Questions

What is whiplash Injury?

The term "whiplash" injury was first coined by Harold Crowe in 1928 to define acceleration-deceleration injuries occurring to the cervical spine or neck region. Later modified to an all-encompassing term known as whiplash-associated disorders (WAD), these clinical entities have been refined to describe any collection of neck-related symptoms following a motor vehicle accident (MVA).

Whiplash and whiplash-associated disorders (WAD) affect a variety of anatomical structures of the cervical spine, depending on the force and direction of impact as well as many other factors. Causes of pain can be any of these tissues, with the strain injury resulting in secondary oedema, hemorrhage, and inflammation.

Symptoms of Whiplash Injury?

Whiplash-associated disorder is a complex condition with varied disturbances in motor, sensorimotor, and sensory functions and psychological distress. The most common symptoms are sub-occipital headache and/or neck pain that is constant or motion-induced. There may be up to 48 hours delay of symptom onset from the initial injury.

Motor Dysfunction

·         Restricted range of motion of the cervical spine. 

·         Altered patterns of muscle recruitment in both the cervical spine and shoulder girdle regions (clearly a feature of chronic WAD)  

·         Mechanical cervical spine instability

Sensorimotor Dysfunction.  

·         Loss of balance

·         Disturbed neck influenced eye movement control

Sensory Dysfunction: Sensory Hypersensitivity to a Variety of Stimuli

·         Psychological distress

·         Post-traumatic stress

·         Concentration and memory problems

·         Sleep disturbances

·         Anxiety

·         Depression

·         Initial depression: associated with greater neck and low back pain severity, numbness/tingling in arms/hands, vision problems, dizziness, fracture.

·         Persistent depression: associated with older age, greater initial neck and low back pain, post-crash dizziness, anxiety, numbness/tingling, vision and hearing problems

Degeneration of Cervical Muscles

·         Neck stiffness

·         Fatty infiltrate may be present in the deep muscles in the suboccipital region and the multifidi may account for some of the functional impairments such as: Proprioceptive deficits, Balance loss, Disturbed motor control of the neck

Other Symptoms

The following symptoms may also occur

·         Tinnitus

·         Malaise

·         Disequilibrium/Dizziness

·         Thoracic, temporomandibular, facial, and limb pain

Causes of Whiplash Injury?

Whiplash-associated disorders describe a group of neck-related clinical symptoms manifesting after an MVA or car crash-related mechanism.  The pathophysiologic process remains poorly understood and ultimately difficult to describe.  Previous speculated underlying mechanisms had attributed multifactorial elements including vertebral distraction to the facet joint capsule region of the cervical spine causing pain.  Other plausible explanations can include any combination of minor (i.e., clinically irrelevant) injuries to either the facet joint(s), spinal ligaments, dorsal root ganglia/nerve roots, intervertebral discs, cartilage, and paraspinal muscle spasms or contusions of the intraarticular meniscus hemarthrosis may cause symptoms consistent with WADs or "whiplash" injuries.

Diagnosis of Whiplash Injury

The assessment of individuals with WAD should follow the normal cervical examination.

Subjective

The subjective history should specifically include information about:

·         Prior history of neck problems (including a previous whiplash)

·         Prior history of long-term problems (injury and illness)

·         Current psychosocial problems (family, job-related, financial)

·         Symptoms (location + time of onset)

·         Mechanism of injury (e.g. sport, motor vehicle)

Objective

Physical examination is required to identify signs and symptoms and classify WAD according to the QTF-WAD

Inspection and Palpation

During palpation, stiffness and tenderness of the muscles may be observed.  These physical symptoms are present in grade 1, 2 and 3.

ROM Testing

In grade 1 WAD, there are no physical signs, so there will be no decreased ROM. In grades 2 and 3, a decreased ROM can be identified by testing the neck flexion, extension, rotation and 3D movements.

Neurological Examination

To distinguish grade 3 from grade 2, a neurological examination is needed. Patients with grade 3 have symptoms of hypersensitivity to a variety of stimuli. These can be subjectively reported by patients, and may include allodynia, high irritability of pain, cold sensitivity, and poor sleep due to pain.

Objectively, the results of the neurological examination are hypo reflection, decreased muscles force and sensory deficits in dermatome and myotome. These responses may occur independently of psychological distress. Other physical tests for hypersensitivity include pressure algometers, pain with the application of ice.

Treatment of Whiplash Injury

·         Education, resumption of normal activity, and mobilization exercises are generally the treatment of choice. 

·         Ultrasound has also been shown to relieve muscle pain for whiplash-associated disorders.

·         First-line treatments include analgesics, nonsteroidal anti-inflammatories, ice, and heat.

·         Other controversial analgesic measures include muscle relaxants, which have been shown to have some therapeutic effect in limited studies. 

·         Biofeedback has also demonstrated effectiveness when used in conjunction with other modalities in acute WAD. 

·         Injection of lidocaine intramuscularly was also found to relieve pain symptoms. 

·         Most treatments alone appeared to have moderate effectiveness with combinations of treatment measures improving efficacy and early mobilization consistently most effective

Physical therapy management: Physical therapy can help you feel better and may prevent further injury. Your physical therapist will guide you through exercises to strengthen your muscles, improve posture and restore normal movement.

Exercises may include:

·          Rotating your neck in both directions

·         Tilting your head side to side

·         Bending your neck toward your chest

·         Rolling your shoulders

·         In some cases, transcutaneous electrical nerve stimulation (TENS) may be used. TENS applies a mild electric current to the skin. Limited research suggests this treatment may temporarily ease neck pain and improve muscle strength.

·         The number of physical therapy sessions needed will vary from person to person. Your physical therapist can also create a personalized exercise routine that you can do at home.

·         Foam collars

Soft foam cervical collars were once commonly used for whiplash injuries to hold the neck and head still. However, studies have shown that keeping the neck still for long periods of time can decrease muscle strength and interfere with recovery.

Still, use of a collar to limit movement may help reduce pain soon after your injury, and may help you sleep at night. Recommendations for using a collar vary though. Some experts suggest limiting use to no more than 72 hours, while others say it may be worn up to three hours a day for a few weeks.

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