What is Whiplash?
Whiplash refers to an acceleration or deceleration injury to the neck (cervical spine) & is most commonly associated with rear-end motor accident. The injury can affect several structures in the neck including the joints, muscles, ligaments & nerves. Because of the wide spectrum of presentations in terms of severity & involved structures, whiplash injuries can prove difficult to manage clinically.
Causes of whiplash
A whiplash injury usually occurs due to a motor vehicle accident, particularly a rear-end collision. The unexpected impact causes extreme flexion and extension of the neck which stretches the muscles (and/or ligaments) of the neck and upper back. At times the neck may also be jerked sideways. This stretches the muscles (and nerves) extending from the neck to the shoulder. Contrary to common perception even low speed collisions at less than 10 miles per hour are liable to cause a whiplash injury. In severe road traffic accidents there may be a coexisting injury to the low back or the head.
Workplace related accidents are the second most common cause of whiplash injuries after road traffic accidents. The other cause of whiplash includes a sudden hit to the head in contacts sports such as rugby or boxing.
What are the symptoms of Whiplash?
Symptoms associated with whiplash include stiff, painful neck & shoulders. Headaches may also be present. Occasionally, these symptoms may take hours or several days after the accident to manifest. Patients will often report a limitation in neck motion, especially rotation. In most cases symptoms will resolve over a number of weeks; however, there is large variability in time-scales required for recovery.
The common symptoms of whiplash include:
- spasm of muscles of the neck and shoulder
- localised or generalised areas of tenderness in the neck
- pain and stiffness in the upper back
- whiplash related headaches or cervicogenic headaches
- radiating pain, numbness, tingling and weakness in one or both arms.
Other less common symptoms include low back pain, jaw pain and stiffness, anxiety, sleep disorders, dizziness or light headedness, disorientation, memory lapses, stress, and fear of driving. The patient may also find himself irritable and tired most of the time.
Grading of symptoms
Whiplash associated disorder encompasses a large spectrum of physical and psychological symptoms. The disorder has been graded by the Quebec task Force according to the severity and extent of the physical symptoms. The 5 grades of WAD are as follows:
- Grade 0: Patient does not present with any neck pain, stiffness, or any other physical signs
- Grade 1: Patient complains of pain, stiffness or tenderness in the neck region
- Grade 2: pain stiffness and point tenderness in the neck along with reduced range of motion in the neck.
- Grade 3: neck complaints accompanied by neurological signs such as decreased deep tendon reflexes, weakness and sensory deficits.
- Grade 4: neck complaints and fracture or dislocation, or injury to the spinal cord.
Red Flags or 5 D’s that require immediate specialist attention
Presence of symptoms like Diplopia (double vision), Disorientation, difficulty in swallowing, Disturbance in bowel bladder control and Difficulty in walking- indicate an injury to the spinal cord. It is a medical emergency that warrants specialised medical attention. Nausea, tinnitus (ringing in the ears) or breathing problems are other serious signs that require immediate medical intervention.
What makes diagnosing and treating whiplash injury difficult?
The symptoms of whiplash can be quite vague and complex at times. Also, as there may be a latent period before the symptoms show up diagnosis becomes problematic. Exacerbation of underlying conditions such as spinal osteoarthritis or subacromial bursitis, as a result of the trauma, may make matters more complex. This also makes it hard to diagnose a whiplash.
The recovery of a whiplash injury does not follow a set course. In majority of the cases the symptoms of whiplash resolve within 2-3 months. But studies have shown that, in some people, pain may persist beyond 12 months. In fact there have been instances where the pain due to whiplash has persisted for several years.
Certain factors such as increased age, female gender, pre-existing stress/anxiety and poor physical fitness delay the recovery after a whiplash. The emotional quotient attached with the injury also acts as a deterrent to recovery.
Whiplash injury management at Naas Physiotherapy clinic
Naas physiotherapy clinic specialises in the treatment and rehabilitation of whiplash injuries.
- Neck pain and stiffness are the most common complaints with a whiplash injury. The pain may be mild or severe. It can be localised or may radiate down the arms. The sudden jolt to the neck may result in injury to a muscle or ligament. Usually the anterior longitudinal ligament that runs along the front of most frequently affected structures. The quadratus lumborum muscle in the low back may be injured as well. The violent neck movement results in neck muscle spasm and/or a facet joint lock between the cervical vertebrae leading to neck stiffness.
