CLINICAL CONSENSUS

Apart from anatomical studies, much of the scientific understanding of soft-tissue injury and healing is derived from animal models, and there is little information on the normal recuperation period. In the animal model of soft-tissue healing, there is a brief period (less than 72 hours) of acute inflammation and reaction, followed by a period of repair and regeneration (approximately 72 hours to up to six weeks) and finally by a period of remodeling and maturation that can last up to a year. Starting from this model, it is reasonable to estimate a healing period of between four and six weeks in cases of WAD with partial tear of soft-tissues. However, many cases are mild and will heal in a much shorter time. The model may not apply to WAD with neurological signs or symptoms, because nerve injury could prolong recovery.

Prolonged immobilization of WAD injuries may increase scar tissue and reduce cervical mobility. Normal function of the patient must be encouraged when possible. A return to regular activities, starting at the stage of fibroplasia and throughout the maturation phase, can enhance optimal healing.

The Task Force is also aware that the manifestations and prognosis of WAD are influenced by psychosocial factors. The relationship and interactions between the patient and the clinician may themselves affect the evolution of WAD, as has been described for other disorders. The patients' own psychologic makeup and psychosocial environment may also affect the prognosis and should be considered. The clinician should therefore be alert to these possible influences when evaluating and managing the patient. Opinions from consultants with expertise in the behavioral sciences or from multidisciplinary groups experienced in WAD management may be helpful for atypical evolutions of WAD. However, it should be noted that the efficacy and effectiveness of psychological or psychiatric interventions in WAD have not been demonstrated (See Section 4: Best Evidence Synthesis).