title: Does early management of whiplash-associated disorders assist or impede recovery?
abstract: METHODS
  Narrative review of the literature and commentary.
  
  
  OBJECTIVE
  To discuss from an epidemiological and sociological perspective whether the early clinical management of whiplash-associated disorders can lead to iatrogenic disability.
  
  
  BACKGROUND
  There is a lack of evidence supporting the effectiveness of early rehabilitation care for whiplash-associated disorders.
  
  
  METHODS
  We describe the epidemiological evidence on the effectiveness of early rehabilitation on health outcomes for patients with whiplash-associated disorders and analyze from a sociological perspective how the medicalization of this condition may have contributed to increasing its burden on disability.
  
  
  RESULTS
  The evidence from randomized clinical trials suggests that education, exercise, and mobilization are effective modalities to treat whiplash-associated disorders. However, the evidence from large population-based cohort studies and a pragmatic randomized trial suggests that too much health care and rehabilitation too early after the injury can be associated with delayed recovery and the development of chronic pain and disability. These findings suggest that clinicians may be inadvertently contributing to the development of iatrogenic disability. The epidemiological evidence is supported by the sociological concepts of medicalization, iatrogenesis, and moral hazard.
  
  
  CONCLUSIONS
  The current evidence suggests that too much health care too early after the injury is associated with delayed recovery. Clinicians need to be educated about the risk of iatrogenic disability.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, and Toronto Western Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada. pcote@uhnresearch.ca
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.forename: Sophie
authors.initials: S
authors.lastname: Soklaridis
mesh_terms: D006801:Humans; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology; D013997:Time Factors; D014911:Whiplash Injuries / Q000150:complications / Q000503:physiopathology / Q000628:therapy*