Deep soft tissue techniques, gentle muscle stretching, manual therapy techniques such as joint mobilisation, manipulation, myofascial release and muscle energy technique help to relieve the pain, spasm and stiffness.
- Cervicogenic headache after a whiplash is another frequently occurring symptom. The patient reports pain at the back of the head and neck.
Deep neck flexor strengthening, cervical mobilisation, neck posture correction and proprioceptive exercises effectively help mitigate the headaches.
- Shoulder and/or upper back pain usually occurs in a more severe whiplash injuries. Shoulder pain occurs when the neck is forcefully rotated during the accident. This stretches the structures from the neck to the shoulder. The patient complains of pain and incomplete range of motion at the shoulder.
Shoulder stability and strengthening exercises and shoulder stretches help to improve joint mobility.
- Radiating Pain (Radiculopathy) or radiating pain is a result of compression of the nerves as a result of trauma sustained during the accident. The patient may complain of burning, numbness, pins and needles, and tingling along the arm.
Neural and cervical mobilisation, trigger point therapy and supportive taping helps to alleviate the pain. Reassurance is integral to patient compliance as this symptoms are slow to resolve.
- Jaw pain and stiffness is a less common symptom of whiplash. Stiffness in the upper cervical segments can also contribute to reduced jaw movement.
Temporomandibular joint mobilisation and cervical mobilisation help to resolve the pain and stiffness in just a few sessions.
- Emotional issues like anxiety, fear, stress, sleep deprivation, fatigue, depression and irritability are the intangible side effects of whiplash that cannot be ignored. Patients who suffer from stress or anxiety tend to have increased muscle tension in the body that aggravates the pain and muscle spasm resulting from whiplash.
- Cognitive therapy and meditation/relaxation techniques as adjuncts to light aerobic exercises, go a long way to resolve anxiety issues. They also help patients to manage chronic pain resulting from a whiplash.
Treatment of Whiplash Injuries
The key to whiplash management is early intervention & progressive increased exercise intensity. Oftentimes, there is significant restriction of the cervical facet joints and tenderness of the surrounding musculature. Manual therapies will aim to restore normal joint motion & address areas of scar tissue development in muscle.
It is important to be reassured by the fact that prognosis for those who have undergone whiplash injuries is generally good. The Québec task force on Whiplash-Associated Disorders concludes that there is little evidence for the use of cervical collars and corticosteroid injections in the management of whiplash injuries. Instead of actively rest & use of neck collars, the latest research suggests that an active rehabilitation approach will lead to a more rapid recovery. The Quebec Task Force suggests that prolonged immobilisation can reduce cervical mobility & increase scar tissue in the neck. Here at the Physio Clinic Naas our aim is to get people back to their regular activities as soon as possible after whiplash injuries.
Conquer whiplash at Naas Physiotherapy Clinic
At Naas Physiotherapy clinic, our focus is on developing a personalised treatment plan for each patient. As these injuries can take a considerable time to heal, adherence to rehabilitation is of paramount importance so patients can return to their pre-accident activities. The importance of maintaining an acitve lifestyle and the negative impact on recovery of lack of activity is also emphasised. A holistic approach to management of whiplash is promoted.
Activity modification guidance/ergonomic advice for lifting and carrying
- Advice for environmental modification (if needed)
- Joint Mobilisation and Manipulation
- Manual Therapy
- Deep soft tissue massage
- Myofascial release
- Muscle energy technique
- Stretching and Core strengthening
- Shoulder stabilisation exercises
- Complete Biomechanical Analysis
- Posture and Gait analysis
- Correction of muscle strength imbalance
- Kinesiology Taping and Supportive Taping
- Balance and Proprioceptive exercises
- Aerobic exercises and generalised muscle strengthening exercises
- Relaxation techniques
It has been shown that individuals who undergo whiplash & develop chronic neck pain have alterations in muscle activation patterns in the neck. The deep stabilising muscles of the neck have been shown to be weaker in such patients & therefore interventions are required to redress this muscle imbalance and restore normal movement. The classic presentation for such individuals is forwards head carriage where the head sits in front of the shoulders. The muscles on the front of the neck will often appear very taught and prominent in such individuals. Detailed analysis is required to identify which muscles are underactive & which ones are overactive in order to design a specific rehabilitation programme.
To find out more contact Naas Physio Clinic now on:
(045) 874 682
or email us at email@example.com[/vc_column_text][/vc_column][/vc_row]