Whiplash Disorder

• Whiplash Disorder - pathology/anatomy:

  • hyperextension and hyperflexion of the cervical spine following impact. Commonly following road traffic accident, but can occur in sport etc
  • Rapid hyperextension followed by hyperflexion (S shape) of the cervical spine
  • Injury can affect any structure zygapophyseal joints, intervertebral discs, vertebral bodies, and nerve tissue etc
  • need to look out for yellow flags - personality e.g. looking for compensation for the accident
  • need to clear red flags

  
• Whiplash Disorder - Clinical presentation:

  • History & MOI: following road traffic accident, impact activity
  • Subjective: wide variety of symptoms, but commonly report pain in neck, head, shoulder(s), thoracic, interscapular, arm, lumbar region. Can also suffer from headache, dizziness, loss of balance, visual disturbances, paraesthesia, anaesthesia & weakness
  • Objective: Loss of cervical ROM (could be due to acute pain or chronic adaptation), muscle spasm (due to protecting tissue or pain), possible sensory changes, reduced function, may have signs of distress
• Whiplash Disorder - Clinical presentation:

  • Key impairments: pain, reduced ROM of Cervical/Thoracic spine and reduced function
  • Investigations: Dependent on symptoms and presence of red flags - fractures, spinal cord injury, vertebral artery dysfunction
• Whiplash Disorder - Management:

  • Advice and education: pacing, reassurance and education, encourage movement and return to activity
  • Symptom control: Pain management/analgesia, hands on techniques generally kept to a minimum
  • Build capacity: Restore movement of cervical spine, Strengthen cervical spine muscles
  • Return to function: consider return to work and activities/sport, especially if its been going on for 6 months +
  • In later stage monitor mood/levels of anxiety and consider referral to wider multidisciplinary team including referral to pain team
• Whiplash Disorder - Prognosis:

  • one third of people will be recovered at 3 months
  • another third may have persistent low levels of pain and disability
  • final third may have high levels of pain and disability
  • correlation shown between amount of pain immediately after traumatic event and prognosis - high level of pain after event leads to poorer prognosis
• Whiplash Disorder - overall management:

  • clear red flags
  • encourage normal movement whilst controlling pain to try and reassure pts that movement wont cause harm and get pts back to daily activities as quickly as they can without provoking symptoms
  • may also need support from multidisciplinary team to get best outcome