title: Management of whiplash-associated disorder addressing thoracic and cervical spine impairments: a case report.
abstract: METHODS
  Clinical case report.
  
  
  OBJECTIVE
  To describe a physical therapy program addressing impairments of the upper thoracic and cervical spine region for an individual with a whiplash-associated disorder.
  
  
  BACKGROUND
  A 32-year-old female with complaint of diffuse posterior cervical and upper thoracic region pain was evaluated 2 weeks following a motor vehicle accident. The patient reported that she was unable to sit for longer than 10 minutes or perform household duties for longer than 1 hour. In addition, she was unable to perform her tasks as a postal worker or participate in her customary running and aerobic exercise activities because of pain in the cervical and upper thoracic region.
  
  
  METHODS
  An examination for physical impairments was performed, including the measurement of cervical range of motion using the CROM device, and the assessment of soft tissue and segmental mobility of the upper thoracic and cervical spine regions. The Northwick Park Neck Pain Questionnaire was used to assess functional limitations and disability. Manual therapy and therapeutic exercises were applied to address the identified impairments. Manual therapy techniques included soft tissue mobilization, joint mobilization, and joint manipulation.
  
  
  RESULTS
  The patient's cervical range of motion was improved and the disability score improved from 25% to 19.5% 3 days after the initial session addressing the thoracic spine. Following a second session also addressing thoracic spine impairments and the use of therapeutic exercises for 7 days, the disability score improved to 11.1%. At the final visit 17 days following the third visit, which focused on addressing the cervical spine impairments, there was complete resolution of signs and symptoms and disability.
  
  
  CONCLUSIONS
  Interventions addressing the impairments of the upper thoracic and cervical spine region were associated with reducing pain, increasing cervical range of motion, and facilitating return to work and physical activities in a patient with a whiplash-associated disorder. There is a need for continued research investigating the efficacy of providing interventions to the thoracic spine for patients with whiplash-related injuries.
authors.affiliation: Clinical Residency Faculty, Kaiser Permanente Southern California, Orthopaedic Physical Therapy Residency, Los Angeles, CA, USA. Cuong.X.Pho@kp.org
authors.forename: Cuong
authors.initials: C
authors.lastname: Pho
authors.forename: Joe
authors.initials: J
authors.lastname: Godges
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries / Q000503:physiopathology; D005260:Female; D006801:Humans; D007596:Joints / Q000503:physiopathology; D009132:Muscles / Q000503:physiopathology; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D013904:Thoracic Vertebrae / Q000293:injuries / Q000503:physiopathology; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000209:etiology / Q000534:rehabilitation*