Whiplash05 Jun 2014, Posted by Blog in
What is Whiplash?
Whiplash is a relatively common injury that occurs to a person’s neck after a sudden acceleration-deceleration force that causes rapid forward and backward movement of the head and neck, most commonly from motor vehicle accidents. The term “whiplash injury” describes damage to both the bone structures and soft tissues, while “whiplash associated disorders” describes a more severe and chronic condition. Fortunately, whiplash is typically not a life threatening injury, but it can lead to a prolonged period of partial disability.
Over the past 20 years the incidence of reported cases of whiplash has risen dramatically in many Western countries. In British Columbia, whiplash accounts for an estimated 60 percent of all injuries caused by motor vehicle accidents – almost double the world average.
The guidelines are based on the latest research, which supports early and active rehabilitation and a return to normal activities as soon as possible. For instance a prospective randomized clinical trial with 168 patients with whiplash showed that early mobilization using physiotherapy is superior to standard therapy (initial rest, recommended soft collar and gradual self-mobilization) in terms of pain intensity and disability researchers recommended that mobilization using physiotherapy be considered the new adequate standard therapy in acute management of whiplash injury. In another study, 97 patients with a whiplash injury caused by a motor vehicle accident were randomly assigned to four treatment groups: active vs. standard treatment, and early (within 96 hours) vs. delayed (two weeks) treatment. Results showed that active treatment reduced pain more than standard treatment, and that early active treatment was more effective in reducing pain than delayed active treatment. The guidelines also reflect the findings of various systematic reviews. In terms of prognostic factors influencing WAD, two reviews confirm that patients with high levels of initial pain were most likely to experience a prolonged time for recovery. Often mentioned factors such as age, gender and compensation do not seem to be of prognostic value. Another review discusses the significant amount of money being spend on WAD–including the direct economic costs such as legal, medical, rehabilitation, and pharmaceutical expenses, as well as indirect costs such as time off work – and points to recent trends in literature recognizing physiotherapy as an effective treatment for WAD.
The clinical guidelines accept the five-part classification of WAD developed by the 1995 Quebec Task Force on WAD and provide recommendations for levels I to III.
Clinical Classification of WAD
I. Neck complaint of stiffness, pain or tenderness only. No physical signs.
II. Neck complaint AND musculoskeletal sign(s)*
III. Neck complaint AND neurological sign(s)**
IV. Neck complaint AND fracture or dislocation
* Including decreased range of motion, point tenderness.
** Including decreased or absent deep tendon reflexes, weakness and sensory deficits.
The clinical guidelines include four main recommendations consistent with recent literature on optimal treatment outcomes.
1. History Taking
The histories for WAD patients should include the date and events leading to the injury, present symptoms, history of recovery time for past injuries, medical history, medications and treatment interventions, diagnostic tests, current employment history, and coping strategies.
2. Physical Examination
Physical examination should include general observation, examination of movement, stability testing, muscular strength tests, and neurological tests.
Information from the subjective and objective examinations allows classification of the patient’s condition according to the Quebec Task Force classification for WAD. If WAD III or severe WAD II is diagnosed, x-rays should be done. Physiotherapy is not indicated for acute WAD IV (fracture).
4. Treatment Plan
The primary goal of treatment is an early return to normal daily activity and the prevention of a chronic condition. Patient education, exercise prescription and manual (hands-on) therapy are recommended
For more information on Motor Vehicle Injuries, Check out our ICBC Treatment page.