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Whiplash - Not Just From Cars

car crashA whiplash injury can result in a neck 'sprain' when your head is suddenly jolted backwards and forwards in a whip-like movement, or is suddenly forcibly rotated. This can often cause the neck muscles and ligaments to stretch beyond their normal range, known as a 'sprain'. Symptoms may not always be immediate and can even be delayed for hours or days after the injury.

Rather than just a simple sprain to the muscle and ligaments of the neck, research suggests that during a road traffic accident involving a rear-end shunt, the neck curves in an abnormal S-shape which can alter normal neck movement. Normally, the joints at the back of your neck glide over each other and are self-lubricated, but a whiplash injury forces them together, potentially damaging the surrounding area, which can include nerves, muscles, ligaments and discs.

There are tiny receptors in the ligaments around the neck called proprioceptors. These relay information to your brain about the position of the joints. If these structures have been damaged due to whiplash, you could experience dizziness, nausea or light-headedness. The most common symptoms may also include:

  • neck pain (88-100% of cases)
  • headaches (54-66% of cases)
  • radiating pains to the head, shoulder, arms or inter-scapular region
  • generalised increased sensitivity
  • fatigue
  • poor concentration

Not just car accidents

Whiplash is also known as an acceleration/deceleration injury and needs not always be the result of car accidents. In fact, you do not have to hit your head or neck – a sudden movement from a fall may cause injury. Welders, for example, may also suffer whiplash-type symptoms as a result of repetitive 'nodding down' their masks more than 50 times in a day. Head-bangers at music concerts have been known to suffer too!

Evidence-based Treatment

The outlook for whiplash (WAD) is usually encouraging. However, some people may present with varied, prolonged and disabling symptoms. There is evidence to suggest that manual therapy treatments are more effective than passive ones, such as exercise only treatment. Therefore, treatment should aim to promote activity, relieve pain, improve function, empower the patient and ensure return to work as quickly as possible to prevent chronic pain.

A recent study showed that appropriate management of WAD could improve pain, function and regain movement. Chiropractors, Physiotherapists and Osteopaths can utilise a wide range of treatment techniques to aid recovery, including manual therapy, exercise, soft tissue massage, patient education and reassurance. Treatment should be tailored specifically to individual cases, using the most up to date research and guidelines in order to provide patients with the best possible standard of care.

A review of the best evidence available strongly supports this, concluding that mobilisation and manipulation combined with exercises are more effective than stand-alone physical treatments. It has also been suggested that prolonged use of soft collars, rest, or inactivity may actually prolong disability.

Whiplash in the News...

A recent report by a House of Commons Select Committee, stating that the cost of car insurance could be dramatically cut if the government took action to place restrictions on whiplash claims, comes amidst a growing sense of a compensation culture without limits. Indeed, a survey by LV= car insurance that found up to 60% of GP's reported a rise in patients attempting to make fraudulent claims for road injuries in the past two years.

However, many people who are involved in road accidents do suffer genuine problems and many associations like the British Chiropractic Association, Chartered Society of Physiotherapy and the British Osteopathic Association are calling for better diagnosis and patient management of whiplash associated disorders.

As regulated professionals, Chiropractors, Physiotherapists and Osteopaths are well placed to provide a diagnosis of musculoskeletal problems arising from car accidents, providing timely and effective patient management. This not only gets patients back to 'normal' as quickly as possible, but can also save on treatment costs, thus reducing the overall cost to the insurers.

WAD should be assessed by a specialist such as Chiropractor, Physiotherapist, Osteopath, Musculoskeletal Doctor or your GP. Your specialist will then provide you with a tailor made treatment plan for your problem, and if necessary refer you for further investigations or scans.

If you are concerned about any of the above, book an appointment with one of our clinicians for a consultation.

Contributing Authors:

Shelley Doole DC MChiro

References

Binder, A. (2007a) The diagnosis and treatment of nonspecific neck pain and whiplash. Europa Medicophysica 43(1), 79-89.

Hurwitz, E.L., Carragee, E.J., van der Velde, G. et al. (2008) Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. European Spine Journal 17(Suppl 1), 123-S152.

CKS Clinical Knowledge Summaries (2011) Neck Pain- Whiplash Injury. NHS Evidence. Accessed 20th March 2012 [Online]

http://www.cks.nhs.uk/neck_pain_whiplash_injury/management/scenario_late_whiplash_syndrome

Shaw, L., Descarreaux, M., Bryans, R. et al (2010) A Systematic Review of Chiropractic Management of Whiplash Associated Disorders: Recommendations for Advancing Evidence-Based Practice and Research, 35: 369-394.

Chartered Society of Physiotherapy (2011) Clinical Guidelines for the Physiotherapy Management of Whiplash-Associated Disorder (WAD). Accessed 20th March 2012 [Online]

http://www.csp.org.uk/publications/clinical-guidelines-physiotherapy-management-whiplash-associated-disorder-wad

Disclaimer: This blog offers advice only, if you are unsure of your own circumstances, you are advised to check with a medical professional.