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Whiplash: Diagnosis & Treatment

Whiplash injury can certainly trigger emotional and cognitive changes, including:

  • Travel anxiety
  • Post traumatic stress disorder
  • Depression
  • Fear of movement
  • Sleep disturbance
  • Lower levels of concentration

The evidence suggests that the development of chronic symptoms is influenced more by psychological, social or cultural factors.

Pathophysiology
Autopsy studies have shown that in severe whiplash, damage is caused by the sheer force to bone, joints, ligaments, muscles and nerves. Haemorrhages and haematomas occur in the neck muscles along with tears in the inter-spinous and supra-spinous ligaments. The main clinically important structures involved are the  apophyseal joints, the intervertebral discs and the intervertebral ligaments. Often there is immediate pain or the onset may be delayed up to 48 hours. This implies a more neuro-muscular origin to the pain. The delayed onset improves the prognosis.

The nerves that may be involved include the accessory nerve, the cervical sympathetic chain and the vertebral nerves. There may be a resultant vertebral artery spasm and ischaemic effects on the brain stem. Temporo- mandibular joint function may also be disturbed due to the mechanical forces during the injury.

Very often MRI and CT scans, along with radiographs, are mostly normal as are electromyograms.

Progress of Symptoms
Most patients recover within about two months but in a significant minority the symptoms may continue for years or indefinitely.

Headache
Headache is a common pain experienced after whiplash injury. This may be caused by muscle contraction or tension but it may be secondary to other tissue injury in the cervical spine. The headache may be unilateral and throbbing in nature which suggests a vascular cause. The headaches can resemble migraines or they may be focal and stabbing in nature. Some patients also complain of pain, numbness, tingling, coldness or weakness in one or both arms. Other symptoms include dysphagia, blurred vision, Horner's Syndrome, tinnitus, hearing loss, dizziness, fatigue and cognitive deficiencies. These symptoms may be related to damage of the cervical sympathetic chain.

Low back pain can occur in 42% of accidents and this type of low back pain will often come on several days or weeks after the accident. Data from retrospective studies suggests that persistent symptoms are more likely to develop if the patient has pain or parasthaesia in the arms or if there is evidence of pre-existing degenerative change on X-ray. If there is a reversal of lordosis or if abnormal neurological signs are present, these may also be indicators of a poor prognosis.  

There is increasing evidence that a proportion of victims develop behavioural or psychiatric problems. For example, in a study of 63 whiplash victims with no other injury, 18% had a phobic anxiety at three months and 12% at one year after the accident. 5% had post traumatic stress disorder at one year and 18% suffered from travel anxiety. Compensation did not predict these outcomes.