Understanding whiplash: Causes, symptoms & effective physiotherapy treatments 

Whiplash is a common mechanism of injury that occurs when the neck is rapidly jerked backward and forward due to a sudden impact. This is most commonly seen in car accidents when rear-ended but can occur due to other reasons. This sudden acceleration and deceleration force can result in a whiplash associated disorder (WAD) which is a term describing a cluster of symptoms. Symptoms such as pain, stiffness & headaches are common features. 

In this blog post, we’ll delve deeper into the injury, the symptoms and how physiotherapy can play a crucial role in the recovery process for individuals dealing with whiplash.

What can be injured during whiplash? 

Potential injured structures in the neck region include:

• Facet joints.
• Joint capsule.
• Spinal ligaments.
• Nerve roots.
• Intervertebral discs.
• Cartilage.
• Paraspinal muscles.
• Intra-articular meniscus (1).

Symptoms: 

Symptoms and disorders that can manifest in all grades include:

• Deafness.
• Dizziness.
• Tinnitus (ringing in ears).
• Headache.
• Memory loss.
• Dysphagia (difficulty swallowing).
• Temporomandibular (jaw) joint pain.

Other symptoms can include the following:

• Pain in the neck to the head, upper/mid back and arms.
• Sleep difficulties.
• Neck stiffness.
• Vestibular problems (inner ear).
• Visual disturbances.
• Memory and concentration problems.
• Psychological manifestations including fear, anxiety and depression (3). 

Classification of Whiplash Associated Disorders (WAD) (1995 by Quebec Task force) (2): 

GRADE CLASSIFICATION:

Grade 0: No complaint about the neck. No physical sign(s).

Grade I: Complaint of neck pain, stiffness or tenderness only. No physical sign(s).

Grade II: Neck complaint AND musculoskeletal sign(s). Musculoskeletal signs include decreased range of movement and point tenderness.

Grade III: Neck complaint AND neurological sign(s). Neurological signs include decreased or absent tendon reflexes, weakness and sensory deficits.

Grade IV:  Neck complaint AND fracture or dislocation.

How long does whiplash usually last?

In most cases of WADs, recovery varies from several days up to 12 weeks. Factors that can affect the prognosis for WADs can be:

• High levels of pain early post injury.
• Negative expectations of recovery.
• Symptoms post traumatic stress.
• Pain catastrophization.
• Hypersensitivity to cold (4).

Seeking active treatment the first 3 months after injury is critical in preventing ongoing pain and disability. Individuals with higher risk of longer lasting whiplash are important to be screened for early and managed holistically. This may include the additional support of clinical psychology, pain specialists as deemed suitable by your GP in liaison with your physiotherapist.  

Physiotherapy approach to whiplash treatment:

Tailored physiotherapy plays a crucial role in the recovery process for individuals. Evidence suggests that treatment success is highly dependent on having early physiotherapy intervention, and includes active exercise, education and manual therapy treatment. While therapy may still be beneficial after the 3-month period, often symptoms become more complex to treat secondary to tissue changes and compensatory movement patterns. 

• Education is essential for management of expectations, knowledge of soft tissue healing timelines and encouragement to stay active. Continuing usual activity is very important unless high grade WAD to avoid chronic symptoms and compensation. 
• Range of motion and Stretching Exercises – Early movement can help to alleviate stiffness and pain.
• Strengthening and Postural Exercises – Early strengthening can help prevent muscle wasting and can improve movement patterns to alleviate pain & normalise function. 
• Modalities – Use of heat, cold, ultrasound and acupuncture to manage pain.
• Manual therapy – Mobilisation of joints can help to increase movement and modulate pain. 

Conclusion: 

Whiplash can be a painful and challenging injury to deal with, but with physiotherapy care, individuals can experience significant relief and a faster recovery. If you’ve experienced whiplash or suspect you might have, it’s crucial to seek professional medical help. Consulting a physiotherapist can be an essential step towards regaining your quality of life. Remember, patience and consistency in following your physiotherapy program are key to achieving a successful recovery.

~Lucy Bowden
Physiotherapist

References: 

1. Whiplash Associated Disorders, Physiopedia  
2. State Insurance Regulatory Authority: Guidelines for the management of acute whiplash-associated disorders – for health professionals. Sydney: third edition 2014.
3. Ghorayeb JH. The nosological classification of whiplash-associated disorder: a narrative review. J Can Chiropr Assoc. 2021 Apr;65(1):76-93. PMID: 34035543; PMCID: PMC8128336.
4. Max. (2023). Management of Whiplash Associated Disorders. Retrieved from https://www.physiotutors.com/whiplash-treatment/

You may find these other PMPP blogs interesting:

https://portmelbournephysio.com.au/different-types-of-vertigo/
https://portmelbournephysio.com.au/strengthening-exercises-for-neck-pain/
https://portmelbournephysio.com.au/physiotherapy-management-for-cervicogenic-headaches/
https://portmelbournephysio.com.au/does-exercise-reduce-pain/