Cervical Whiplash Injury
The term whiplash injury is used for a neck injury caused by a sudden movement of the head forwards, backwards or sideways.The injury is also called Whiplash Associated Disorders. Whiplash injury is common in road traffic accidents, and may also be caused by sports injuries, falls or assaults. Most cases of whiplash injury occur as the result of rear-end vehicle collisions. Most of the injuries happen in cervical spine 5 (C-5) and cervical spine 6 (C-6). A whiplash injury from an automobile accident is called a cervical acceleration-deceleration injury. Whiplash associated disorders sometimes includes injury to the brain. The most common areas of the spine affected by whiplash are the neck and middle of the spine. Rates of whiplash are higher in persons using a seat belt with shoulder restraint [than with no restraint], poor posture and poorly-fitted head restraints. Whiplash injury is more common in women than men.
- Sudden or excessive hyperextension, hyperflexion, or rotation of the neck and causes neck pain and other symptoms
- Rear end collision in a motor vehicle is common cause of whiplash injury.
- Injury might also occur in kinematics, roller coaster rides at an amusement park, skiing accidents, airplane travel, or simply from being hit, kicked or shaken.
The pain and other symptoms of whiplash injury may not develop until 6-12 hours or even after a few days.
The symptoms may include:
- Pain in neck and jaw with or without decrease in range of movements
- Tightness in paraspinal muscles muscle tightness and spasm
- Interscapular pain, shoulder pain
- Reduced range of movements and neck tenderness
- Headache, dizziness, vertigo, blurring of vision.
- Numbness, weakness, paraesthesia, sphincter disturbance and increase in relexes in upper limbs and lower limbs in cases of cord injury
- Retropharyngeal [behind the pharynx] swelling and difficulty in swallowing.
- Insomnia, anxiety (general anxiety and/or travel anxiety when in a car) or depression.
Conservative treatment of cervical whiplash injury is the first line of action. This includes physical therapy to reduce inflammation and associated pain. Course of minor injuries is usually self-limited and can be managed by analgesic drugs, neck support like cervical collar and local cold/heat therapy. Other treatments, like ultrasound and massage and exercises may also help. Most cases resolve in a few days. But other neck strains may take weeks or longer to heal.
Physical Therapy Interventions
Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis, and the goals of the patient or client. Common interventions in the treatment of cervical whiplash injury include:
- Manual Therapeutic Technique (MTT): hands on care, including soft tissue massage, and joint mobilization by a physical therapist to modulate pain and reduce any soft tissue or tendon irritation.
- Therapeutic Exercises (TE) including strengthening exercises to improve strength of the muscles in the neck, and increase stability.
- Neuromuscular Reeducation (NMR) to restore stability, begin retraining the neck, improve proximal joint stability and improve movement technique and mechanics in daily use of the neck.
- Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the neck and shoulder.
- Home program that includes strengthening, stretching and stabilization exercises as well as instructions to help the person perform daily tasks and advance to the next functional level.
Procedures that your physician may recommend and perform in addition to physical therapy.
- REST and ICE
- The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
- Steroidal Injections to reduce inflammation
- Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
Most people recover full function following a course of conservative care of physical therapy to strengthen and stabilize the neck. The consequences of whiplash range from mild pain for a few days to severe disability.
Following factors may indicate long-term chronicity and disability:
- A negative attitude
- Fear avoidance behaviour
- Reduced activity
- Not willing to participate in active movement regimen
- Depression, low morale and social withdrawal.
- Social or financial problems.