Physiotherapy For Whiplash

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What is Whiplash?

Whiplash describes the forces that are applied to the head and neck in rear-end or side-impact motor vehicle collisions. These are most commonly acceleration-deceleration forces, which may cause painful injury to some of the many important structures in the neck, including ligaments, muscles, and joints.

Whiplash-Associated Disorder (WAD) is a common musculoskeletal complaint experienced after being exposed to these forces in a motor vehicle injury. Whiplash (or WAD) can vary enormously in severity from one person to another and can be a very complex condition due to a variety of factors.

In very practical terms, not only might you be suffering from the pain associated with the accident, but there may also be high levels of systemic inflammation associated with the injury. As we have mentioned in a previous blog, inflammation is a crucial and valuable part of the human body’s healing process. It does, however, often increase our sensitivity to pain. Think of how, when you have a sunburn a light touch to the burnt skin can be painful. You may experience this effect in your neck for a period after the accident.

Add to this the trauma, and the stress associated with an MVA. Research suggests that many people will often present with post-traumatic stress disorder (PTSD)-like symptoms post-MVA1. For the majority, this will resolve naturally with time. For others, targeted psychological intervention may be of benefit as part of treatment for a whiplash-associated disorder.

These are just some of the factors that may play a role in pain and recovery in the presence of a whiplash-associated disorder.

Whiplash Recovery

People will recover from WAD at different rates. Some will recover in days or weeks. Others may take months until they experience a significant change in symptoms. WAD can be challenging to manage, and a few people may find they have persistent symptoms related to a motor vehicle incident. There may be great variation in the intensity of symptoms from person to person, and treatment will vary, too. 

All of this is precisely why it is of great benefit to see a physiotherapist early on.

Physiotherapists sit at the centre of management for WAD, effectively guiding rehabilitation of any musculoskeletal concerns, as well as guiding referral as indicated for further multidisciplinary management. 

In the first instance, we will assess for features of concern that would suggest a medical referral or another course of management. For example, we might suggest an X-ray or other scan in conjunction with your medical professional. An X-ray may not show any specific injury, as fractures are relatively rare in WAD and sources of pain can be many and varied. However, a scan may allow us to clear the possibility of bony involvement such as a fracture, which requires a different plan for management.

Sometimes, injury-specific questionnaires can be really useful to identify the areas of your life that are impacted by your whiplash. Often, your physiotherapist may use a questionnaire such as the Neck Disability Index. Another fantastic tool is the University of Queensland RECOVER Research Centre WhipPredict tool. This is a research-based tool designed to allow clinicians to plan effective management after motor vehicles and optimise recovery. Optimal management may centre solely around physiotherapy or may involve other health practitioners, such as a psychologist.

Managing Whiplash

Research suggests several things that may contribute to better outcomes in WAD. Firstly, staying involved in your usual work and other activities as much as possible is of benefit. Research suggests that better recovery is seen in those who resume normal work sooner and remain active and engaged.

However, some degree of avoiding unnecessary strain may be appropriate for you, and your usual activities may need modifying somewhat in the early and middle stages of recovery. This might mean being adaptable and embracing a different concept of being physically active. For instance, if you normally play football or lift heavy weights at the gym, you might find swimming or walking a better way of staying active early on.

Your neck is very likely to benefit from specific exercises to assist in recovery. Not only does your neck need to support your head and produce movement, but it also has an innate sense of how it is positioned and plays an important role in generating movement in response to sensory stimuli such as sound and sight.

These functions can all be disrupted in WAD.

Your physiotherapist will guide you in the exercises you need, assessing your specific challenges and designing an exercise program designed to target them. Every rehabilitation plan is carefully crafted to suit the individual and the stage of recovery they are at.

Your physiotherapist can utilise manual therapy (massage and other gentle hands-on techniques) which can help to reduce pain and help you to move better again. This is something that is very difficult to do for yourself at any time. Even more than that, given the variability of pain and sensitivity in WAD, it takes some skill to ensure this is done effectively.

Stress management matters, too. Research suggests that this can contribute to better outcomes in WAD. A motor vehicle incident is a stressful event, and recovering effectively from it can benefit from putting some effective stress management strategies in place. 

Of course, for many people, normal stress management strategies may involve exercise, going out with friends, or other activities that can feel challenging in the presence of pain. Problem-solving around this, and generating effective and manageable stress management strategies may be part of the work you do with your physiotherapist.

Whiplash Physiotherapy

Physiotherapy for Whiplash

The above provides general advice and guidelines. But making the right choices in a challenging time of life can be daunting. It might seem simple to read through, but there are lots of things your physiotherapist will work on with you.

Some of the key things your physiotherapist will do as a part of your treatment include;

  • assessment of your levels of pain and any restrictions to normal movement 
  • use questionnaires or other tools to see which other health practitioners you may benefit from seeing
  • refer you as indicated for additional assessment or treatment such as scans, and possibly input of a psychologist
  • guide you in the right choices around returning to work and discuss any strategies to support your return to work
  • discuss a plan for staying active and any modifications to your usual activities that may be required
  • discuss strategies for managing stress (or, as before, refer to an appropriate professional to work with you on this)
  • utilise manual therapy to help with symptomatic relief
  • provide specific exercises to manage your condition and impairments
  • progress exercises over the course of treatment to ensure optimal outcomes. This will help get you back to doing all the things you love without restriction!

For concerns regarding whiplash, make sure to contact our physiotherapy team to get your recovery started.

The below article was taken from the Motor Accident Insurance Commission (MAIC) whiplash injury recovery booklet. It is an excellent resource for those suffering whiplash.

Whiplash injury recovery – MAIC

  1. Sterling, Hendrikz, Kenardy 2010 Pain 150:22-28
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