What is a whiplash?
According to the Quebec task force whiplash injuries are defined as bony or soft tissue injuries resulting from rear-end or side impact, predominantly in motor vehicle accidents, and from other mishaps as a result of an acceleration-deceleration mechanism of energy transfer to the neck.
Are car accidents the only cause of whiplash?
In other words, whiplash results from a forceful hyper-extension (extreme bending backwards) and hyper-flexion (extreme bending forward) injury to the neck. Whiplash results when the soft tissues (the muscles and ligaments) of your neck extend beyond their typical range of motion. Whiplash injuries may occur as a result of car accidents, falls and sports related injuries.
What are the symptoms of a whiplash?
If a person sustained a whiplash injury, their symptoms might not appear for a while, so it’s important to pay attention to any physical changes for a few days following any accident. Whiplash is associated with a wide variety of clinical symptoms including:
- Neck pain and stiffness
- Upper back, shoulder and arm pain and paresthesias (tingling and numbness)
- Visual disturbances
- Temporomandibular (jaw joint) dysfunction
- Headache
- Problems with memory and concentration
- Fatigue
- Psychological distress (i.e. depression, fear, anxiety, anger)
All or some of these symptoms and signs together are collectively termed whiplash associated disorder (WAD).
Are all whiplashes the same?
In studies and classification models, WADs are usually graded according to the objective findings during a clinical examination. Each higher level of classification has the symptoms of the lower level plus additional findings. WAD is often classified as either:
WAD I
WAD I patients present with some muscle soreness and pain but no loss of neck range of motion (ROM).
WAD II
WAD II patients in addition pain or muscle soreness also have a loss of neck ROM.
WAD III
WAD III patients have pain, loss of ROM and objective findings of nerve root injury.
WAD IV
WAD IV patients have pain, loss of ROM, nerve root findings and a fracture or dislocation.
Can a whiplash result in more severe injuries?
In rare cases, there may be more serious injuries present as a result of trauma to the neck. These symptoms would be new to the patient following a traumatic event and they warrant an urgent and thorough clinical examination. The symptoms of a serious neck injury may include:
- Drop attacks (sudden spontaneous falls while standing or walking)
- Dysphagia (difficulty swallowing)
- Dysphasia (difficulty producing and understanding spoken language)
- Dysarthria (difficulty speaking/slurring speech)
- Diplopia (double vision)
- Ataxia (uncoordinated, staggering walking)
- Complete inability to move neck, following a high speed trauma
Do I need an X-Ray to diagnose my whiplash?
Whiplash type injuries are usually not well identified during X-ray tests in an acute phase. The diagnosis is made after a thorough examination by a physiotherapist or a doctor. This will include test of active and passive movement, neurological tests and screening tests for the painful and non painful areas. Your health provider will then give you a diagnosis based on the patient’s symptoms and a clinical exam.
What is the treatment for a Whiplash?
In the acute phases, recent studies suggest that early mobilization may lead to improved outcomes and that rest and motion restriction (like wearing a neck collar when not indicated) may hinder recovery. Treatment is often geared to control pain and normalize strength and range of motion and can include:
Manual Therapy
Hands on treatment by physiotherapists to mobilize (move) injured joints and muscles.
Exercise therapy
The goal of early treatment is to restore mobility at the neck, focus on muscles strength to support proper movement and restore the proprioception (sense of balance and spatial positioning).
Acupuncture
Inserting fine sterile needles in the skin to help stimulate nervous system to reduce pain and relax muscle spasm. Click here to see our previous blog post explaining the use of acupuncture.
Electrotherapeutic modalities
Ultrasound, interferential current, TENS can be used to help control pain and inflammation and assist with healing.
Cryotherapy (ice)
One of our previous blog posts discussed the use of heat vs. ice. Usually in the acute phase of a whiplash the use of ice is recommended. Applying cold to the injured area will help you to decrease pain, swelling and inflammation.Your physiotherapist will decide on the best treatment plan for you, following a detailed history taking and physical examination.
What is my expected prognosis?
There is great amount of variability in recovery outcomes in whiplash patients. This is a source of considerable controversy. Some of the factors that have been consistently associated with delayed recovery including being older age, higher initial pain intensity, neurologic deficit and preexisting neck pain.
As mentioned previously, early and effective management of symptoms with mobility and good exercise program can help the patient suffering from whiplash-associated dysfunction optimize their chances of full recovery and return to their pre-existing level of function.
Will my pain become chronic?
10-25% of the patients that sustain a whiplash will experience chronic symptoms. This is defined as symptoms present beyond the normal phase of healing, 6 months up to a year after the original injury.
One study found neck muscle degeneration in the group of patients that were involved in car accidents. The muscle fibers were replaced by fat content, which started to occur in as little as a few weeks after the accident. This muscle degeneration was not found in the group of chronic neck pain patients due to causes other than whiplash. This study also looked at whether or not this muscle degeneration can be reversed. It was found that after a 10 week neck muscle strengthening program, supervised by a physiotherapist, the fat deposits in the muscle can be reduced and the size of the muscle fibers were increased. This change in the muscle fibers was also correlated to a reduction in the painful symptoms.
In the treatment of chronic whiplash many other therapeutic interventions have been suggested over time, including but not limited to: temporomandibular joint treatment, cervical facet joint treatment. These areas should all be assessed by your physiotherapist during the initial consultation to help prevent your symptoms from becoming chronic. If conservative management fails to resolve your symptoms further medical treatment could include injection therapies such as intra-articular corticosteroid injections, and botulinim toxin (Botox) injections.
Most importantly, managing whiplash symptoms early on with targeted physiotherapy treatment, including early mobility restoration, will help greatly in optimizing the outcome of whiplash injury as well as will help to reduce possible stress and psychological changes associated with delayed recovery and lingering of pain.
Not Sure Where to start?
You’re not alone. There are a number of risk factors that can cause symptoms to persist with generalized approaches. Our physiotherapists and massage therapists have the experience and training to evaluate and diagnose your current status and the tools to get you started and progressing towards better health. Contact us to get started on your goals!
References:
- Spitzer WO, et al. Scientific monograph of the Quebec task force on whiplash-associated disorders: redefining “Whiplash” and its management. Spine. 1995;8S:1S–73S.
- Pastakia, K., Kumar, S. Acute Whiplash ASsociated Disorders (WAD) Open Access Emergency Medicine 2011: 29-32
- Borchegrevnik GE, Kaasa A, McDonagh D, et al. Acute treatment of whiplash neck sprain injuries. Spine 1998;23:25–31.
- Shaun O’Leary et al. Morphological changes in the cervical muscles of women with chronic whiplash can be modified with exercise – a pilot study. Muscle Nerve. 2015 Nov; 52(5): 772–779.
- Dufton JA, et al. Prognostic factors associated with minimal improvement following acute whiplash-associated disorders. Spine. 2006;20:E759–65.
