WHIPLASH – CAUSES AND TREATMENT

Whiplash is a non-medical expression used to describe relatively common injuries caused to a human’s neck because of sudden and unrestrained forward and backward movement of neck and head after a rapid acceleration-deceleration force. This type of injury is usually a result of motor vehicle accidents. This type of neck injury affects both soft tissues and the bone structure of the neck. Whiplash associated disorders is a term used to describe a more chronic and severe condition. Typically, whiplash is not a life threatening injury but it might lead to a partial disability for a long time. Most of the people who sustain such injuries might not experience such long term pains but some might experience pains even after years of the accident.

Causes

The most common cause of a whiplash injury is a motor vehicle accident especially when a person is in a static car and is hit from behind by another vehicle in motion. After sustaining a rare impact, the lower bones of the neck (lower cervical vertebrae) go into a hyperextension position while the upper bones of the neck (upper cervical vertebrae) are hyperflexed. These movements cause the cervical spine to assume an abnormal S-Shape. It is this abnormal movement that damages the soft tissues that hold the muscles, facet capsules, and ligament of the cervical vertebrae together. Severe impact can also cause several other injuries to the nerve roots, cervical muscles, ligaments, discs, and intervertebral joints.

Symptoms

The most common symptom of whiplash is muscle stiffness and pain in neck. The symptoms largely depend on the severity of the injury but the symptoms and signs may include:

·         Swelling in neck

·         Difficulty in rotating, extending, or flexing the head

·         Difficulty in chewing due to tightness of jaw

·         Fatigue

·         Disturbance in sleep

·         Trouble concentrating

·         Headache

·         Back pain

·         Tinnitus (ringing in ear)

·         Visual disturbance

·         Weakness in arms

·         Pain in arms

·         Dizziness

The more chronic and severe case of “whiplash associated disorder” may include the following symptoms:

·         Insomnia (disturbance in sleep)

·         Post traumatic stress disorder

·         Dependency on drugs

·         Stress

·         Anxiety

·         Frustration

·         Anger

·         Depression

Treatment

The treatment of whiplash injury depends upon the symptoms present in the patient. The most important factor in managing and treating whiplash is to educate the patients about their condition. This would include knowledge of the cause, possible treatments, and their outcomes. Patients should understand that this is not something that they can simply ignore, but that almost all the patients fully recover. Patients who are not well aware of the situation might develop severe “whiplash associated disorder.”

In the past, the initial cure for whiplash was usually a soft cervical collar that the patient had to wear for several weeks. The aim was to control the range of motion of the neck in order to avoid any additional injuries. But after more recent studies, it became evident that immobilization of neck for a long time can slow the process of healing. In case there is no evidence of abnormal alignment of the spine, then early range of movement is advised.

Patients who are treated with exercises for early range of motion have exhibited rapid improvement, and more reliable improvement in all their symptoms. On the other hand, decrease in the range of motion leads to increased stiffness and pain. Immobilization may also cause decrease in the blood flow to the injured soft tissues, muscle atrophy, and healing the muscles in shortened range which makes that less flexible. 

Physical therapy can also be very useful to aid patients wean from a cervical collar and to help them strength their muscles. Occupational therapies can also be used to help patents return to their work environments. 

In case the patients start to develop psychological symptoms such as depression, anxiety, and anger after sustaining the injury then it is advised that the emotional condition should be promptly treated. This will help patients understand their chances of complete recovery and will also reduce their chances of developing chronic symptoms. 

Factors That Can Affect the Prognosis of Whiplash Injury

Following are some of the risk factors that can influence the prognosis of this injury:

·         The symptoms and pain of Whiplash persisting beyond the duration of 6 months.

·         Significant joint capsule, nerve, disc and ligament injury.

·         Patient being older than 65 years of age.

·         Need to restart treatment due to more than one bout of pain.

·         Delay in starting the treatment.

·         Injury was sustained in a small car.

·         Head restraint was more than 2” far from the head of occupant.

·         The occupant was under the influence of alcohol at the time of the accident.

·         The occupant already had a previous whiplash injury.

·         Pre-existing evidence of degenerative changes.

·         Use of cervical collar for more than 2 weeks.

·         Initial radicular (tingling, numbness, arm pain) symptoms.

·         A previous fusion cervical spine.

The symptoms of the injury may appear in 2 to 3 days of the injury or immediately after it. 

For more information on Dr. Joseph Mills, visit: www.westhillspaincenter.com or call: 631-659-2980

References

Cunha, J. P. DO, FACOEP. Whiplash. Retrieved from <http://www.emedicinehealth.com/whiplash/article_em.htm>

Eck, J. C. DO, MS. Whiplash. Retrieved from <http://www.medicinenet.com/whiplash/article.htm#whiplash_facts>

Murphy, D. DC. What is Whiplash? Retrieved from http://www.spine-health.com/conditions/neck-pain/what-whiplash