Whiplash What is it?
Whiplash is an acceleration-deceleration mechanism of energy transfer to the neck. It may result from rear-end or side-impact motor vehicle collisions but can also occur during sport (diving, snowboarding) and other types of falls. The impact may result in bony or soft-tissue injuries (whiplash injury), which in turn may lead to a variety of clinical manifestations called Whiplash Associated Disorders (WAD). WAD is a good example of a medical condition where there is often an apparent disconnect between the magnitude of injury and the magnitude of disability.
What are its causes?
WAD is considered to be “the most common non-hospitalised injury resulting from a road traffic crash”. The risk that patients develop WAD after an accident with an acceleration-deceleration mechanism of energy transfer of the neck depends on a variety of factors:
- the severity of the impact, however, it is difficult to obtain objective evidence to confirm this.
- neck pain present before the accident is a risk factor for acute neck pain after the collision.
- women seem to be slightly more at risk of developing WAD.
- Age is also important; younger people (18-23) are more likely to file insurance claims and/or are at greater risk of being treated for WAD.
How can physiotherapy help treat whiplash?
Management approaches for patients with WAD are poorly researched. Very often these patients do not fit into treatment categories as defined for other cervical pain problems due to multiple factors, and even within the WAD group, there are multiple variances which warrant individualized treatment approaches. A whiplash-associated disorder is a debilitating and costly condition of at least 6-month duration. Although the majority of patients with whiplash show no physical signs.
Treatment for acute whiplash can be delayed due to multiple social, economic, and psychological factors. Psychological factors such as depression, anxiety, expectations for recovery, and high psychological distress have been identified as important prognostic factors for WAD patients. Education provided by physiotherapists or general practitioners is important in preventing of chronic whiplash and must be part of the biopsychosocial approach for whiplash patients.
The target of education is removing therapy barriers, enhancing therapy compliance and preventing and treating chronicity.
There is strong evidence that to reduce pain, disability and improve mobility in both verbal education and written advice are helpful.
Spinal manual therapy is often used in the clinical management of neck pain. It is not easy to tease out the effects of manual therapy alone because most studies used it as part of a multimodal package of treatment.
There is a difference between a patient suffering from acute whiplash and a patient suffering from chronic whiplash. There is a suggestion that the injury in combination with psychological factors may lead to chronic WAD.
A multidisciplinary therapy with cognitive, behavioral therapy and physical therapy, including neck exercises are effective in the management of WAD patients with chronic neck pain.
When behavioural therapy is used in the therapy, it decreases the patient’s pain intensity in problematic daily activities. Therefore, functional behavioral analyses can be used to adopted for planning and treatment.
There is evidence that exercise programs have a positive result in reducing pain in the short term. Exercise programmes are the most effective noninvasive treatment for patients with chronic WAD, although many questions remain regarding the relative effectiveness of various exercises There is also evidence suggesting that coordination exercises should be added to the treatment to reduce neck pain.
Adjunct to physiotherapy
Some researches have been used a high dose of methylprednisolone but the positive results are distant from the reality. The practice of specific exercises can be useful in patients with this diagnosis.
Consideration of exercise programme
Different types of exercise can be considered for WAD, including ROM exercises, McKenzie exercises, postural exercises, and strengthening and motor control exercises. It is not clear which type of exercise is more effective or if specific exercise is more effective than general activity or merely advice to remain active.
Active treatment which consists of early active mobilization that is applied gently and over a small ROM, and which is repeated 10 times in each direction every waking hour seems to be as effective at reducing the pain after the whiplash injury as on ROM.