Whiplash-Associated Disorder (WAD), commonly following road traffic collisions and other acceleration injuries, remains a complex rehabilitation challenge. Individuals with persistent symptoms frequently report ongoing neck pain, dizziness and impaired balance, often long after tissue healing would be expected. While neck-specific exercise programmes are widely used to address pain and disability, their influence on objective balance measures has been less clearly defined in higher grade chronic cases.
A longitudinal case–control study published in Scientific Reports in 2024 examined whether a structured neck-specific exercise intervention could improve static balance in individuals with chronic whiplash-associated disorders grades 2 and 3. The findings offer valuable insight into the relationship between cervical sensorimotor rehabilitation and postural control.
Study Design and Assessment Approach
The study included 30 individuals with chronic whiplash-associated disorder and 30 age- and gender-matched healthy controls. Static balance was quantified using postural sway measures recorded via a validated smartphone application positioned at the pelvis. This enabled objective assessment of balance performance under controlled and clinically relevant conditions.
Balance testing focused on two tasks designed to challenge postural stability:
- Double stance with eyes closed, used as the primary outcome measure
- Single leg stance with eyes open, used as a secondary outcome measure
By reducing or altering visual input, these tasks increased reliance on proprioceptive and vestibular contributions to balance, systems known to be affected following whiplash injury.
Neck-Specific Exercise Intervention
Participants with chronic whiplash undertook a three-month neck-specific exercise programme delivered in a progressive and individualised manner. Rather than focusing on strength alone, the intervention targeted cervical motor control, endurance and sensorimotor integration.
A core component of the programme involved deep cervical muscle activation and control. Exercises were performed at low load, with an emphasis on precise, slow movements designed to improve segmental control of the cervical spine. This approach aimed to restore function of the deep neck flexors and extensors while minimising compensatory over-activity of superficial musculature, a common feature in chronic whiplash.
As control improved, exercises progressed to develop neck muscle endurance and functional strength. These included sustained holds and repeated movements, sometimes incorporating light resistance, to improve the capacity of the cervical musculature to maintain control during everyday head movements.
Crucially, the programme incorporated sensorimotor and proprioceptive training. Participants practised accurate head positioning tasks, often involving returning the head to a neutral position following movement. These exercises were progressively challenged by reducing visual input, increasing movement complexity, or integrating balance demands. The intention was to enhance cervical afferent input and its integration with postural control systems, rather than simply increasing muscular output.
Throughout the intervention, emphasis was placed on movement quality, accuracy and feedback, supporting motor relearning rather than repetition alone.
Key Findings
At baseline, individuals with chronic whiplash demonstrated significantly greater postural sway than healthy controls during double stance with eyes closed, indicating impaired balance control when visual cues were removed. This finding is consistent with established evidence of disturbed cervical proprioception and altered sensorimotor function following whiplash injury.
Following the three-month exercise programme, the whiplash group showed statistically significant improvements in postural sway across both balance tasks. Notably:
- Postural sway during double stance with eyes closed was reduced to a level comparable with healthy controls
- Single leg stance performance also improved significantly over time
While associations between self-reported dizziness and sway measures were moderate, the objective improvements observed suggest that balance control can be meaningfully influenced through targeted cervical rehabilitation, even in individuals with long-standing symptoms.
Clinical Interpretation
Postural sway reflects the nervous system’s ability to integrate sensory information from visual, vestibular and proprioceptive sources to maintain upright stability. In chronic whiplash, disruption of cervical afferent input is thought to impair this integration, particularly when reliance on vision is reduced.
The findings from this 2024 study support the premise that restoring precise cervical motor control and sensorimotor function can reduce postural instability. The elimination of differences between the whiplash group and healthy controls following intervention is clinically significant and challenges the assumption that higher grade chronic whiplash is inherently resistant to rehabilitation.
Implications for Rehabilitation Practice
For clinicians working with persistent neck pain, dizziness and balance disturbance, this study reinforces several important principles:
- Cervical rehabilitation should prioritise control, endurance and proprioception, not strength alone
- Objective balance measures such as postural sway can complement patient-reported outcomes
- Improvements in balance are achievable in chronic presentations when exercise is specific and progressive
In practice, rehabilitation approaches that provide clear external feedback on head and neck movement, for example through simple head-mounted visual reference systems, may help patients develop greater awareness and accuracy of cervical control. Such feedback can support motor relearning and reinforce sensorimotor integration alongside structured exercise programmes.
Conclusion
This 2024 Scientific Reports study adds important evidence supporting neck-specific exercise as a means of improving balance control in individuals with chronic whiplash-associated disorder. The observed reductions in postural sway, particularly under conditions of reduced visual input, highlight the central role of cervical sensorimotor function in postural stability.
For clinicians seeking evidence-informed strategies to address persistent balance impairment following whiplash, targeted neck-specific rehabilitation, supported by objective assessment and appropriate feedback mechanisms, represents a credible and clinically relevant approach.
Reference
Karlsson, J., Peterson, G., Wibault, J., Dedering, Å., Peolsson, A., and Peterson, M. D. (2024). Neck-specific exercise improves balance in chronic whiplash-associated disorders: a longitudinal case–control intervention study. Scientific Reports, 14, Article 66176.