What is whiplash (Whiplash-Associated Disorder)?
Whiplash is a term describing any injury to the neck and head which involves a sudden acceleration and deceleration, with the neck quickly hyperextending and then hyperflexing. The most common cause of whiplash injuries occur from motor vehicle accidents, more specifically with rear-end accidents. Whiplash-Associated Disorders, or WAD, is usually described as one of four classifications:
- WAD I: neck pain, stiffness & tenderness only
- WAD II: neck pain, and an observable musculoskeletal disorder
- WAD III: neck pain, with neurological signs/symptoms
- WAD IV: neck pain, with a fracture or dislocation
Symptoms will vary depending on the level of injury and classification of whiplash. Common signs & symptoms include:
- Neck pain/stiffness often radiating to the head, arm, & upper back
- Loss of range of motion
- Headaches that are usually worse with movement; associated with neck pain.
Other common symptoms include: vertigo/dizziness, auditory/visual disturbances, hoarseness, fatigue, and sleep disturbances. Research has identified anterior cervical musculature (sternocleidomastoid & longissimus coli), cervical ligaments (including anterior longitudinal ligament), cervical disks and the cervical facet joint capsule as potential pain generators in cases of WAD. Symptoms commonly begin approximately 2 days after the initial trauma, but can even occur weeks after the accident.
How is whiplash examined?
In the majority of low-level WAD, magnetic resonance imaging (MRI) often appears normal and is rarely indicated. Similarly, radiographic imaging has been shown to correlate poorly with signs & symptoms experienced by patients, meaning that x-rays often appear normal or do not correspond with the pain and limitations that afflict patients with WAD. X-rays can be valuable, however, to rule out more serious fractures or dislocations, and it is important to get a thorough check-up by a qualified medical professional following any motor vehicle accident to rule out serious injury, or insults to the vascular structures in the cervical spine.
An examination by a qualified physical therapist at Life’s Work Physical Therapy (LWPT) can help screen for these more serious pathologies through specific ligament and vascular tests. Furthermore, an assessment from a physical therapist will work to determine the structures and extent of damage that are causing pain through an examination of range of motion, muscle performance, and cervical segmental mobility. WAD often affects areas other than just the cervical spine, so your physical therapist will also examine other body regions, including the thoracic spine and upper extremities. Normal mobility of the thoracic spine and shoulders allows for effective and efficient mobility of the cervical spine, and dysfunction in these regions will directly affect the ability of the neck to improve after a whiplash injury (see our blog on “Regional Interdependence” & “Cervical Spine and Shoulder Pain”).
What is the treatment for whiplash?
Acutely, many patients involved in trauma associated with whiplash (i.e. rear end) are advised initially to wear a cervical collar for neck stability and pain-relief until their symptoms begin to stabilize. However, studies show that long term immobilization (greater than 3 weeks) results in no better outcomes when compared to early mobilization of the neck. Therefore, an examination by a physical therapist will help determine the best course of action for your condition and get you on the best track towards recovery. It is recommended that early and active mobilization is critical for a quick return to normal function, but determination on the amount of activity is dependent on the individual circumstances based on the extent of trauma from the accident.
Once evaluated by a physical therapist at Life’s Work PT, treatment usually begins by attempting to reduce muscle guarding, improve joint mobility, and normalize range of motion. This is generally achieved through soft tissue work, passive and active range of motion, and joint mobilizations. Therapists at Life’s Work PT are trained in the assessment and treatment of specific segmental mobility issues of the cervical and thoracic spine through joint mobilization and manipulation. Research indicates that manipulation of the thoracic spine is highly effective at reducing pain and improving mobility dysfunctions of the cervical spine. Similarly, care is taken to treat shoulder girdle and upper extremity mobility and strength imbalances, as a high correlation has been shown between scapular dysfunction and neck pain.
Lastly, treatment is focused on postural retraining to improve spine alignment and positioning. This involves specifically retraining and strengthening muscles in the back, neck, and shoulder girdle. Most patients with WAD participate in a deep neck flexor (DNF) training program aimed at improving postural endurance and maintenance of the cervical stability musculature.
If you have been involved in an accident or are experiencing any of the symptoms mentioned above that are affecting your functional activities, please contact Life’s Work Physical Therapy today to schedule an hour-long evaluation with one of our skilled therapists!