Whiplash-Associated Disorders (Whiplash)
Whiplash-Associated Disorders (Whiplash)
Whiplash and whiplash-associated disorders (WAD) represent a range of injuries to the neck caused by or related to sudden trauma of the neck. Whiplash is commonly associated with road traffic accidents, usually when the vehicle has been hit in the rear; however, the injury can be sustained in many other ways, including falls
Four grades of Whiplash-Associated Disorder were defined by the Quebec Task Force for Whiplash:
• Grade 0: no neck pain, stiffness, or any physical signs are noticed
• Grade 1: neck complaints of pain, stiffness or tenderness only but no physical signs are noted by the examining physician.
• Grade 2: neck complaints and the examining physician finds decreased range of motion and point tenderness in the neck.
• Grade 3: neck complaints plus neurological signs such as decreased deep tendon reflexes, weakness and sensory deficits.
• Grade 4: neck complaints and fracture or dislocation, or injury to the spinal cord.
Whiplash and Neck Pain
Whiplash occurs when your head is suddenly extended backwards and then immediately forwards in a whip-like movement. This can cause some neck muscles and ligaments to stretch more than normal, resulting in neck strain. The common cause is when you are in a car that is hit from behind by another car. Being in a car hit from the side or front can also cause whiplash. There are joint within the neck called facet joint, these can often also become irritated with whiplash.
Whiplash and associated neck pain is very common. About 2 in 3 people involved in car crashes develop neck pain (with or without other injuries). Some people can also have symptoms when the car crash was minor. Even slow car bumps may cause enough whipping of the neck to cause symptoms. Less commonly, whiplash can occur with everyday activities such as jolting the neck when you trip or fall.
Whiplash can often cause pain and stiffness in the neck, ranging in serverity. It may take several hours after the injury for symptoms to appear. The pain and stiffness often become worse on the day after an injury. In about half of cases, the pain first develops the day after the injury. This may be because the inflammation or bruising around a sprained muscle can take a while to build up, often over night.
Mobility issues often result, whereby turning or bending the neck may be difficult.
You may also feel pain or stiffness in the shoulders or down the arms.
Dizziness, headache, blurred vision, or pain on swallowing may occur for a short while, but soon go. Get the area assessed if any of these symptoms persist.
Some people become irritable for a few days and find it difficult to concentrate.
What is the outlook (prognosis) after a whiplash neck sprain?
The outlook is good in most cases. Whereby symptoms begin to improve after a few days. In about 6 in 10 cases, the symptoms are much better or gone within 3-7 weeks. However, it is not unusual to take a few months for symptoms to go completely. In about 1 in 4 cases there is still some pain or stiffness after six months. In a small number of cases, some stiffness or pain may come and go for a long time after the injury..
Treatment for a whiplash and neck pain
Exercise your neck and keep active (mobility exercise)
At first the pain may be bad, and you may need to rest the neck for a day or so. But as soon as you are able to try and prevent your neck from ’stiffen up'. Promote gradual mobility exercises to increase the range. Every few hours gently move the neck in each direction. Do this several times a day.
In the past, some people have worn a neck collar for long periods after a whiplash sprain, and have been reluctant to move their neck. Studies have shown that you are more likely to make a quicker recovery if you do regular neck exercises, and keep your neck active rather than resting it for long periods in a collar.
Painkillers are often helpful. It is best to take painkillers regularly until the pain eases. This is better than taking them now and again just when the pain is very bad. If you take them regularly, it may prevent the pain from getting severe, and enable you to exercise and keep your neck active..
• Paracetamol at full strength is often sufficient. For an adult this is two 500 mg tablets, four times a day.
• Anti-inflammatory painkillers. Some people find that these work better than paracetamol. They include ibuprofen. Other types such as diclofenac, naproxen, or tolfenamic need a prescription. Some people with asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers.
• A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol.
• A muscle relaxant such as diazepam is sometimes prescribed for a few days if your neck muscles become tense and make the pain worse.
• Maintain good posture at all times! Brace your shoulders slightly backwards, and walk upright to reduce muscle imbalances. Try not to stoop when you sit at a desk. Sit upright.
• A firm supporting pillow seems to help some people when sleeping.
• Osteopathy. For manual therapy and advice on neck exercises.
• Driving. To drive safely you must be able to turn your head quickly. It is be best not to drive until any bad pain or stiffness has settled.
• Treatment may vary and you should go back to see a doctor
• if the pain becomes worse.
Damage to the front of the neck, spine or spinal cord sometimes occurs from a severe whiplash injury, if there are any issues with swallowing or server pin and needles going down the arms, you much visit your GP immediately.
Article written by Adam Whatley
Registered Osteopath, Whiplash and neck pain Specialist
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