Physiotherapy interventions for the management of whiplash injuries

Abstract

Age dependent decrease in androgen levels is the main and most important mechanism responsible for involutional osteoporosis in men. Decreased physical activity may contribute to the development of osteoporosis. Supplementation with DHEA and increased physical activity may counteract the development of male osteoporosis and decrease fracture risk. DHEA may increase bone formation after conversion to testosterone, and exercise — by activation of the canonical Wnt/β-catenin pathway. The aim of the present study was to examine the effect of DHEA and moderate exercise on mechanical properties of long bones in rats with androgen deficiency induced by orchidectomy. The experiments were carried out on 3-month-old Wistar rats, divided into following groups (n=8–10 rats per group): non-orchidectomized control rats, orchidectomized (ORX) control rats, ORX rats receiving DHEA, ORX rats submitted to exercise, ORX rats receiving DHEA submitted to exercise. The rats were submitted to the moderate exercise on the treadmill once daily (1 hour) for 8 weeks. DHEA was administered at a dose 7 mg/kg p.o. once daily for 8 weeks. Mechanical properties of tibial metaphysis and femoral diaphysis (in three-point bending tests) and femoral neck (in a compression test), bone turnover markers (serum osteocalcin and C-terminal telopeptide of type I collagen fragments), geometric parameters, mass, and mass of bone mineral in the tibia and femur were studied. Androgen deficiency inhibited bone formation and resorption. It weakened mechanical properties of tibial metaphysis as well as femoral neck and diaphysis, and decreased bone mass and mass of bone mineral. Exercise increased bone formation and counteracted unfavorable changes in mechanical properties of tibial metaphysis and femoral neck, induced by androgen deficiency. DHEA increased bone formation and significantly inhibited the effect of androgen deficiency on the mechanical properties of the tibial metaphysis. Administration of DHAE combined with exercise counteracted unfavorable changes in bone mechanical properties (especially in the tibial metaphysis) induced by androgen deficiency. This article is part of a Special Issue entitled ECTS 2011. Disclosure of interest: None declared. doi:10.1016/j.bone.2011.03.670 PP540-T Physiotherapy interventions for the management of whiplash injuries V. Barkatsa ⁎, C. Iliadis , V. Moraitis , N. Syrmos , M. Tzagarakis , K. Tsipras d a Physiotherapy, Greece b Neurosurgery, Venizeleion General Hospital, Heraklion, Greece c Pathology, General Hospital, Rethymno, Greece d Endocrinology, Greek Institute of Social Security, Athens, Greece Abstract: Introduction/background: Whiplash injuries are associated with motor Introduction/background: Whiplash injuries are associated with motor vehicle accidents or in sporting mishaps after an acceleration–deceleration mechanism of energy transfer to the neck. The injury results in a series of clinical manifestations (mainly cervical pain 88% and headaches) known as Whiplash Associated Disorder. The syndrome involves trauma to amultiplicity of tissues in the cervical spine and it may affect other areas of the vertebral column. Clinicians are challenged to use different treatments in order to relieve symptoms and to improve body function. Method: systematic review of the effectiveness of physiotherapy interventions in the management of whiplash injuries using MEDLINE, CINAHL, Cochrane database systematic reviews and published guidelines. Results: In the acute stage (0 to 2 weeks after injury) physiotherapy interventions recommended for pain reduction are active exercises, manual mobilisation, use of TENS, education and advice and relaxation techniques compared to electrotherapy, traction, and the use of soft collar. There is insufficient evidence to support the use of massage and acupuncture. In the sub acute stage (2–12 weeks after injury) and in the chronic stage( after 12 weeks) a multimodal programme including active exercises, postural training, manual techniques, physical agents and psychosocial support should be used to reduce pain and enable people to return to normal activities. Conclusion: Recovery is improved by early active management and early return to pre-accidental activities. This article is part of a Special Issue entitled ECTS 2011.