Whiplash injury is a frequent consequence of a rapid and uncontrolled forward and backward movement of the head and the neck as a result of a sudden forceful acceleration-deceleration force. The most common cause is motor vehicle accidents. The resulting injury is to the neck, including both the bone and the soft tissue. Sometimes a whiplash injury can lead to a whiplash-associated disorder (WAD) which is a more persistent and more serious health issue.
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Whiplash is not commonly dangerous but can result in a long time of recovery due to loss of normal function. In some cases the symptoms will persist for years after the trauma, as is seen in a few patients following even a minor vehicle collision. Mostly, however, recovery is rapid and complete.
The most common situation in which whiplash occurs is when the car in which the victim is stationary and is hit by another vehicle from the back. This means the person’s head and neck first jerk backwards due to the forward impact upon the seat, which throws the torso forward causing the head and neck to fall into hyperextension. Almost immediately they then recover and fall forward.
WAD is so named because the neck as well as the shoulder and back are affected by the injury. Another disorder known as shoulder impingement syndrome is also seen after a vehicle accident, though the reason is not known. With this condition, it is difficult to sleep on the affected side or to reach up above the head or behind the back.
Anatomy of whiplash and WAD
The spinal column protects the spinal cord which is a large bundle of nerves leaving the brain and supplying nerves to the rest of the body. This transfers information between the brain and the body in a two-way fashion. It lies inside the spinal column, which is made up of a stack of flat roughly circular bones called the vertebrae, separated from each other by narrow fibrous discs attached to the top and bottom vertebrae of each pair. The vertebrae are bonded by strong ligaments of tough connective tissue as well as by muscles. The bones, connective tissue and muscle all operate in unison to support and shield the spinal column which in turn protects the spinal cord.
Treatment of whiplash and WAD
Exercises to improve the range of movement
Early initiation of range of movement (ROM) exercises following a whiplash injury is associated with better recovery in terms of faster and more frequent decrease in symptom intensity. The exercises often mean rotating the neck and head carefully in a specific manner about 10 times an hour. They are started only when the medical professional judges the person ready to do them without further aggravating the injury, generally within about 4 days following the accident or cause of injury.
This type of treatment helps make the muscles around the spinal column stronger, thus relaxing the neck and preventing pain during movements. It may also include occupational therapy which focuses on helping the individual function well at work after an injury.
Heat and ice packs
While both ice and heat packs are great to reduce pain, ice is generally used for only 5-10 minutes in the early stage of injury, followed by 10-20 minutes of heat pack application. This helps control the inflammation around the neck spine. The packs (of whichever type) must be wrapped in a towel to prevent direct contact with the skin which could cause burning, which is always a possibility when using this type of therapy.
Just pottering about at home for a few days and letting the body heal itself is a good way to deal with whiplash. However, if the pain and other symptoms persist even after a few days, the affected person should definitely have things evaluated by a health professional.
Electrotherapy and other pain relief modalities
There are many ways to relieve the pain and spasticity of muscles affected by a whiplash injury, such as ultrasound, electrotherapy, TENS (transcutaneous electrical nerve stimulation), interferential therapy and acupuncture.
Chronic neck pain may often indicate life stresses, and these should be identified and the underlying causes dealt with before the neck pain resolves. Psychotherapy and cognitive behavioral therapy are two approaches that may help with this issue. It is important to bring out and deal with stressors, emotional damage, anger, depression or mental trauma even if they occurred long ago.
This mode of therapy should be considered if the symptoms last over 4 weeks past the date of injury, and must be done only by an osteopath or a chiropractor. They perform what is called a spinal adjustment to manually restore or enhance the mobility of the spine. While this treatment typically involves the use of some force, and may be followed by spinal pain to the touch for another 2-3 days afterwards, it can improve the symptoms to a noticeable extent in many cases.
After a whiplash injury, the site of injury must not be immobilized as with a neck collar, because this only makes the muscles go stiff and impedes normal healing. The aim of treatment in whiplash injury is to help restore the normal mobility of the neck. A collar should therefore be worn not longer than 24 or at most 48 hours, and for the best improvement it should be removed as soon as the symptoms start to show a positive change.
The individual with whiplash should return to normal work and even to the workplace as soon as possible to avoid delay in recovery.
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