Whiplash-Associated Disorders

Whiplash injury, first described by Harold Crowe in 1928, is the most common type of injury following road traffic accidents (RTA). Most patients recover within 2-3 weeks following the injury. Nevertheless, a significant proportion of those with whiplash injury will transition from an acute (0-12 weeks) to a chronic (> 12 weeks post-injury) pain status which makes managing this condition a challenge.

Whiplash-associated disorders (WAD) are defined as an acceleration-deceleration mechanism of energy transferred to the head and neck relative to other parts of the body. This means that there is an abrupt change in speed causing the body to be thrust forward (neck goes into hyperextension) and then backwards (neck goes into hyperflexion) in quick succession, usually resulting from a rear-end or side-impact RTA. However, it is not dependent on the involvement of an automobile, as other mechanisms of injury could also result in a whiplash-type injury such as, skiing and diving.

Most patients with traffic injuries report pain in the neck and upper limb pain. Other common symptoms include:

• Headache
• Stiffness
• Shoulder and back pain
• Numbness
• Dizziness
• Sleeping difficulties
• Fatigue

Patients whose symptoms fail to resolve quickly often exhibit a multitude of symptoms that include, but are not limited to:

• Pain
• Dizziness
• Visual and auditory disturbances
• Temporomandibular joint dysfunction
• Photophobia (sensitivity to light)
• Dysphonia (hoarseness of the voice)
• Dysphagia (difficulty in swallowing)
• Cognitive difficulties such as, concentration and memory loss, anxiety, insomnia and depression

Chiropractic care can help relieve the neuromusculoskeletal symptoms associated with whiplash-associated disorder. This is achieved by exercise therapy which involves prescribing a program of functional exercises that act to stretch tight muscles and then strengthening the weaker ones. Chiropractors also perform manipulation therapy on the neck, shoulder and upper back to correct the misalignments sustained during injury to improve movement in those regions. Passive modalities such as therapeutic ultrasound, high-intensity laser and interferential current therapy can also help in pain and symptom reduction.

Getting a whiplash injury treated promptly is of utmost importance as it can help to prevent the transition from an acute pain status to a chronic one, with all of its associated symptoms. Should a patient be suffering from chronic WAD, chiropractic care still represents a good treatment option, but it is likely that the patient would be co-managed with other members of the healthcare professional depending on what symptoms the patient suffers from.

References

1. BruceBlaus, 2017. File:Whiplash.png. Wikimedia commons [online]. Available from: https://commons.wikimedia.org/wiki/File:Whiplash.png#metadata [Accessed September 2022].
2. Bussières, AE., Stewart, G., Al-Zoubi, F., Decina, P., Descarreaux, M., Hayden, J., Hendrickson, B., Hincapié, C., Pagé, I., Passmore, S., Srbely, J., Stupar, M., Weisberg, J., Ornelas, J., 2016. The treatment of neck pain-associated disorders and whiplash-associated disorders: a clinical practice guideline. Journal of manipulative and physiological therapeutics [online], 39 (8), 523-564.
3. Elliott, JM., Noteboom, JT., Flynn, TW., Sterling, M., 2009. Characterization of acute and chronic whiplash-associated disorders. Journal of orthopaedic and sports physical therapy [online], 39 (5), 312-323.
4. Moore, A., Jackson, A., Jordan, J., Hammersley, S., Hill, J., Mercer, C., Smith, C., Thompson, J., Woby, S., Hudson, A., 2005. Clinical guidelines for the physiotherapy management of whiplash associated disorder: quick reference guide [online]. London: Chartered Society of Physiotherapy.
5. Pastakia, K., Kumar, S., 2011. Acute whiplash associated disorders (WAD). Open access emergency medicine [online], 3, 29-32.
6. Sterling, M., 2014. Physiotherapy management of whiplash-associated disorders (WAD). Journal of physiotherapy [online], 60 (1), 5-12.