Whiplash-associated disorders (WAD) is an umbrella term used to characterize the myriad symptoms that can occur when soft tissues are injured during rapid acceleration and deceleration of the head and neck in a whiplash event, such as a rear-end automobile collision. Despite advances in the understanding and treatment of WAD, it is estimated that nearly half of whiplash patients continue to experience ongoing pain and disability for a year or longer. Recent studies have identified reduced neck muscle endurance as a risk factor for chronic WAD, but what happens in a real-world setting when neck muscle strengthening is included as part of treatment?

To explore this question, a May 2025 study recruited 140 patients with chronic WAD who completed pre-intervention assessments of neck pain, neck-related disability, neck function, and psychosocial factors. Participants were then assigned to one of two treatment groups: at-home exercises delivered through Internet-based instruction or in-office exercises facilitated by a physiotherapist. Treatment frequency ranged from two to four sessions per week over a twelve-week period. Participants completed the same assessments three months and fifteen months following the conclusion of care.

The results demonstrated that both in-person and at-home exercise approaches produced similar improvements in neck pain, disability, and function, and these improvements were associated with increased neck muscle endurance. While this finding provides important confirmation that addressing impaired neck muscle endurance may help reduce persistent WAD symptoms, the results related to psychosocial factors—how a person perceives, responds to, and recovers from neck pain and injury—were particularly noteworthy. The data showed significant post-treatment improvements in self-efficacy, fear-avoidance beliefs, depressive symptoms, and catastrophizing. This is especially meaningful, as these factors are known to be present early after injury and are strongly associated with the development of chronic WAD.

While further research is needed to confirm these findings and better understand the underlying mechanisms involved, the results suggest that assessment of neck muscle endurance should be included as part of the initial clinical evaluation, with targeted exercises prescribed for patients to perform between in-person visits with their chiropractor or other healthcare provider, if needed. Beyond the personal and family-level benefits associated with successful WAD recovery, any intervention that reduces the risk of chronic WAD may also offer substantial macroeconomic benefits, including improved productivity and reduced litigation-related costs, which could ultimately contribute to lower automobile insurance expenses.