What is whiplash?
What are the common causes of whiplash injury?
Mechanism of InjuryDuring 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 WhiplashPatients 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
- Difficulty concentrating
- Memory problems
- Ringing in the ears
- Sleep disturbances
- Blurred vision
- Weakness, numbness, or tingling in arms and/or legs
What is the prognosis of whiplash?
- 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.
How can Physiotherapy and Massage therapy help whiplash?
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 PhysiotherapyWhiplash 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 TherapyMassage 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 MovementToday, 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 InjuryIt 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 WhiplashThe 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?
Physiological effects of Low Intensity Laser TherapyWith 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
What lifestyle and self-care measures can you do for yourself to relieve acute and chronic neck pain?
First Aid and Anti-inflammatoryPatients 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 MovementPatients 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 PosturePatients 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 MedicationInjections 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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