bounded with your skin). There is no need to shave skin prior to this type of tape application. Once shown the correct method by your physiotherapist, it is easy to apply to yourself (as long as you can reach the area!)

For further information regarding Kinesio Tape, please see the Kinesio site at for more details.