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Whiplash: Patient Advice

by Dr Simon Petrides MB BS DO DM-SMed Dip Sports Med FFSEM (UK&I)
Musculoskeletal & Sports Physician | The Blackberry Clinic, Milton Keynes

In the event of suffering whiplash, patients are advised:

  • The sooner you get your neck moving the better
  • The long term prognosis is good.
  • Most whiplash injuries are not serious.
  • If you develop pain a day or two after the accident, that is a sign of a better prognosis.
  • The acute pain usually settles within days or a few weeks.
  • If the neck pain persists for a long time, that does not necessarily mean that it is serious.
  • Resting for more than a day or two usually does not help and may prolong pain and disability.
  • The best results are in people who stay active, exercise their neck and get on with life despite the pain.
  • X-Rays and MRI scans do not normally help in ordinary whiplash injury. If you have a violent accident and your neck is very painful, you should go to Accident & Emergency or see your doctor, just to make sure there is no serious damage. That is particularly important if you have:

1. Been unconscious
2. Disturbed vision
3. Severe muscle spasm and your neck is in an abnormal position
4. Pins and needles, numbness and/or weakness in your arms or legs
5. Any difficulty with balance or walking

  • Painkillers and other treatments can help to control the pain to let you get started on your active management regime.
  • Collars are sometimes given for immediate support but research shows that after the first few days it may delay recovery.
  • Local heat or cold can be used for short term relief or pain and muscle spasm. There is no golden rule - some people will prefer heat and some will prefer cold pack.
  • Most specialists agree that manipulation or mobilisation can help. This is safely done by a qualified osteopath, physiotherapist or chiropractor. You should begin to feel the benefit within a few sessions and there is no value in treatment for months on end.
  • Neck Stretching and Neck Exercises. The following exercises may be helpful:

Neck Stretching: You need to stretch in all directions, forwards and backwards, leaning over to both sides and turning your head to the right and left. Move slowly in one direction then in the opposite direction as far as you feel you can. Repeat about ten times every hour or so. You should avoid rolling your head around.

Shoulder Stretching: Shrug your shoulders while breathing in and then relax them when breathing out. Circle your arms one at a time, backwards and forwards, repeat about ten times in each direction every hour.

Neck Strengthening: Put your hand on the side of your head and apply increasing pressure. As you resist you will feel your muscles contracting. Maintain force for ten seconds and then gradually release.  Repeat other side. Similarly push forwards again both hands on your forehead and then backwards against your clasped hand, behind your head.

Neck Co-ordination: Lie on your back with your head on a thin pillow, push your head backwards into the centre of the pillow whilst still pressing down and looking straight up. Push towards each corner of the pillow in turn without really moving your head - this helps you to learn to control your neck muscles and movements.

If you need extra help, visit a physiotherapist, osteopath or chiropractor who may show you how to do the exercises properly and can advance you through a more intense regime.

  • Avoid anxiety and stress, which can aggravate or prolong pain. If it is a problem then you need to recognise that it is at an early stage and try different management strategies for it. Learning relaxation exercises can help, along with controlled breathing, muscle relaxation and other techniques. Exercise is also an excellent way of reducing stress and tension.

Early Warning Signs of People at Risk of Chronic Pain

  • Belief that you have a serious injury
  • Inability to accept reassurance
  • Avoiding movement due to fear of damage
  • Continuing to rest and avoid normal daily activities
  • Waiting for treatment to help, rather than believing you can help yourself to recover
  • Becoming depressed and anxious regarding the situation

Prognosis
If you are still off work after 3-6 weeks you are at risk of developing a long term problem. There is a 10% risk that you will still be off work in one year's time.

Further Advice

  • Sitting: Choose an ergonomic comfortable chair, get up and stretch regularly.
  • Desk Work: Adjust the height of your chair to suit your desk. Adjust your keyboard and computer screen to comply with ergonomic guidelines. Keep the mouse close to you. Get up and stretch regularly.
  • Driving: Stop regularly for a few minutes' break. Get out of the car to stretch. Make sure your headrest is level with the top of your head, and no more than 2" behind it. Make sure the steering wheel is directly in front of you and that you can hold it comfortably.
  • Shopping: Carry shopping hugged to the body or split the load between more bags. Remember to use a trolley.
  • Daily Activities: Try to avoid repetitive activity and remember to use your arms at or below shoulder level.
  • Sports: Continue with normal sports, as long as it is non-impact. Reduce intensity if necessary. If swimming, try varying the stroke pattern.
  • Sleeping: Find the most comfortable pillow, whether it is an orthopaedic pillow or not. Take painkillers one hour before going to bed.

Don't be an Avoider - be a Coper!
The "Avoider" is frightened by the pain and worries about the progress of the injury. The avoider is afraid that the pain means damage, which it does not. The avoider rests and withdraws from life, waiting for the pain to get better. The "Coper" knows that the pain will get better, does not fear for the future and carries on as normally as possible. The coper deals with pain by being positive, staying active and carrying on with normal life. The Avoiders suffer most, they have pain for longer and have more time off work and they can become disabled. The Copers get better faster, enjoy life more and have less trouble in the long term.  

Source
The Whiplash Book published by TSO (The Stationery Office).