Some of my most worthwhile experiences with patients have been in getting them back on the road to recovery after a prolonged period of disability after a motor vehicle accident. At the same time, it can be very frustrating as a physiotherapist to see so many injuries not being managed properly from day one. I have encountered too many people who, months after there injury, are stuck in a cycle of pain and disability because they were not provided with the appropriate advice early on after their injury.
Contrary to how others may view people in this situation in a negative light i.e. ‘faking it’ or being motivated for monetary gain, the vast majority of people who have sustained motor vehicle accident injuries (i.e. whiplash), but are slow or plateaued in their recovery, are in fact very motivated to get back to normal and feeling better. It’s just so hard for the average person to know what the ‘right’ treatment is, and all they can do is trust that the person they are seeing is doing the right job.
There are many types of care providers (i.e. physio, chiro, massage, athletic therapy, etc.) that you can see after a motor vehicle accident. Even within each of these professions, there is a huge variance in their approaches to rehab, and they are all marketing themselves as being the ‘go-to expert’ in their fields. There is so much to choose from out there that it can be overwhelming and almost impossible for the average person to know what the right choice is. I’ve written this post to provide you with science-based and common-sense knowledge on recovering from a motor vehicle accident injury such as whiplash, including what to look for from the care provider you are seeing, and what to expect from yourself as an active participant in your recovery. When recovering from a motor vehicle accident, we must always start with the basics: communication, education, and exercise, which all too often get overlooked in favor of more complicated, trendy, or fancy approaches.
First and foremost, communication is key. Your care provider needs to fully understand the scope of your symptoms, how it is impacting your day to day life, and how you are managing during your recovery. They need to spend time with you. They need to be present. How can someone truly help if they aren’t taking the time to understand the ins and outs of how your injury is impacting your life? It is crucial that the patient communicates to their care provider on what is important and meaningful to them, so those appropriate goals can be set and made a part of your rehab plan. For example, getting full range of motion back might be meaningful to the care provider, but not to you the patient if you are still in pain and still not back to doing the things you enjoy. If the care provider you are seeing spends the first 20 minutes of their appointment talking more than you, rather than listening to your story, there is a problem.
It is equally important that your care provider spends lots of time educating you about your injuries and why they are doing what they are doing, and what they want you to do when you aren't in the clinic. It does not matter what happens during your appointment if you have no idea what to be doing on your own time once your appointment is over. They should educate you about your specific diagnosis, what is safe to do and what isn’t, how much pain is safe to push through, and the rationale behind the exercises t hey give you, and the plan of action from starting therapy to ending therapy.
The third, and equally most important part of proper rehabilitation is an individualized, progressive exercise program. Full stop. Exercise-based rehabilitation should be the foundation to your recovery, and there is plenty of research, and consensus amongst clinicians and researchers alike, to back this claim up. I see too many people, months after their injury, who have only been given a couple of exercises for widespread injuries, or they are still doing the same exercises they were given in their first week. This is not okay. Muscles and joints require progressive exercise, or controlled amounts of stress, in order to heal and recover. Yes, too much stress on your tissues can aggravate your condition, but not enough tissue stress and things won’t heal. Every session should put some emphasis on exercise rehab, and you should see your exercises progressed every 1-2 weeks. The vast majority of injuries should begin with active rehab within a week of the accident unless you have broken bones or severe tears and/or you have been told by a medical doctor to not exercise yet. Way too often I see people weeks or months into their injury who have been told that they need to wait for their pain to settle down before getting back to their regular activities, such as the gym, housework, or playing with their children. This is bad advice. Research (and common sense) shows that early, graduated return to all pre-injury activities is associated with better recovery and better long-term outcomes. It is okay to work to a point of mild discomfort. Ease yourself back into your regular activities as soon as you can. Of course, this is within reason-- for example, if you were playing high contact sports before the injury, it may take time to get back to competing, but most people can start with light practice very early on. The longer you wait to get back to your normal activities, the more prolonged your recovery will likely be.
Be wary of all of the passive, trendy, or fad treatments out there. By passive treatment, I mean hands-on work done by other people, or treatments done with a machine, or anything else that doesn’t include exercise rehab or education. This includes spinal adjustments/manipulation, needling, shockwave therapy, NUCCA, rolfing, laser, dry needling, acupuncture, and so on. Every year the list of options gets longer so there is no way to list them all here. Most passive treatments are based on conflicting or limited research and scientific evidence, despite advertising claims to the contrary, and do little more than provide temporary relief from your symptoms. The other problem is when there is some science behind a particular passive treatment, care providers often miss the forest for the trees. That is, they get caught up in the trendy new treatment and make it the main component of the session, and put exercise, effective communication, and education on the back burner.
