Using Biofeedback as a Treatment Tool when Managing Whiplash Associated Disorder Symptoms During Pregnancy

Background: Whiplash associated disorder (WAD) affects up to 980,000 people in the United States and typically occurs from motor vehicle accidents. Case Description: A 37-year-old female displayed whiplash affective disorder symptoms after being rear-ended in a car accident. She was 9 weeks pregnant and had pain in her low back, upper back, and neck. She had impaired muscle control and activation, which caused a muscle imbalance of overactivity in the upper trapezius, lumbar paraspinals, and iliopsoas. A treatment plan was constructed to correct motor/postural deficits secondary to whiplash symptoms. Examination: The patient demonstrated muscle increased tone at the bilateral upper trapezius and lumbar paraspinals with palpable trigger points. Postural deficits included forward head and anterior pelvic tilt with lordosis and a pivot point at the L5 vertebrae. Intervention: The patient was prescribed a progressive comprehensive physical therapy plan of care including neuromuscular re-education exercises designed for lumbar stabilization and restoring scapulohumeral rhythm. She also received manual therapy services in order to apply soft tissue mobilization to the upper trapezius. She continually required verbal/tactile cues until biofeedback was prescribed. Discussion: Although the patient likely benefited from the entire treatment program; the biofeedback intervention demonstrated acute improvements with reducing overactivation of the bilateral upper trapezius with shoulder exercises. This treatment was particularly valuable in this case considering both its efficacy in correcting movement impairments and being safe during pregnancy. Further research is required to investigate the efficacy of surface EMG in treating WAD symptoms for both acute and long-term outcomes.