Efficacy of postural and neck-stabilization exercises for persons with acute whiplash-associated disorders: a systematic review.

PURPOSE We systematically reviewed randomized and quasi-randomized clinical trials in the literature to assess the efficacy of neck stabilization and postural exercises on pain, neck range of motion, and time off work in adults with acute whiplash-associated disorders. METHODS Electronic databases, reference lists of relevant Cochrane reviews, reference lists of studies selected for inclusion, and tables of contents of relevant journals were systematically searched for randomized and quasi-randomized controlled trials. Two independent reviewers selected studies for inclusion, assessed methodological quality, and extracted data. Because of the heterogeneity of the interventions, a qualitative synthesis was performed using "levels of evidence" as recommended by van Tulder et al. RESULTS Eight studies representing five clinical trials were selected for inclusion. Two trials were graded as high quality, two as moderate quality, and one as low quality. Many of these studies had mixed results, demonstrating significant differences on some outcome measures but not on others. CONCLUSIONS There is moderate evidence to support the use of postural exercises for decreasing pain and time off work in the treatment of patients with acute whiplash-associated disorders. However, no evidence exists to support the use of postural exercises for increasing neck range of motion. There is conflicting evidence in support of neck stabilization exercises in the treatment of patients with acute whiplash-associated disorders.