What is whiplash?
Whiplash, or whiplash associated disorders are a group of symptoms that occur when a sudden, unexpected force moves through your spine as a result of rapid acceleration or deceleration.
What causes whiplash?
The most common cause of whiplash is a motor vehicle accident but it may also result from occupational and sporting incidences. In the case of a motor vehicle accident, it occurs most commonly when a vehicle is hit from behind by another vehicle, but injury can happen with an impact from any direction. When hit from behind, the energy of the back vehicle is passed to the front vehicle and also to its passengers. The size and speed of the vehicles involved will determine the amount of energy that is transferred which in turn will have an impact on the risk and severity of a whiplash injury.
At the initial impact the neck bends backwards causing a compressive force to the back of the neck vertebrae. This is followed immediately by the neck bending forwards, applying a stretching force to the back of the neck. These abnormal movements happen extremely quickly and may cause injury to one or more of the structures of the neck, including the vertebrae, joints, muscles, blood vessels, ligaments, nerves, dura and discs.
Symptoms of whiplash
A whiplash injury may cause a variety of symptoms. In the case of a mild whiplash injury one may just experience a sensation of stiffness in one’s neck for a few hours or days. With more severe whiplash injuries one may experience other symptoms such as neck pain (which may also radiate into the head, shoulders, arms or down the spine), limited neck movements, headaches, nausea, dizziness, loss of balance, pins and needles in the upper limbs, weakness, difficulty concentrating, double vision and impairment of memory.
What causes the pain?
It is not always possible to pinpoint an individual structure as the cause of pain, especially in the case of a motor vehicle accident. Injury to any of the muscles, ligaments, joints or discs may cause pain. One’s symptoms often seem to worsen over the first two days as the muscles spasm to protect other injured structures. This is a normal response to an injury.
How long will it take to get better?
The recovery time is different for each person. This is dependent on a number of factors, such as the extent of the injury, treatment received and one’s attitude towards the injury. Most patients recover within 3 months of the injury.
What medical treatment is required?
If a person complains of one or more of the following symptoms: extreme neck and/or arm pain, difficulty breathing, difficulty swallowing, pins and needles or numbness of their upper limbs or all four limbs, severe dizziness and difficulty supporting the weight of their neck, they must be handled with care. Their neck must be supported by a hard collar and they must be taken immediately to a hospital casualty unit to be examined by the casualty doctor. X-rays will be taken of their neck to determine whether they have sustained any ligament or bony trauma. They may require other medical investigations before a decision is made on their treatment.
Fortunately the majority of whiplash injuries are mild to moderate in severity and one will recover, given time and the appropriate treatment. Treatment for whiplash injuries usually includes pain and anti-inflammatory medications and physiotherapy.
Physiotherapists play an important role in educating a person who has suffered a whiplash injury. The person will be able to facilitate their own recovery if they have a good understanding of the injury and aims of treatment. At the first consultation the physiotherapist will examine the person in order to determine the appropriate treatment programme for them. One should always inform the physiotherapist of all the symptoms one is experiencing, even if they seem unimportant, as these symptoms give clues as to the treatment required.
In the early stage of recovery the physiotherapist may use various techniques and electrotherapy to reduce the person’s symptoms and allow healing to occur more rapidly. Studies have shown that effective pain management in the first three weeks after a whiplash injury is important to achieve a good outcome. The physiotherapist will suggest gentle mobilising exercises to improve the person’s range of neck motion.
During the later stage of recovery the physiotherapist will progress the person’s exercise programme as is necessary. The purpose of some of the exercises is to mobilise the different tissues of the neck such as the muscles, joints, neural and connective tissues. Other exercises are designed to improve the strength and endurance of the postural muscles of the neck and shoulder area. Good muscle function is important to decrease the risk of recurrent neck symptoms.
What can one do to recover effectively?
Self-discipline is essential during the early stage of recovery. It is important to pace one’s activities i.e. maintain a balance between rest and activity to manage one’s symptoms and prevent an exacerbation. In severe cases it may be advisable for the person to take some sick leave and decrease their other activities of daily living until their symptoms have subsided. Complete rest is not usually advocated. In milder cases a person might need to modify their work and other activities for a period of time. The physiotherapist will guide the person as to what level of activity is safe. Certain activities such as contact sports and heavy weight lifting may need to be avoided for a number of months depending on the severity of the whiplash injury.
How can the severity of whiplash in motor vehicle accidents be reduced?
It is important to remember that the severity of whiplash injuries sustained in motor vehicle accidents may be dramatically reduced if seat belts are worn by all occupants at all times and head restraints are correctly positioned.