Physiotherapy treatment of whiplash injuries Written by Helen David – OMPTG member What is a whiplash injury? “Whiplash” is a term that is used to describe the injury that occurs when rapid acceleration - deceleration forces are applied to the head and neck area. Whiplash injuries are commonly associated with motor vehicle accidents but can also occur in occupational and sporting incidents. The impact of the accident may result in soft tissue and bony trauma to the neck, which may in turn cause a variety of symptoms. The extent of the trauma is dependent on the mechanism of the injury and on the severity of forces applied to the head and neck area. In the case of a mild whiplash injury, the person may just experience a sensation of stiffness in their neck for a few hours or days. With more severe whiplash injuries the person may experience other symptoms such as neck pain, limited neck movements, headaches, nausea, dizziness and paraesthesia (a sensation of “pins and needles” or numbness) in their upper limbs. How should whiplash be treated? It is advisable for a person who has sustained more severe whiplash trauma to be examined by their general practitioner or medical staff at a hospital casualty department. X-rays should be taken of their neck to determine whether they have sustained any ligament or bone injury. They should be handled with care if they present with any of the following symptoms: severe neck and/or arm pain difficulty breathing and/or swallowing paraesthesia of the arms or of the arms and legs dizziness difficulty supporting the weight of the head If the traumatic incident is severe, or if any of the above symptoms are present, the patient’s neck should be immobilised with a hard collar and they must be transported immediately to a hospital casualty department. The person may need to be examined by a medical specialist such as a traumatologist or a neurosurgeon. The specialist will decide whether the person’s neck injury requires further medical investigations or treatment (medication, hospitalisation or surgery). Only a small percentage of people suffering a whiplash injury require surgery. Fortunately the majority of whiplash injuries are mild to moderate in severity and the person will recover, given time and appropriate management. Optimal healing will occur with early intervention. One should be aware that physiotherapy is a broad discipline and there are many fields of expertise. Members of the OMPTG (Orthopaedic Manipulative Physiotherapy Group) are physiotherapists who have a special interest in orthopaedic conditions and are well qualified to provide whiplash injury patients with effective management. How can physiotherapy help? Depending on the severity of the injury, recovery time can vary greatly from a few weeks to as much as two years. The physiotherapist plays a vital role in educating a whiplash injury victim. The person will be able to facilitate their own progress if they understand the pathology of their injury and the aims of treatment. It is important that the person receives support and reassurance because they may initially be in shock after the accident and later experience anxiety regarding their symptoms. Some may develop emotional side-effects such as depression, anger and irritability if their recovery time is lengthy. This is especially common in individuals where the accident was not their fault. In some instances trauma counseling may be necessary. During the acute / early phase of a whiplash injury a person may have severe muscle spasm in their neck region. Physiotherapists are skilled in using various techniques to reduce pain and muscle spasm, thus allowing healing to occur more rapidly. Studies have shown that effective pain management in the first three weeks after a whiplash injury is important in order to achieve a good outcome. Wearing a soft collar may be useful during this phase to provide support to the neck. It is important to maintain a balance between rest and gentle mobilization / movement. In severe cases it may be advisable for the person to take sick leave and decrease activities of daily living until their symptoms have noticeably subsided. In milder cases the person might need to modify their work and other activities for a period of time. The physiotherapist will suggest a programme of gentle mobilising exercises which are important to improve the range of movement of the neck and facilitate the development of ideal scar tissue. Poor postural habits may cause an additional strain to the damaged structures and advice will be given on improving posture at work and at home. The physiotherapist will guide the person as to when it is safe to return to work and recreational activities. Certain activities such as contact sports and heavy weight lifting may need to be avoided for a number of months depending on the severity of the whiplash injury. The physiotherapist will progress the individual’s exercise programme. Some exercises are designed to mobilise the different tissue systems of the neck such as the muscles, joints, neural tissue and connective tissue. Other exercises are designed to improve the strength and endurance of the postural / supportive muscles of the neck and shoulder area. Good mobility and muscle function are vital to prevent or minimize recurrences of neck pain. It is important to remember that the severity of whiplash injuries sustained in motor vehicle accidents can be dramatically reduced if seat belts are worn by all occupants at all times and head restraints are correctly positioned. How do I find an OMPTG physiotherapist in my area? Visit our OMPTG website at www.omptg.co.za or email us at [email protected]