A whiplash injury typically occurs when a static car is rear ended by another traveling at speed- this causes the car drivers head to be thrown forward then backwards causing a traumatic injury to the neck. It can also occur in contact sports such as boxing, american football and rugby.
Neck Pain may be noticed immediately or in the days following the accident. The area of pain can extend into one or both arms and headaches are common. Parasthesia- tingling and numb sensations in the arms-can also be present.
Whiplash type injuries vary hugely in severity. The severe ones may even get fractures in the neck bones. Generally it is just soft tissue that is damaged. The patient may notice weakness in the neck making it difficult to lift the head off the pillow when getting out of bed. Decreased movement or stiffness is a common feature.
One of the most frustrating thing for whiplash patients is that the injury is “invisible”. A strained wrist or ankle would be visibly bruised and swollen and may be put in a cast – this is very “visible” and people are likely to be helpful and empathetic to the injured patient. It is important to tell your friends and colleagues about your whiplash injury – otherwise they will not know and may expect you to be able to do your normal activities.
Diagnosis is made by taking a history of the injury and examining the head and neck. X rays are often taken to out rule fracture. Remember that x-rays do not show soft tissue[ muscles, ligaments or nerves ]. Just because your x ray is normal does not mean that your neck is undamaged.
Initial assessment will involve a history taking followed by an examination of the neck joints range of motion and muscle strength. A neurological examination of the arms – to test muscle strength and nerve sensitivity may also be undertaken especially if the patient has arm pain , pins and needles or numbness.
Whiplash treatment initially will involve pain management and electrotherapeutc modalities: Interferential therapy, ultrasound, T.E.N.S.,hot or cold packs, Joint mobilisations, myofascial dry needling, massage ,and exercise may be used to help. Biofeedback tools can be useful to retrain some of the deep neck muscles. A temporary soft collar may be prescribed.
Restoration of normal neck movement will be the main aim and manual therapy [massage, myofascial release ,passive intervertebral joint mobilisations] and exercise will be used to attain this. Patients compliance with the physiotherapist in following advise and carrying out prescribed exercises is very important.This will optimize healing and recovery.
The majority of patients recover fully from this type of injury. They return to all their pre-accident sports and activities. Time taken to full recovery varies from weeks to months. In severe whiplash injuries recovery can take longer. Patients with a positive attitude towards recovery that resume their normal activities of daily living tend to recover faster than those who decrease their activity levels.
Generally we would advise patients to return to work and normal activities of daily living as soon as possible. This might mean returning to work part time or to modified duties.
House hold chores will need to be rotated. By this we mean vacume clean 1 room at a time not the whole house in one day. Ironing should be spread out over the week and not done all in one day.It would not be wise to take on heavy DIY or garden projects until recovered.
Chronic whiplash Management
A small percentage can go on to develop chronic pain. We quickly become suspicious of this if patients do not get improvements in pain and stiffness with traditional physio techniques in an appropriate time frame. In this group of patients we teach relaxation techniques and pain management strategies. Further investigations may be indicated such as M.R.I. scans. The Chartered Physiotherapist will liaise with the patients GP to ensure medication is appropriate for pain control. The type of pain medication used for chronic pain is different to that used in the acute stages of an injury.
At Swords physio we aim to get patients self managing their condition with our support. They may need to attend for physiotherapy when exacerbation occurs and once this settles go back to self management.
Home care advise for Whiplash injuries
-sit tall, do not let your chin poke forwards. If possible rest your head against the back of a tall chair.
-gentle exercises,rhythmic exercises into rotation [twisting] are more tolerable than forceful stretching exercises
-use ice for pain control in acute phase [ first 48 hours]
– heat after first 48 hours for muscle relaxation and pain control.[hot showers and microwavable heat packs ]
– use a wireless head set for phone calls. Never cradle the handset between your ear and shoulder.
-avoid prolonged laptop use and prolonged reading . Instead use a desk top computer with a correctly adjusted screen for short periods only.
– if going to the cinema reserve a seat in the center of the theatre that way your neck is not twisted to look at the screen.
_ use a book stand for reading.
– keep your neck in neutral as you sleep using the support of 1-2 pillows. Avoid lying face down.
– keep moving and check your posture every 15 minutes.
– avoid long drives, long movies, long flights and any activity that keeps you fixed in the one position for too long. Remember joints like movement and keeping the neck still for too long will make the neck joints stiff and sore.
With the patients consent we can write physiotherapy reports as requested by solicitors or rehabilitation case managers. We agree costings with insurance firms up front and in many cases the insurance company will pay the clinic directly so the patient is not burdened with the cost of treatment.
We are also familiar with the P.I.A.B. [personal injuries assessment board] paperwork and can prepare reports for it. We welcome referrals from case managers and can help them better understand the impact of the injury on their clients life based on our assessment findings and clinical observations.