Judy Hattle MCSP
Carlisle Physiotherapy & Sports Injury Clinic.
Whiplash Injuries and
Rehabilitation.
The Injury
Occasionally this injury occurs as a result of
sporting trauma, but more often it is a consequence
of an RTA. The more correct term for this type of
injury is a deceleration injury because it is often
caused by the head decelerating in relation to the body,
causing damage to the soft tissues of the neck.
The damage caused will depend upon whether the passenger
was involved in a head-on or a rear-end collision. In a head-on
collision, the neck and head continue to move forward whilst
the body is stopped suddenly. The head only stops moving forward when the chin
makes contact with the chest. This has the effect of stretching the structures at the
back of the neck, namely joints, ligaments and muscles.
In the case of a rear-end collision, the head and neck are thrown back in relation to
the body and the stretch is applied to muscles at the front of the neck. Joints at the
back of the neck called facet joints are compressed and can also be damaged.
In either of these two methods of injury, if the force applied is severe enough there
may be damage to the discs in the neck; the nerves from the spinal cord may be
damaged, blood vessels may be damaged and there may even be bone injury.
Both these types of whiplash may be complicated further if there is a rotational force
applied at the same time. Injuries where this occurs tend to take longer to settle and
rehabilitate.
The severity of the symptoms can be related to the force of the impact although
whiplash type injuries can occur with relatively minor accidents.
Judy Hattle MCSP
Carlisle Physiotherapy & Sports Injury Clinic.
Signs & Symptoms
Immediately following the injury the pain may not be too severe. However, the neck
becomes more stiff and painful, usually reaching its worst point the day after the
incident occurs. The pain may also be felt down the back, in between the scapulae
and into the shoulder region.
If the nerves in the neck have been damaged or irritated, the patient may experience
pain, tingling or numbness down the arms as far as the fingertips. The patient may
also experience weakness in the arms and hands, and may drop things like cups. If
any of these symptoms develop or become worse, the patient should return to
accident and emergency or be checked by their doctor.
Other after-effects of a whiplash injury may include headaches, dizziness, slightly red
eyes, facial tingling, hearing problems and throat pain. These are not usually serious,
but the patient should always be checked by their doctor.
Treatment
All whiplash type injuries should be checked by a doctor in the accident and
emergency department. A soft collar is occasionally fitted for whiplash sufferers. This
takes the strain of the weight of the head off the ligaments and muscles of the neck.
The patient should be encouraged to remove this as soon as possible and to start
moving the neck to decrease dependency on it.
In the acute stage, pain-relieving medication prescribed by a doctor is the most
effective form of pain relief. Patients should be encouraged to apply ice packs as often
as every two hours for twenty minutes to reduce muscle spasm and pain.
As soon as pain allows, but within the first 48 hours, the patient should begin moving
the neck. Although this is very uncomfortable at first, these exercises are the best
way of reducing the pain and stiffness that is present and of accelerating the
recovery.
Following a Whiplash injury it is often painful when trying to sleep. Neck pain is
common when the head is rested down if there is insufficient support. Pillows may
need to be adjusted to support the neck allowing the patient to rest the muscles of
the neck and get a reasonable night of sleep.
Judy Hattle MCSP
Carlisle Physiotherapy & Sports Injury Clinic.
Mobility Exercises for the Neck.
As soon as the pain allows, the following exercises should be commenced. These
exercises can help reduce the stiffness in the neck and accelerate recovery.
1. NECK FLEXION Take the chin towards the
chest, then back up to look
forwards.
2. NECK EXTENSION Move the head back gently
and look up to the ceiling,
then look forwards.
3. ROTATION TO THE RIGHT Look over the right shoulder,
then back to looking
forwards.
4. ROTATION TO THE LEFT Look over the left shoulder,
then back to looking
forwards.
5. SIDE FLEXION TO THE RIGHT Look forwards and try to take
the right ear to the tip of the
right shoulder.
6. SIDE FLEXION TO THE LEFT Look forwards and try to take
the left ear to the tip of the
right shoulder.
These exercises should be should be repeated 10 times, 3 to 5 times each day, as
pain allows. Each time the exercises are done, the patient should be able to move the
neck a little further. If the pain becomes worse, the exercises should be stopped
immediately, and a doctor or chartered physiotherapist consulted.
Patients should be encouraged to resume normal activities gradually. They may need
a graduated return to work and sporting activities. They should be warned that as
they increase their activity levels they might have a temporary increase in discomfort.
They should be reassured that this is quite normal and that as their neck gets used to
the activity level the pain will settle again. If this occurs it is helpful to use ice packs
and analgesia as a temporary measure to help settle the symptoms quickly.