Whiplash Associated Disorder

Whiplash Associated Disorder

Whiplash Associated Disorder is when soft tissue damage (stretch, tearing or rupture) to the ligaments, muscles, intervertebral discs, and other tissues surrounding the cervical spine leads can lead to a variety of symptoms. This typically occurs after a rapid acceleration/deceleration of the neck with some twisting involved. During the trauma damage can occur to the muscles at the front and back of the neck. The movement that causes this is hyperextension (hyper = increase) and hyperflexion.

Symptoms of whiplash associated disorder include neurological referral to the upper extremities, local swelling and redness, headaches, decreased sleep and range of motion. Dizziness can also occur that can be accompanied by ear ringing and double vision.

There are three grades of whiplash disorder. Grade one is when there is mild swelling and stretch, no instability, mild pain at end of range and recovery occurs within two to fourteen days. Grade two involves mild to moderate swelling and instability, ligament damage and recovery occurs between fourteen days and two months. Finally grade three is when there is severe swelling with clear bruising. Possible fracture with instability and ligament damage, complete loss of motion and recovery takes one to three months.

Whiplash most commonly occurs in women in their late 30’s and early 40’s and commonly occurs during motor vehicle accidents, skating and surfing incidents.

Assessment:

Testing of all range of motion of the neck is important to identify any joint sprains or ligament/muscle strains and they are often identified during range of motion. Tests aimed at identifying nerve tension, referral pain and joint injury are also performed. Neurological testing of the nerves of the upper limb (arm) and the head are also performed regardless of whether the patient is experiencing neurological symptoms (numbness, tingling weakness) or is feeling dazed. Imaging such as CT scans can be helpful in showing decreased cervical lordosis (angle of the neck). MRI can also show impact on the soft tissue (muscle, ligament).

Review of evidence for management

Manual Therapy has been shown to decrease muscular tension, increase biomechanical function and prevent contractures. It is not recommended to manipulate in the acute stages of injury however mobilisation of the area to increase blood flow to tissues and impact neuromuscular link to decrease guarding and therefore tissue tension. Once past the acute stage of whiplash depending on the severity manipulation may be considered.

Passive methods such as the use of ice, heat, tens machines and manual therapy assist in preventing chronic pain and disability. They can also decrease inflammation as well as stretch and strengthen muscles of the cervical spine. Your therapist may provide activities that aim to improve strength, endurance, posture, body mechanics and flexibility. It is recommended the patient attend sessions 3 times per week for 4-8 weeks.

Preventatively if patients are involved in a high intensity sport it is recommended that patients stretch before and after activity especially if they are involved in high intensity sport.

Long term therapy includes regaining quality and full quantity of range of motion as well as postural teachings to ensure stabilisation, decreased loading and increased ergonomics.

If you would like too receive treatment for whiplash please call 07 5613 3505 or book through our website.

References

Bickley, R., Belyea, C.M., Harpstrite, J.K., Min, K.S. (2021). Surfing Injuries: A Review for the Orthopaedic Surgeon.  Journal of Bone and Joint Surgery, 9 (4). Pp 1-9. https://doi.org/10.2106/JBJS.RVW.20.00152

Freeman, M.D., Talavera, F., Klein, M.J., Hunter Jr., O.K., Childers, M.K. (2021, April 9). Cervical Sprain and Strain Treatment & Management. Medscape. Cervical Sprain and Strain Treatment & Management: Rehabilitation Program, Medical Issues/Complications, Surgical Intervention (medscape.com)

Matsushita, E. (2019). Oupatient physical therapy for a patient with chronic neck

pain secondary to whiplash associated disorder. [PhD Thesis, California State University] 5712m7024 (calstate.edu)

McArthur, K., Jorgensen, D., Climstein, M., Furness, J. (2020). Epidemiology of Acute Injuries in Surfing: Type, Location, Mechanism, Severity, and Incidence: A Systematic Review. Sports, 8(2), pp 25. https://doi.org/10.3390/sports8020025

Meir R.A, Zhou, S., Rolfe, M.I., Gilleard, W.L., Coutts, R.A. An investigation of surf participation and injury prevalence in Australian surfers: a self-reported retrospective analysis. New Zea- land J Sports Med. 2012;39(2):52-8. (PDF) An investigation of surf participation and injury prevalence in Australian surfers: a self-reported retrospective analysis (researchgate.net)

Parravicini, G. (PT, DO) & Ghiringhelli, M. (PT, DO) (2021). Osteopathic Cranial Manipulation for a Patient With Whiplash-Associated Disorder: A Case Report. Journal of Chiropractic Medicine, 20(3), pp. 163-169. https://doi.org/10.1016/j.jcm.2021.12.003

Vizniak, N.A., (2019). Evidence-Informed Orthopaedic Conditions. 3^rd edition. Prohealthsys.