Chronic Whiplash and Neck Muscle Endurance

Whiplash-associated disorders (WAD) describe a wide range of symptoms that can develop after the soft tissues of the neck are injured during a rapid acceleration–deceleration event, most commonly a rear-end motor vehicle collision.  Although our understanding of whiplash and its treatment has improved over time, recovery is not always straightforward.  Research suggests that nearly half of individuals with whiplash continue to experience pain and functional limitations one year or more after injury.

Recent studies have highlighted reduced neck muscle endurance as an important risk factor for the development of chronic whiplash symptoms.  This raises an important clinical question: what happens when neck muscle endurance training is intentionally included as part of treatment in real-world settings?

A study published in May 2025 examined this issue by following 140 individuals with chronic WAD.  Prior to treatment, participants completed standardized assessments measuring neck pain, neck-related disability, physical function, and several psychosocial factors.  They were then assigned to one of two rehabilitation approaches: a home-based exercise program delivered through online instruction or supervised in-office exercises guided by a physiotherapist.  Participants exercised two to four times per week over a twelve-week period and were re-evaluated three months and fifteen months after completing care.

Both treatment approaches produced meaningful and comparable improvements in neck pain, disability, and overall function.  These clinical gains were closely linked to increases in neck muscle endurance, reinforcing the importance of addressing this specific physical deficit in patients with chronic whiplash.

One of the most compelling findings involved psychosocial outcomes.  Participants demonstrated significant improvements in self-confidence related to managing their symptoms, reduced fear-avoidance behaviors, fewer depressive symptoms, and less catastrophic thinking about pain.  These factors are known to play a major role early after injury and are strongly associated with the transition from acute to chronic whiplash, making these improvements particularly clinically relevant.

Although additional research is needed to further clarify the mechanisms involved, these findings support the routine assessment of neck muscle endurance during the initial evaluation of whiplash patients.  When deficits are identified, targeted endurance exercises can be prescribed and reinforced between in-office visits with a chiropractor or other healthcare provider.

Beyond the clear benefits to individual patients and their families, reducing the risk of chronic whiplash has broader implications.  Successful early intervention may contribute to improved productivity, decreased long-term healthcare utilization, and reduced litigation-related costs—factors that ultimately have the potential to lower overall automobile insurance expenses.

This article is based on content originally published by Chiro-Trust.org.  It has been adapted for use on this website with permission.