MANAGEMENT

WHIPLASH

MULTIDISCIPLINARY MANAGEMENT

By Dr Simon Petrides MB BS, DO, Dip.Sp.Med.

INTRODUCTION The incidence of whiplash injuries of the neck seems to have become more preva- lent in recent years as a result of the use of seatbelts, changes in car design and the increase simply in the numbers of people driving cars. Therapists see many patients with this problem, many of whom suffer chronic symptoms. Patients seem to present with an array of musculoskeletal symptoms which are often associated with neuromuscular and cognitive features. The condition is further confused by personal injury claims and management that is based almost completely on empirical approaches, although the guidelines issued by the Quebec Taskforce (1995) have helped consolidate opinion.

There is an immense amount of literature on whiplash and while a large proportion of the research is of poor quality, the com- mon messages are helpful in directing our approach.

The term whiplash was first used in the early twentieth century to describe the particular mechanism of injury to the head and neck during a sudden accelera-

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tion or deceleration movement. The alter- nating motion of the head is analogous to a whip when it is cracked but more pre- cisely the term Whiplash Associated Disorder (WAD) is more appropriate.

PREVALENCE Most cases of WAD result from car acci- dents. About 20% of car accidents are rear end collisions and these are the ones that typically cause a whiplash-type injury. About one person in fifty is hurt every year in a car accident and the resultant medical and insurance implications run into many millions of pounds annually. This is not helped by the increasingly liti- gious culture in which we live.

When struck from behind, a car will accel- erate forwards followed about 100 mil- liseconds later by the torso and shoulders. The head, because of its weight, lags behind and is then catapulted forward. This applies force of up to 100 lbs to the head producing maximal hyperextension well beyond the physiological limit.

The direction of impact has an influence since a higher velocity change is required for tissue damage in a front or side impact, compared with a rear impact

collision. Poorer prognosis is likely if the neck is rotated at the time of impact.

Well-positioned head restraints do not prevent WAD type injury, although they have been shown in some studies to reduce the incidence and severity if posi- tioned close to and level with the head. Seatbelts, although they reduce the risk of fatal injuries, may actually increase the severity of WAD. This may be due to an increase in force between the torso and the head when the vehicle is jolted.

SYMPTOMS OF WAD

■ Headache ■ Tiredness ■ Neck pain and stiffness ■ Paraesthesia ■ Low back pain ■ Dizziness ■ Poor concentration ■ Blurred vision ■ Visual disturbance ■ Irritability ■ Sleep disturbance ■ Noise sensitivity ■ Forgetfulness ■ Anxiety

Box 1: Symptoms of a whiplash injury www.sportex.net