What is whiplash?

Whiplash is a non-medical term used to describe neck pain following an injury to the soft tissues of the neck (specifically ligaments, tendons, and muscles). It is caused by an abnormal motion or force applied to the neck that causes movement beyond the neck's normal range of motion. It is usually caused by a flexion-extension ( foreward-backward) motion of the neck that pulls and strains the neck muscles and ligaments to the point of injury. Neck whiplash is the term given to an acceleration/deceleration injury of the neck. This may cause damage to numerous structures within the neck.

What are the common causes of whiplash injury?

   

Mechanism of Injury

During an acceleration/deceleration injury of the neck, stretching and compressive forces are placed on the joints, muscles, ligaments and nerves primarily at the front and back of the neck. This may cause widespread damage to these structures if the forces are beyond what the tissues can withstand. In an adult this type of injury may result from:  
  • Auto Accidents. Whiplash injuries most commonly occur in motor vehicle accidents whereby the neck is thrown forcefully forwards and then backwards.
  • Contact Sports. This condition is also frequently seen in contact sports, whereby the usual mechanism of injury is a forceful collision with another player resulting in a jolting force to the head and neck.
   

Symptoms of Whiplash

Patients with this condition usually experience a sudden onset of neck pain during the causative activity. However, occasionally patients may experience little or no pain at the time of injury. In these instances, symptoms typically increase over the following 2 to 3 days and may be prominent at night or first thing in the morning.   The pain associated with neck whiplash can be sharp or dull and may increase with movement or sustained postures like sitting at a computer in poor posture. There may be:  
  • Neck pain and stiffness
  • Upper back and shoulder pain and stiffness
  • Headaches, most commonly at the base of the skull
  • Dizziness and light headedness
  • Fatigue
  Some people also experience more severe symptoms and if so, you should seek medical attention immediately:  
  • Difficulty concentrating
  • Memory problems
  • Ringing in the ears
  • Sleep disturbances
  • Irritability
  • Blurred vision
  • Weakness, numbness, or tingling in arms and/or legs
 

What is the prognosis of whiplash?

    Most patients with mild to moderate cases of neck whiplash heal quickly and have a full recovery with appropriate physiotherapy treatment. In these instances, recovery may take weeks to months. In severe cases, recovery may be significantly longer. Patients with severe neck whiplash may also have an increased likelihood of developing degenerative changes to their joints resulting in long term problems with restricted movement and pain. Immediate treatment for patients with neck whiplash is essential to ensure a speedy recovery.   The success rate of treatment in patients varies and is largely dictated by patient compliance. One of the key components of treatment is that the patient rests sufficiently from any activity that increases their pain until they are symptom free. Your healthfx Physiotherapists and Massage Therapists can help educate you about the positions and postures that you should avoid and direct you to our online videos of these corrective positions and posture. Activities which place large amounts of stress on your neck should be kept to a minimum such prolonged sitting, standing or lying in poor posture. Also, included in this are activities which require you to look down such as texting and using hand held devices; activities requiring arms forward such as working on your computer without a keyboard tray,  and repetitive lifting activities. Resting from aggravating activities allows the body to begin the healing process in the absence of further tissue damage. Some of the important steps to take are:  
  • Avoiding hurtful postures and positions such as sitting, bending lifting,
  • Take time off to rest
  • Seek physiotherapy treatment immediately
  • Avoid repeated strains by becoming away of the postures that you maintain during your work and leisure time.
  • Ensuring good quality and quantity of  sleep (8-10 hours) will  improve your healing.
  • Your Physiotherapist can help supervise and monitory your recovery. Rest, proper position, correct activity, progression into exercise, and return to work are things that your Physiotherapist and Doctor can assist you with.
  Once functional movement tests are pain free, a gradual return to activities is indicated, provided there is no increase in symptoms. Your Physiotherapist can assist you in this gradual progression and can help you prevent a more chronic condition.  

How can Physiotherapy and Massage therapy help whiplash?

    Physiotherapy begins with an assessment and often even prior to Physiotherapy, patients see their doctors to rule out serious injury such as spinal fractures.    