I get how patients get caught up in these treatments as well. When someone is in pain, stressed out and already overloaded with all their other life commitments, probably the last thing they want to do is to move and exercise through pain and discomfort. It sounds so much easier, and more comforting, to buy into the over-exaggerated claims from more flashy treatment approaches. Exercise and hard work isn’t flashy. It doesn’t always make for the attractive marketing. But it works. The reality is that if you get better just by doing passive treatments, there is probably a 90% chance you were going to get better on your own without them to begin with. What’s unfortunate is that people with more severe or complicated injuries get stuck here, and after weeks, months, and years of showing up for treatment, the problem is still there. In can be pretty demoralizing and negatively impact their outlook towards ever getting better. Don’t get me wrong, passive treatments can be very helpful-- as long as they are applied in moderation, and not placed at the center of your treatment plan. If you have a serious injury it needs more than passive treatments to get better. Don’t get into the risky habit of using it as a substitute for the real deal: exercise. This is often how many people get stuck or plateau in their recovery. Instead, use passive treatments as a means of decreasing your pain in the short term to create a window of opportunity to do your exercise rehab with less restriction and discomfort. Massage therapy is a wonderful tool, but also a passive treatment. I think that massage is an excellent way to reset dysfunctional muscles and calm down an overly wound up nervous system, and I refer people for massage quite often. For some minor injuries, massage is all you need, especially if you are already physically active. However, just like with the other passive treatments above, it's easy to get caught up in what’s easy: lying on a treatment table and letting someone else do all the work for you, rather than challenging yourself with active rehab and exercise. If you have more serious injuries, active rehab is essential.
The basics: education, individualized exercise rehab, and effective communication must always come first. Think of passive treatments as side dishes, but not the main course. By the way, the basics I've mentioned here can’t be adequately covered in clinics where care providers, including physiotherapists, only spend 10-15 minutes with each patient. Be wary of this if you find yourself in this kind of situation.
Beyond covering the basics, and limiting passive treatments, what else is important? Show up ready to do some work. Take an active, assertive stance in your recovery. Be ready to push into some occasional pain. Be ready for some ups and downs. Challenge your fears. Communicate when something isn’t working for you and make sure your care provider is spending adequate one-on-one time with you. Recovery can be challenging, but in the long term doing the hard work now is much more likely to get you back to normal. Don’t let yourself feel like a victim. While the motor vehicle accident may not have been your responsibility, putting in the time and work required to get better is. There is actually a growing body of research that shows that people with higher levels of perceived victimhood do worse over the long term, even when their injuries are no worse than those who don’t feel that way. Don’t feel sorry for yourself. Don’t dwell on every ache and pain you feel. Accept what has happened and commit to holding your head high, and commit to doing the work required to get back to normal.
Take a holistic approach to your recovery. The right treatment approach with all of the right exercises still won't work, or at least won’t be as effective, if you are sleep deprived, overly stressed, or eating a diet high in inflammatory and processed foods. Practice some self-care. Take warm baths or showers (heat is usually totally okay after the first few days in most cases), go for a light walk. Socialize with your loved ones. Practice gratitude that the accident wasn’t worse than it was. Make healthy meals for yourself and do things that help you to de-stress. Practice good sleep hygiene, winding down from work and electronic screens a few hours before you go to bed. Work around your injuries to do as much of the activities you enjoy as you possibly can.
Don’t hesitate to talk to a mental health professional if you are dealing with stress, depression, or anxiety as a result of your accident, or if you are afraid to get back to normal activities like driving again. Getting in a car accident is often more than a physical injury, it can also be a psychologically traumatizing experience for many. Your insurance provider should be on board with providing coverage for this, especially if it is recommended by your doctor or any other care providers that you are seeing.
This is what you need to know to take charge of your own recovery and to make sure you are getting the care you need and deserve. If you haven’t been getting proper care for your motor vehicle accident injuries, and its been weeks, months, or even years since the accident, don’t worry. Recovery is still possible in most cases. It might be a longer road for you than if you had started with proper management right away, but that doesn’t mean you won’t be able to get back to normal. You’ve got this.
If you have questions or need more advice on managing your injuries after a motor vehicle accident, feel free to get in touch by calling me or e-mailing mark@physiobox.ca. Drive safe! Disclaimer: This blog post should not be taken as personal medical advice. It is intended for educational purposes only to help people make informed decisions about their healthcare. If you have been injured in a motor vehicle accident, seek professional help first.