Whiplash Disorders

This condition will usually present with pain around the neck, upper back and/or shoulder regions, with referral into the arms/hands in some cases. It will usually occur after a road traffic collision but can be seen in a sporting environment, although this is less frequent. Whiplash injuries are caused by a rapid acceleration-deceleration movement of the neck and spine, causing bony/soft tissue damage ⁽¹⁾.

Current evidence suggests that a combined approach of progressive exercise, use of anti-inflammatories and hot/cold packs as instructed by a health professional is most effective in reducing pain and improving function in whiplash injuries in the early stages. Physiotherapy can be beneficial alongside these other treatments however, self-management and use of exercise are encouraged initially ^{(10, 12).}

Whiplash associated disorders are a result of the rapid acceleration and deceleration that the structures in the neck go through. This sudden change of speeds can cause soft tissue sprains to occur in the local structures and cause inflammation. As a protective measure, local muscles will often go into spasm to attempt to limit the movement and function. This can lead to reports of the muscle feeling ‘tight’ and ‘sore’. The tightness stems from a reluctancy for the muscle to be stretched out and lengthened, whereas the soreness is a result of the microtrauma that the muscle fibres have undergone in the accident.

You may find that the feeling of stiffness in the neck is more noticeable in the morning.  This is due to an increase in tone of the muscle whilst you have been asleep and remaining in one position; it is important to keep the neck moving regularly throughout the day to decrease this tone. Towards the end of the day, you may feel an increase in soreness of the neck – this is due to the muscles working harder than usual when they are in spasm and fatigue quicker as a result whilst supporting the head.

A whiplash-associated disorder is most common following road traffic collisions, however, the actual statistics around the number of whiplash injuries per accident is very limited currently.

Literature around prevalence within sporting environments is also lacking currently, however it is known to be far less common within the sporting environment than within a road traffic collision.

Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.

Your treating clinician will want to know how your condition affects your day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made.

As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from your whiplash injury. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference. Key to the recovery of a whiplash associated disorder is self-management; this includes, but is not limited to:

• Engaging regularly with an exercise programme prescribed by your musculoskeletal physiotherapist.
• Activity modification.
• Use of regular painkillers and anti-inflammatories – as advised by a health professional.
• Use of heat/cold as advised by your musculoskeletal physiotherapist or another healthcare professional ⁽⁹⁾.

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.

As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain reliving treatments to support symptom relief and recovery. Whilst recovering you might benefit from further assessment to ensure you are making progress and establish appropriate progression of treatment.  Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.

Alongside whiplash injuries, it is possible that you may experience flashbacks to the accident or anxiety when travelling. Onward referrals to psychologists can be beneficial in recovery, although they can often resolve naturally.

In severe cases, grade IV, surgical intervention may be required, however, these cases are rare.

NHS: www.nhs.uk/conditions/whiplash/

NICE: https://cks.nice.org.uk/topics/neck-pain-whiplash-injury/