Treatment techniques for Whiplash may comprise of:

  • Teach you the positions and postures to avoid and those to correct and minimize stress on your neck and back
  • Instruction on use of an appropriate pillow or collar for sleeping
  • Activity modification advice
  • Ergonomic advice including lumbar support and corrective chairs
  • Use of either ice or heat depending on your injury state
  • Low Light Laser Therapy to enhance the healing process
  • Soft tissue and trigger point massage
  • Manual Therapy techniques such as joint mobilization to restore normal range of motion in facet joints
  • Anti-inflammatory advice
  • Exercises to improve flexibility, strength (particularly the deep cervical flexors) and posture
  • Progressive integration of activity and further development of a personal improvement plan
   

Manual Physiotherapy

Whiplash usually causes facet joint sprains, muscle strains and can vary in intensity. In the first few days of the acute phase of injury, manual therapy treatment consists of soft tissue techniques aimed to reduce pain and headaches,  joint mobilization techniques to regain joint mobility and reduce pain,  and instruction  about the postures to avoid and posture to assume to minimize additional stress.  As inflammation reduces, the focus of manual treatment becomes the restoration of normal range of motion and the affected facet joints are assessed more specifically for individual motion losses. These motion studies involve gentle pressures on your neck at the level of each joint to palpate the slides and glides that occur.  These movements are called the arthrokinematic movements of the spine. During this phase, direct mobilization to the injured facets is performed to restore the natural gliding motions at these joints.  At the same time, Massage Therapy and Low Intensity Laser Therapy are recommended with a gradual return to exercise.    

Massage Therapy

Massage Therapy is very helpful in the recovery of a whiplash injury. In the early stages, the goal of the Massage Therapy is to reduce muscle tone and spasm using gentle Swedish massage techniques. As the symptoms diminish, Massage Therapy becomes more focused and specific to the sub acute stage of healing and to the affected muscles, primarily those of the neck, head, upper back and shoulders. During the final stage of healing deep tissue massage may be introduced , including trigger point and myofascial techniques to restore and increase range of motion, flexibility and mobility.  

How can exercise and physical development help after whiplash injury?

   

Assessment of Functional Movement

Today, individuals are more interested in working harder to become stronger and healthier. A tremendous number of individuals are performing high level activities even though they are inefficient in thier fundamental movements; without knowing it, these individuals may be fitter but have underlying problems. We start with a functional movement screen that looks at some of the essential movement skills for daily living and also for an activity based lifestyle. This information in addition to our previous orthopaedic assessment findings will allow us to develop a personal improvement plan just for you. This plan will have specific goals, be measurable, call you to action, be progressive, and will suggest time lines for success.  During your Physiotherapy sessions, we will monitor and support you progress scientific perspective.      

Rehabilitative Exercise after Whiplash Injury

It is important to regain functional neck range of motion, as well as to strengthen the muscles which help to support the neck and spine. In addition to manual hands on therapy techniques used by our practitioners, exercises to increase range of motion can be performed at home and at Physiotherapy. These include flexion (chin to chest), extension (chin to ceiling), side flexion (ear to shoulder), and rotation (turn head to look over the shoulder). Your Physiotherapist will perform manual therapy techniques to release restrictions and follow up with range of motion exercises in order to maintain this new range of motion. Exercises for maintaining range of motion exercises can help to decrease pain and improve joint health by aiding blood and nutrients in getting to the joint. The next goal following a whiplash injury is to regain strength and correct posture. There are a series exercises to progressively develop optimal posture. Patients will start with simple posture correction exercises that both reinforce good posture, and also stretch and strengthen specific postural muscles. We typically start with active postural correction, exercises that you can do all day long at work and home, and then progress to resistance training using elastic bands and cables to challenge these muscles further. Your Physiotherapist will advise which exercises are appropriate at which point of each patient's treatment and will progress the exercises throughout the course of treatment.    

Physical Development after Whiplash

The final step is to establish a personal improvement health plan to continue to develop physically throughout your life. This is especially necessary after injury or an accident when you have become de-conditioned. All of our staff have a combination of health and sports science training, having dual training in both kinesiology and Physiotherapy, allowing us to provide a biomechanical focus. Once you have recovered from your injuries, our therapists will perform a functional movement screen and analysis to identify individual muscle imbalances that are unique to your inherited structure,  movement patterns, and to your goals and interests in living a healthy physical life. We develop an individualized program that focuses on:  
  • Your specific imbalances and movement patterns at work, home, and those evident during the activities that you participate in.
  • Your structural and genetic posture and alignment characteristics and how they affect your activity
  • Ergonomics specific to your workplace and home
 

How can Low Intensity Laser Therapy help whiplash?

