Whiplash

Whiplash is a mechanism of injury involving acceleration-deceleration forces on the cervical spine (neck) and is almost universally associated with injury after motor vehicle collisions. The impact may result in bony or soft tissue injuries, which can lead to a variety of clinical manifestations termed whiplash associated disorders (WAD).

The forces involved in a whiplash injury force the cervical spine (neck) into a state of hyperextension and hyperflexion. The diagram shows the forces at work during the mechanism of a whiplash injury.

WAD is a term referring an acceleration-deceleration mechanism of energy transfer to the neck.  This can occur through:

  • A rear end or side impact motor vehicle collision
  • A sporting accident e.g. in diving or rugby 

  • Neck pain occurs in 62%-100% of whiplash injuries and is a hallmark symptom
  • Pain can radiate to the back of the head (occiput) and shoulder girdle
  • Headaches occur in 82% of cases
  • Upper back pain occur in 35%- 42% of cases,
  • P&N’s or numbness in the arm/hand
  • Dizziness
  • Other reported, but rare, symptoms include:
    •  Dysphagia
    • Vertigo
    •  Visual and auditory disturbances
    • Cognitive impairment   

In 2005 the CSP produced a set of clinical guidelines for physiotherapists to use when treating WAD patients.  The focus of these guidelines is to provide evidence based treatment recommendations.

  • Gentle exercises to keep the neck moving – highly recommended to help with the patients pain and ensure that the neck does not stiffen up.  It is recommended that active exercises for pain reduction are started within 4 days of injury.
  • Muscle re-education and proprioception – are a specific set of exercises to help the patient understand head-on-neck awareness and imperative if the patient has not received treatment soon after the incident
  • Advice and Management Education
  • Pain control – through the use of medication and TENs
  • Manual Therapy – used for the reduction of pain, increasing neck range of movement and function
  • Soft Tissue Mobilisations– used for the reduction of pain