Whiplash is a fairly common
condition that occurs when the neck is suddenly forced forwards and backwards,
usually from motor vehicle collisions. Before 1928, whiplash was sometimes
called “railway spine” as it was used to describe injuries that occurred to
people involved in train accidents. Since 1928, much has been studied and
reported about this condition and in 1995, the term, “whiplash associated
disorders” or WAD, was introduced. The WAD classification of whiplash patients
includes 3 main category (WAD I, II and III) and a few years later, WAD II was
broken into 2 sub-categories (WAD I, IIa, IIb, III). This occurred because some
patients in WAD II took a longer time to heal than others. Here are the basic definitions of WAD I, II,
III:
- WAD I:
Patients have complaints but no objective findings meaning we cannot
reproduce your pain during our examinations
- WAD
IIa: Patients have complaints with objective findings but a normal range
of movement of the neck and no neurological findings (normal strength and
sensation ability)
- WAD
IIb: Same as WAD IIa except here, neck movements are decreased
- WAD
III: Here, neurological abnormal findings (weakness and/or sensation) are
present.
- WAD
IV: Includes fractures and dislocations.
Because of this unique difference, this category is often left out
of the research that uses this category system to determine prognosis of
the WAD case.
This system is very useful as it has
the ability to predict the results in a case long before the conclusion of the
case.
We have discussed the cause of
whiplash in previous articles and what happens when we are hit from behind
unexpectedly. In essence, we cannot
guard against the abnormal forces that occur in the neck as it all happens
faster than we can voluntarily contract our muscles. Also, the myth about no
car damage = no injury is just that – a
myth! In fact, in low speed impacts,
less damage to the car transfers greater forces to the contents inside because
the energy of the force is not absorbed by crushing metal (elastic vs. plastic
deformity).
Symptoms of whiplash vary widely.
Most common symptoms include neck pain and stiffness, headache, shoulder
pain/stiffness, dizziness, fatigue, jaw pain, arm pain, arm weakness, visual
disturbances, ringing ear noises, and sometimes back pain. If symptoms continue and chronic WAD occurs,
depression, anger, frustration, anxiety, stress, drug dependency,
post-traumatic stress syndrome, sleep disturbance, and social isolation can
occur.
Diagnosis is based on the history,
physical exam, x-ray, MRI, and if nerve damage occurs (WAD III), an EMG.
Treatment includes rest, ice and later heat, exercise, pain management and
avoiding prolonged use of a collar.
Chiropractic includes all of these as well as manipulation,
mobilization, muscle release methods, and patient education. Prompt return to
normal activity including work is important to avoid the negative spiral into
long term disability.