    Low Intensity Laser Therapy (LILT) is the use of monochromatic light. Meditech Bioflex has been producing this technology for 20 years and has an extensive in house clinical lab.   The light source is placed in contact with the skin allowing the photon energy to penetrate tissue, where it interacts with various intracellular biomolecules resulting in the restoration of normal cell morphology and function. This process also enhances the body's natural healing propensities.   Low Intensity Laser Therapy does not heat or cut tissue. Unlike many pharmacological treatments that mask pain or only address the symptoms of the disease, Laser Therapy treats the underlying condition or pathology to promote healing. The technology utilizes superluminous laser diodes to irradiate diseased or traumatized tissue with photons. These particles of energy are selectively absorbed by the cell membrane and intracellular molecules, resulting in the initiation of a cascade of complex physiological reactions, leading to the restoration of normal cell structure and function.   The process is curative and therefore results in the elimination of symptoms including pain. In addition, it enhances the body’s immune system response and facilitates natural healing. The therapy is completely safe and has no adverse side effects. The technology is highly effective in the treatment of musculoskeletal conditions, arthritis, sports injuries, wound healing and a wide range of dermatological conditions. Whiplash injury typically involves strain to muscles, ligaments, and joints and typically involves several levels and a more wide spread area of injury due to the forceful nature of the injury. Muscles of the neck, although short, cross over several joints and so the discomfort is generally more global initially. Laser therapy directed by multiple diodes are able to reach these tissues.    

Physiological effects of Low Intensity Laser Therapy

With LILT there is an increased production and release of:  
  • Endorphins - natural analgesics
  • Cortisol – a precursor of cortisone
  • Growth hormone – instrumental in tissue repair
  • ATP – improves and regulates cellular metabolism
  •  Collagen, DNA, fibroblasts - an increase in protein synthesis
  • A facilitated venous and lymphatic flow
  • Increased angiogenesis – the elevation of oxygen saturation
  • Enhanced immune response
  These responses are some of the many processes that accelerate cellular regeneration (cartilage, epithelium) and restore normal cell morphology and function. Treatments are typically 25 minutes to over 1 hour depending on the condition and area being treated   The most popular technical / clinical information requested is available on the Meditech website under Laser Reports. You may visit the Meditech website research section directly for detailed abstracts, case profiles and articles on a variety of topics relating to the use of low intensity laser therapy in the treatment of various medical conditions.      

What lifestyle and self-care measures can you do for yourself to relieve acute and chronic neck pain?

   

First Aid and Anti-inflammatory

Patients with neck whiplash should follow first aid principles in the initial phase of injury. The regime is beneficial in the first 72 hours following symptom onset or when inflammatory signs are present (i.e. morning pain or pain with rest). For patients with this condition, rest from aggravating activities, maintaining optimal posture and support, and applying  cold and ice over painful areas for 10-15 minutes every few hours is helpful. Anti-inflammatory medication may also hasten the healing process by reducing the pain and swelling associated with inflammation.    

Early Movement

Patients with this condition should perform early movement and postural exercises to prevent stiffness from developing and to ensure the neck is functioning correctly. The treating physiotherapist can advise which exercises are appropriate and when they should be commenced.    

Good Posture

Patients should also pay particular attention to maintaining good posture as much as possible to minimize stress on the neck. This is particularly important when sitting or driving. Optimal sitting posture can be obtained by sitting tall on an appropriate chair, with your back against the support of the chair and a pillow or rolled up towel for lumbar support positioned in the small of your back. Your shoulders should be back and your chin should be tucked in slightly.   Patients with whiplash should avoid maintaining poor posture in any position, as this places considerable stress on the neck. This may rapidly aggravate the condition.    

Medicine and Injections of Medication

Injections of medications may help relieve neck pain in the chronic state, however, this symptomatic approach may not get to the root of your problems.  

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