Neck blog series part 4: Whiplash Associated Disorder:

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What is Whiplash?


“acceleration-deceleration mechanism of energy transfer to the neck”
“from motor vehicle collisions, but can also occur during other mishaps”
“result in bony or soft-tissue injuries (whiplash-injury), which may in turn lead to a variety of clinical manifestations called Whiplash-Associated Disorders (WAD)”
(Spitzer, 1995)

Whiplash is graded as follows:
Grade 0: no neck complaints or signs
Grade 1: Pain, stiffness or tenderness, no physical signs
Grade 2: Pain, stiffness or tenderness, musculoskeletal signs
Grade 3: neurological signs with or without musculoskeletal signs
Grade 4: fracture or dislocation
Late whiplash: symptoms for more than 6 months

What are the common symptoms of Whiplash?

This depends on what structures are injured.

Here is a list of the common injuries caused by whiplash:


Facet joints:
Haemarthroses, capsular tears/rupture, articular cartilage damage, joint fractures.
Often involved in persistent pain: C2-3 (60%of cases) and the next commonly injured is C5-6.

Dorsal Root Ganglion and nerve roots:
Vulnerable to stretching and injury due to their location.

Ligaments:
Contribute to persistent symptoms.

Disc:
C5-6 is the most common.


Muscle injury:
Sternocleidomastoid is commonly injured and it is injured more superficially and posteriorly.

Bannister et al (2009):
States the most common symptoms are:
Neck pain and stiffness,
Occipital headache and upper limb paraesthesia

Elliott et al (2009):
Psychological distress

Chartered Society of Physiotherapy (CSP) clinical guidelines (2005):
Shoulder and arm pain,
Generalised hypersensitivity,
Muscle weakness,

TMJ (jaw) pain, visual disturbance,
Impaired proprioceptive control

What causes Whiplash?

Rear-end collisions account for half of cases!
Associated with more severe symptoms
(Bannister et al, 2009)

What actually occurs?
0-50 milliseconds (ms): Cervical and thoracic spine straighten as car seat pushes torso forward
50-75ms: Abnormal “S-shaped” cervical curve of lower segmental extension and upper flexion
Just under 100ms: maximal head and neck displacement: All cervical levels extended
(Elliott et al, 2009)

How do you diagnose Whiplash?


Scholten-Peeters et al (2009):
No validated diagnostic tests!
Need to look at general observation and cervical active range of movement,
Neurological exam,
Muscular stability and proprioception

CSP (2005):
Need to assess Red and yellow flags (psychological and signs of severe physical injury)

Cervical instability:
Sharp-Purser test is 69% for ruling in & 96% for ruling out of Cervical instability in terms of accuracy (Cleland & Koppenhaver 2005)

Palpation to the facet joints in the neck is accurate to help diagnose neck injury to a probability of 82% (Cleland & Koppenhaver 2005)

So what can help?

Acute: (0-2 weeks post-injury)
Active exercise within 4 days to reduce pain,
Self-management education to reduce symptoms,
Encourage return to normal activities ASAP

Sub acute: (2-12 weeks)
Multimodal program (postural training, manual techniques, psychological support) to reduce pain and aid return to work,
Massage for mechanical neck pain was found to provide immediate effectiveness both in pain & tenderness (Patel et al 2012)
Psychotherapy aids physical recovery from whiplash (Dunne et al 2012)

Chronic: (12 weeks plus)
Harder to treat so needs multimodal approach but with more emphasis on psychological issues.

What is my prognosis?

Prognosis is worse with the following:

Physical:
High initial pain and disability levels,
Early cervical movement loss (Elliott et al 2009)
History of neck pain prior to accident
Female (Walton et al 2009)

Psychological :
Post-traumatic stress symptoms (Elliot et al 2009)
Catastrophizing (Walton et al 2009)
Passive coping, fear of movement (Carroll et al 2009)

Carroll et al (2009):
50% report neck pain symptoms 1 year post injury,
Recovery seems to be multifactorial

Kamper et al (2008):
In the initial 3 months recovery occurs for many but after this rate of recovery level off!
Initially pain and disability reduce rapidly but show little improvement after 3 months

Sterling (2009):
Effective assessment and management in the acute stage is vital to prevent chronicity as it will be harder to recover after this.

If you need any further information or would like to book an appointment then call Hawkes Physiotherapy on 01782 771861 or 07866195914

Stay tuned for the next neck series blog article, part 5, coming soon!

WWW.HAWKESPHYSIOTHERAPY.CO.UK

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