Whiplash and Whiplash Associated Disorder
A whiplash injury is often caused by traumatic sports injuries, falls, or motor vehicle accidents, when a back-and-forth movement of the neck occurs forcefully and rapidly. It is defined as an acceleration-deceleration mechanism of energy transfer to the neck and head. [1] This high impact force may cause bony or soft tissue injuries in the cervical spine (neck), with most evidence currently supporting the involvement of cervical facet joints (See our neck pain post) causing neck pain. [2]
The term Whiplash Associated Disorder (WAD) describes the presentation of symptoms associated with a whiplash injury, with neck pain as the leading complaint. [1] The Quebec Task Force (QTF) establishes different grades of WAD used to medically classify people who have sustained whiplash injuries and help manage treatment better. These grades are based on the severity of symptoms, ranging from stiffness and tenderness to a fracture or dislocation of the neck. [3]
Chronic WAD
Chronic WAD can be a major disability, which can prevent people from enjoying their normal daily activities. Most sufferers return back to usual activities within a few weeks and half will resume usual activities within a month even though they have not fully recovered yet. Only a small percentage cannot return to work or normal activities within a year [4].
Predisposing factors for developing chronic WAD are being female and middle-aged experiencing neck pain prior to the incident and high psychological stress. [5] It is also predicted that those who have persisting symptoms for 3 months after the incident may be likely to experience discomfort for at least 2 years or even more. This all means that both physical, as well as psychological factors have to be considered during management of WAD. [6]
A Physiotherapeutic Approach
A thorough assessment should be done to rule out any “red flag” conditions like a fracture or dislocation of the cervical spine; identifying any sensory impairments; evaluating sensorimotor control, cervical range of motion and muscle recruitment patterns in the neck and shoulder region. [7]
Adopting a biopsychosocial approach is important to address all domains of the patient’s life – not just at the injury level, but also in the work environment, or if there are areas of anxiety or psychological stressors the patient is facing, as all these factors contribute to recovery.
An important approach towards management is to use cognitive behavioural therapy, which focuses on addressing negative beliefs about recovery, and how to remain positive and constructive throughout the recovery process. Teasell (2010) proposed that reassurance is vital in preventing WAD patients from falling into chronicity. [8] The person is also encouraged to keep generally active and make time for self-care activities to reduce mental stress [4]. Keeping a positive attitude and avoiding using the injury as an excuse to get attention and sympathy would have a positive effect towards recovery [4].
A multinational research team comprising of Swedes and Australians found that a group which had a physiotherapist-led neck-specific exercise program with a behavioural approach (NESB) saw improved neck disability scores more than a group which performed unsupervised individualised exercises, at both 3 and 6 month follow-ups [9]. Improvements in factors other than neck disability (current pain, pain bothersomeness, self-efficacy) were similar between both groups at the 6 month follow-up – however, the researchers found that the participants in the unsupervised physical activity program used significantly more painkillers than the supervised group at both 3 and 6 months follow-ups.
Treatment Options
Although the use of pain medication may help alleviate pain in the first few days, prolonged usage of painkillers and muscle relaxants may be harmful as they reduce the threshold for pain tolerance in the longer term [4]. The use of manual mobilisation may be helpful in the beginning, but is not recommended as a long term treatment. [4] Passive therapies such as ultrasound, hot/cold pack, acupuncture, massage, electrostimulation, magnets and laser therapy were also not effective [4]. Early exercise therapy is superior to using a soft collar in terms of reducing pain intensity and disability. [11]
In conclusion, staying active early and engaging in physical activities, be it supervised or unsupervised, is very important in helping one recover from WAD. Prolonged rest and passive therapies are discouraged. It is equally important to have a positive outlook during the course of recovery to prevent WAD sufferers from falling into chronic pain.
Download a free practical guide to management of whiplash here: Practical management of whiplash: a guide for patients.
Download a free recovery booklet for whiplash injury here: Whiplash injury recovery: a self-help guide.
References
- Anderson C, Yeung E, Tong T, Reed N. A narrative review on cervical interventions in adults with chronic whiplash-associated disorder. BMJ Open Sport Exerc Med. 2018;4(1):e000299.
- Siegmund GP. 2002. The biomechanics of whiplash injury. BCMJ. 44(5). 243-247.
- Sterling M. (2004). A proposed new classification system for whiplash associated disorder- implications for assessment and management. Man Ther. 9(2). 60-70.
- Allen, M. (2012). A practical management of whiplash: a guide for patients. BCMJ, Vol. 44, No. 6, July, August 2002, pp 317-21.
- Carstensen TB. 2012. The influence of psychosocial factors on recovery following acute whiplash trauma. Dan Med J. 59(12). B4560.
- McClune T. et al. (2002). Whiplash associated disorders: a review of the literature to guide patient information and advice. Emerg Med J,19, pp 499–506.
- Jull G. et al (2008 p.110) Whiplash, Headache, and Neck Pain. Churchill Livingstone: United Kingdom.
- Teasell RW. et al. (2010) A research synthesis of therapeutic interventions for whiplash-associated disorder: Part 1- overview and summary. Pain Res Manag. 15(5). 287-294.
- Ludvigsson ML,Peterson G,O’Leary S, Dedering Å, Peolsson A.The effect of neck-specific exercise with, or without a behavioral approach, on pain, disability, and self-efficacy in chronic whiplash-associated disorders: a randomized clinical trial. Clin J Pain. 2015 Apr;31(4):294-303.
- Motor Accidents Authority (2001). Guidelines for the management of whiplash associated disorders. [Online] Available at: http://www.whiplashprevention.org/SiteCollectionDocuments/Research%20Articles/Medical%20-%20Whiplash/GuidelinesDiagnosingWhiplash.pdf [accessed on 21 February 2017]
- Schnabel M. Ferrari. R. Vassiliou T. Kaluza G. (2004) Randomised, controlled outcome study of active mobilisation compared with collar therapy for whiplash injury. Emerg Med J. 21(3). 306-10.
Send us a message:
