Whiplash Injury, Treatment Options, And Pain Management, Head, And Neck!
Understanding Whiplash Injury, Causes, Symptoms, Diagnosis, And Treatment:
Whiplash is a type of injury to the spinal cord due to sudden movement of one’s head, either backward or forward. A whiplash neck injury is very commonly associated with motor vehicles accident, generally when they hit in the rear side of the person.
According to the statistics, around 430000 people from the UK claimed for whiplash in the year 2007. That amounts to 75% of the total motor insurance claims of the country. That alone speaks volumes about the need for understanding whiplash injuries and all that is associated with it.
Whiplash injury is defined as,
“an acceleration-deceleration mechanism of energy transferred to the neck usually as a result of a motor vehicle crash.” The impact may result in skeletal or soft-tissue injuries, which in turn can lead to a variety of clinical manifestations, including neck pain, neck stiffness, headache, dizziness, paresthesias, and cognitive difficulties such as memory loss. These clinical manifestations are known as whiplash-associated disorder (WAD).
The QTF developed a classification system for WAD based on the severity of signs and symptoms: The Quebec task force.
Grade Classification:
- 0 No complaint about the neck. No physical signs.
- I Neck complaint of pain, stiffness, or tenderness only. No physical signs.
- II Neck complaint and musculoskeletal signs. Musculoskeletal signs include decreased range of motion and point tenderness.
- III Neck complaint and neurological signs. Neurological signs include decreased or absent deep tendon reflexes, weakness, and sensory deficits.
- IV Neck complaints and fracture or dislocation.
A. Pathophysiology:
The pathophysiology of whiplash is not entirely clear. Evidence suggests both structural lesions and effects on sensory and motor function Evidence of:
- Lesions to cervical spine structures, particularly the zygapophyseal joints.
- Sensory disturbances are indicative of augmented central pain processing mechanisms.
- Disturbed muscle function in the form of morphological muscle changes and disturbances in movement and neuromotor control.
- Disturbed sensorimotor control, including kinesthetic deficits, loss of balance, and loss of eye movement control. These features seem to be associated with symptoms of dizziness.
B. Clinical Features:
- The onset of symptoms may occur immediately after the accident or may be delayed for up to 12 to 15 hours.
- The predominant symptom is neck pain, but a headache, back pain, and shoulder/arm pain can also be present.
- Other common symptoms include dizziness, visual and auditory disturbances, temporomandibular joint pain, photophobia, fatigue, and cognitive difficulties.
- People with whiplash may be psychologically distressed, and such distress seems to be associated with symptom persistence.
- Post-traumatic stress symptoms are emerging as an important psychological feature in some patients.
Approximately 20–30% of those injured will display a complex presentation comprising:
- Sensory disturbances such as allodynia and widespread hyperalgesia in the neck region, but also
at remote sites such as the lower limbs. - Cold hyperalgesia, which seems important as it is associated with poor recovery and with
nonresponsiveness to standard physical treatment approaches such as exercise. - Spinal cord hyperexcitability via heightened flexor withdrawal responses.
- Marked loss of neck movement.
- Motor control deficits, including altered patterns of muscle recruitment in the neck and shoulder
girdles. - Fatty infiltration of the neck flexor and extensor muscles identified on MRI.
Signs and Symptoms of a Whiplash:
These are the most common symptoms of whiplash, Common signs, and symptoms of whiplash:
- Neck pain and stiffness.
- Worsening of pain with neck movement.
- Loss of range of motion in the neck.
- Headaches, most often starting at the base of the skull.
- Tenderness or pain in the shoulder, upper back, or arms.
- Tingling or numbness in the arms.
- Fatigue.
- Dizziness.
Some people also experience:
- Blurred vision.
- Ringing in the ears (tinnitus).
- Sleep disturbances.
- Irritability.
- Difficulty concentrating.
- Memory problems.
- Depression.
It is always a good idea to get medical attention after any trauma, especially an auto accident that may seem minor. This especially holds true with whiplash because whiplash can take up to 24 hours to materialize. Thus, you do not want to wait until it is so severe that you cannot function. You should seek treatment immediately after an accident or trauma if you have any of the symptoms at the scene of the trauma.
If you decide to reject treatment at the scene,
seek medical attention if you start to experience any of the symptoms. Another reason to seek medical attention for whiplash is that these symptoms can represent many medical ailments. Thus, you may seek treatment for whiplash and find out there is something else that needs attention. Take whiplash seriously and get your doctor’s help if you think you have the injury.
Contact your doctor if you have:
- Severe pain despite taking paracetamol or ibuprofen
- Tingling or pins and needles on one or both sides of your body
- Problems with walking or sitting upright
- Sudden “electric shock” feeling in your neck and back may also go into your arms and legs
- Your arms or legs feel weak.
These symptoms could be caused by damage to the nerves in your neck or back.
Risk Factors:
The risk of long-term problems is very small and the chances for complete recovery are good. However, whiplash is still a strain injury and, as with other strain injuries, it is not unusual for the pain to last for a few months or even longer.
Symptoms of whiplash do not always appear immediately when the injury occurs. It may take hours for the symptoms to show and they may continue to get worse in the days after the injury. They usually pass after a few days or weeks. Often the pain can flare up from time to time before it goes completely.
The following risk factors have been linked to a worse outcome:
- Having had whiplash before.
- Older age.
- Existing low back or neck pain.
- A high-speed injury.
Causes:
There are many different causes of whiplash. Car accident injuries are the most common, but sports injuries, bicycle crashes, and other accidents can also result in similar neck pain and stiffness.
In an accident where a car is side-swiped, for example, the impact causes the body to fly to the side quickly, with the head following the body’s movements. Sudden stopping of the car flings the head to the other side, often resulting in the head hitting a window.
This can leave the spine and soft tissues in the neck unstable, requiring a series of chiropractic appointments for whiplash treatment, or maybe even medical treatment for concussion.
How Is Whiplash Diagnosed and Treated?
A. Diagnosis:
A qualified chiropractor will ask various questions to determine the extent of the neck injury before starting any whiplash treatment. These questions may include: why you think you have whiplash; car accident details, details about your injury, and the nature of your symptoms.
Along with a complete medical history and physical exam, tests for whiplash may include the following. Many whiplash injuries include damage to soft tissue that can’t be seen on X-rays:
- X-ray. Electromagnetic energy beams produce images of internal tissues, bones, and organs onto film.
- Magnetic resonance imaging (MRI). Large magnets and a computer make detailed images of organs and soft tissue structures in your body.
- Computed tomography (CT) scan. X-rays and computer technology make horizontal, or axial, images (often called slices) of your body. A CT scan shows detailed images of any part of your body, including your bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
B. Treatment:
Treatment for whiplash can last from a few weeks to months, depending on the severity of the injuries. A chiropractor, physician, or physical therapist may use a variety of techniques to help relieve the symptoms and improve overall spine health.
These techniques may include one or a combination of:
- Chiropractic adjustments
- Cold, and heat therapy.
- Massage.
- Strength training, or body mechanics training.
- Anti-inflammatory drugs or pain relievers may be prescribed if whiplash sufferers need additional pain relief.
Your healthcare provider will determine specific treatment for whiplash, based on YOUR:
- Age, overall health, and medical history.
- The extent of your injury.
- Tolerance for specific medicines, procedures, or therapies.
- Expectations for the course of your injury.
- Opinion or preference.
Also, Treatment may include:
- Ice applications for the first 24 hours.
- Cervical (neck) collar.
- Gentle, active movement after 24 hours.
- Nonsteroidal anti-inflammatory medicines (NSAIDs such as ibuprofen).
- Muscle relaxing medicines.
- Physical therapy.
- Osteopathic manipulation.
It is important,
that whiplash treatment is sought immediately if one thinks they may be suffering from whiplash, car accident-related, or not. Bicycle accidents and sports injuries may not always seem like obvious causes of whiplash, but active cyclists should take the time to receive whiplash treatment if they think a neck injury has occurred. A chiropractor can develop a treatment plan suited for any type of neck or spine injury resulting in whiplash.
Things you can do to treat whiplash:
Do:
- Take painkillers, such as paracetamol or ibuprofen, to help with the pain.
- Try to continue doing everyday activities – it might hurt a little but it will speed up your recovery.
Don’t:
- Use a neck brace or collar to support your neck – this does not help.
- Rest your neck for long periods of time.
Pain Management:
1. Medication:
Take a painkiller such as paracetamol or an anti-inflammatory such as ibuprofen, to reduce the pain and swelling. If symptoms persist, your GP can prescribe stronger painkillers.
2. Heat:
- The use of heat (i.e. a hot water bottle) will help the tissues to relax.
- This is helpful to do for about 20 minutes, both before and after stretching exercises.
- Avoid the use of hot packs if you are unable to detect the difference between hot and cold over the affected.
- Be careful not to have the hot pack too hot as it is easy to get burnt.
3. Exercise:
Regular gentle stretches of the neck are important to allow healing to the damaged tissues.
- They improve blood flow, the healing of tissues, and the health of the joint.
- They also maintain movement and flexibility.
- If the neck remains in one position it will become even more stiff and painful to move.
- Exercises should be carried out little and often (every hour).
- Roll your shoulders forwards and backward. Hunch shoulders to ears and relax.
- Move your neck slowly in all directions and hold for 10 seconds.
- This may cause stretching pain, this is normal.
4. Sleep:
There are no fixed rules when it comes to sleeping. Just find a position that is comfortable, supported by pillows if necessary.
5. Advice:
Research has shown that whiplash patient who rests for several weeks and wears a soft collar actually recovers more slowly than those who follow a normal routine and keep the neck moving. We know that worrying can also slow down your recovery.
6. Driving:
To drive safely, you must be able to turn your head quickly. It is best not to drive until severe pain or stiffness has settled. Discuss with your insurance company and GP when it is safe and legal for you to drive again.
7. Injections:
An injection of lidocaine (Xylocaine) — a numbing medicine — into painful muscle areas may be used to decrease pain so that you can do physical therapy.
8. Persistent pain:
Pain can be persistent for a number of reasons:
- No early movement.
- Anxiety or depression.
- Previous neck problems.
Keeping the neck moving regularly with exercise is proven to be the best way of getting better quickly.
Summing Up:
Whiplash and WAD are a common and costly burden on the health care system. Associated disabilities and absence from work create a large impact on economic productivity. Diagnosis of these injuries can be difficult for the practitioner and frustrating for the patient. The most recent literature suggests that whiplash injury may occur as a result of hyperextension of the lower cervical vertebrae in relation to a relative flexion of the upper cervical vertebrae.
Treatment can.
be delayed and confused by multiple social, economic, and psychological factors. Recent literature suggests that early mobilization and return to activity may offer the best chance for recovery. Still, a highly variable rate of recovery is reported in the literature. The absence of clear diagnostic and treatment options for this common medical problem suggests that further research is duly warranted.
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Disclaimer: “Nothing in this article makes any claim to offer cures or treatment of any disease or illness. If you are sick please consult with your doctor.”
References:
Brito, G.A.C.; Ribeiro, R.A.; Cunha, F.Q.; Souza, M.H.L.P. Hydrogen sulfide prevents ethanol-induced gastric damage in mice: Role of ATP-sensitive potassium channels and capsaicin-sensitive primary afferents neurons. J. Pharmacol. Exp. Ther. 2009, 330, 764–770.
Konturek, S.J.; Pawlik, W. W. Interaction of nonsteroidal anti-inflammatory drugs (NSAID) with Helicobacter pylori in the stomach of humans and experimental animals. J. Physiol. Pharmacol. 2006, 57, 67–79.Excellent nutrition is the basis of a healthy lifestyle!
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