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Whiplash

Whiplash-MECHANISM.webp

What is Whiplash ?

  • Whiplash is the term used to describe neck pain and stiffness following a violent collision; usually a car accident. It can also be accompanied by headaches, dizziness, fatigue, jaw pain (TMJ), numbness and tingling in the upper extremities. Whiplash, if not treated properly soon after the injury, can set the stage for long-term (chronic) neck problems.

 

  • Technically, whiplash occurs when the body is suddenly accelerated then decelerated, which is precisely what happens in a "rear-fender" car accident: upon impact from behind, the torso accelerates rapidly to the same speed as the colliding car. Because of the neck's flexibility, the head simultaneously arcs backward, injuring soft tissue structures (muscle, ligaments and tendons) around the neck and upper shoulders. When the force of the collision stops (within one second), the torso suddenly stops, but the head accelerates forward and over corrects, causing the neck to sharply flex (bend) forward resulting in further soft tissue injury. In severe cases, ligaments rupture causing joint instability; nerve injury may occur, as well as fractures.

 

  • Immediately after a whiplash event that results in soft tissue injury, swelling starts very gradually. The injured tissues release a variety of inflammatory products which irritate nerve endings and cause pain. As the swelling progresses, it increases internal pressure in the joints, causing them to stiffen. Typically, swelling following a whiplash accident peaks 72 hours after the accident. This explains why your neck hurts the most several hours after the accident, instead of immediately after the accident.

 

  • It is important to know that whiplash can occur from even low velocity collisions. The reason is that the kinetic energy (force) of a car is very high, even at five miles per hour, due to the large mass of the car. The non suspecting passenger is also completely relaxed at the neck which allows for more “non-guarded” range of motion. This energy is transferred to the occupants of the vehicle and is actually more violent if the cars do not deform (dent), which is often the case in low impact collisions. Therefore, even if you were in a low-impact accident that was enough to cause a whiplash effect, It is advisable to get checked to make sure problems don’t develop later on.

Classification of Whiplash Associated Disorders

It is important to understand the classification of WAD to help guide treatment and symptom management. In 1995 the Quebec Task force developed guidelines to classify and manage WAD symptoms.

  • Grade 0: No complaints about neck pain. No physical signs.

  • Grade I: Complaint of neck pain, stiffness or tenderness only. No physical signs.

  • Grade II: Complaint of neck pain and musculoskeletal signs including decreased range of motion and point tenderness.

  • Grade III: Complaint of neck pain, musculoskeletal signs and neurological signs including decreased or absent deep tendon reflexes, muscle weakness and sensory deficits.

  • Grade IV: Complaint of neck pain and fracture or dislocation.

Structural Causes of Whiplash

Whiplash Symptoms

Symptoms of whiplash injury are varied and include:

  • Pain that can extend from the neck into the head, jaw, upper back, mid back and upper extremities

  • Neck stiffness

  • Headaches

  • Sleep difficulties

  • Vestibular problems

  • Visual disturbances

  • Memory and concentration problems

  • Psychological manifestations including fear, anxiety and depression

Various factors also affect the severity of whiplash symptoms including severity of the impact, previously present neck pain, age and gender

How Long Does Whiplash Usually Last?

In most cases of WADs recovery varies from several days up to 12 weeks after the injury occurs. However, factors that can affect the prognosis for WADs include severity of injury, comorbidities prior to the injury, age and socioeconomic environment.[vi] Seeking active treatment the first 3 months after injury is critical in preventing ongoing pain and disability.

What Happens if Whiplash Goes Untreated?

Evidence suggests that treatment success is highly dependent on having early physiotherapy intervention that includes active exercise, education and manual therapy treatment. While therapy may still be beneficial after the 3-month period, often symptoms become more difficult to treat secondary to tissue changes and compensatory movement patterns.  Symptoms persisting after this period are termed chronic whiplash.

Physiotherapy Approach to Whiplash Treatment

Management of whiplash injuries will vary depending on the classification of injury as well as any other injuries that have occurred due to the accident. However, implementing an early and active treatment approach has been shown to have a positive impact on pain and disability.

Physiotherapy treatment includes:

  • Education – Education is essential for management of expectations, knowledge of soft tissue healing timelines, encouraging activity and use to avoid chronic symptoms

  • Range of motion and Stretching Exercises – Early movement can help to alleviate stiffness and pain

  • Strengthening and Postural Exercises – Early strengthening can help prevent muscle wasting and can improve movement patterns to alleviate pain

  • Modalities – Use of heat, cold, ultrasound and acupuncture to manage pain

  • Manual therapy – Mobilization of joints can help to increase movement

There is strong evidence to support physiotherapy intervention after whiplash injuries. At Propel Physiotherapy our therapists have the experience and training in WADs to provide a comprehensive assessment to best determine a client’s needs and provide personalized whiplash treatment. Our therapists will work with you to help you get back to pain free living and doing what you love to do.

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