Assistant Professor

Physiotherapy, School of Health Sciences

CSJM University

Kanpur  Uttar Pradesh, India 

Assistant Professor

Physiotherapy, School of Health Sciences

CSJM University

Kanpur, Uttar Pradesh, India

Abstract

Harold Crowe first coined the term "whiplash" injury in 1928 to refer to acceleration-deceleration injuries to the cervical spine or neck.  These clinical categories have been developed to characterise any combination of neck-related symptoms following a motor vehicle accident (MVA). The term "whiplash-associated disorders" (WAD) has since been expanded to include all whiplash-related symptoms. Because there is, by definition, no structural pathology found after a thorough diagnostic workup, the elusive difficulty in describing these injuries still exists.  Therefore, WADs continue to be an excluding diagnosis. While whiplash injuries are very frequent, little is known about how they happen and how best to treat them. Whiplash injuries are thought to occur in about 4 out of every 1,000 people. The two most frequent radiographic findings are preexisting degenerative abnormalities or a little flattening of the cervical spine's typical lordotic curvature. For situations of suspected disc or spinal cord damage, fracture, or ligamentous damage, computed tomography and magnetic resonance imaging are typically used. According to biomechanics research, C6 rotates back into extension following a rear impact before the upper cervical vertebrae move. As a result, the upper vertebrae were in a position of relative flexion while the lower cervical vertebrae were in extension, creating a S shape in the cervical spine. Treatment options include early physical therapy, analgesia, rest, and soft braces.  The damage may be acute and result in full healing, or it may be chronic and result in ongoing pain, impairment, and use of medical resources.

Keywords: Whiplash, Hyper Flexion, Hyperextension, Cervical Spine. 

Introduction

When the head is suddenly jerked forward (hyperflexion) and backward (hyperextension) as a result of violent acceleration-deceleration movements, the neck sustain a cervical whiplash injury. Injuries to the neck's bones, ligaments, muscles, tendons, and joints can result from whiplash. Whiplash is frequently brought on by rear-end vehicle accidents, but it can also be brought on by sports injuries, physical abuse, and other traumas including falls.

Whiplash refers to a single idea yet can result in a variety of negative repercussions. Experts refer to illnesses that result from whiplash as "whiplash-associated disorders." Whiplash can also result from abrupt changes in movement in either direction. First responders and medical staff frequently treat whiplash as an emergency condition since it involves a neck injury. Additionally, until they can confirm, treat, and stabilise a dangerous injury, or rule out that type of damage, healthcare professionals will approach it with extreme caution.

 

Types of Injury:  There are two types of injury;

1. Cervical hyperextension injuries: It happens to the drivers or occupants of a vehicle that is stopped or going slowly and is hit from behind. The head lags as the body is propelled forward, which causes the neck to extend excessively. The neck then abruptly snaps into flexion once the head and neck have extended to their most distant extent.

2. Cervical hyperflexion injury: The cervical spine is flexed and the head is propelled forward by a sudden deceleration injury. The chin restricts forward flexion, yet the forward motion might be enough to disrupt the nervous system and produce longitudinal distraction. The ensuing recoil may result in hyperextension.

GRADES OF WHIPLAS INJURY:

Grade 0: No physical symptoms or complaints.

Grade 1: Neck issues are present but there are no physical signs.

Grade 2: Represents musculoskeletal symptoms and complaints of the neck.

Grade 3: Neurological symptoms and neck issues.

Grade 4: neck discomfort and a fracture or dislocation

i. C2, C6 or C7 are the levels at which the majority of cervical spine fractures occur.

ii. The majority of fatal cervical spine injuries happen in the higher cervical levels, either at C1 or C2, which is the cranio-cervical junction.

SYMPTOMS:

The disorder commonly occurs as the result of an automobile accident and may include injury to intervertebral joints, discs, and ligaments, cervical muscles, and nerve roots. Symptoms such as neck pain may be present directly after the injury or may be delayed for several days. In addition to neck pain, other symptoms may include:

i. Neck pain and stiffness

ii. Worsening of pain with neck movement

iii. Loss of range of motion in the neck

iv. Headaches, most often starting at the base of the skull

v. Tenderness or pain in the shoulder, upper back or arms

vi. Tingling or numbness in the arms

vii. Fatigue

viii. Dizziness 

Some people also have:

i. Blurred vision

ii. Ringing in the ears (tinnitus)

iii. Sleep disturbances

iv. Irritability

v. Difficulty concentrating

vi. Memory problems

vii. Depression 

Causes:

The most common cause of whiplash is having your head violently and suddenly pushed backward and then forward. This movement has the potential to harm the neck's ligaments, muscles, nerves, and other tissues in addition to the spine's bones and discs.

Whiplash can happen as a result of:

i. Automobile accidents: Whiplash is frequently caused by rear-end crashes.

ii. Physical abuse or assault: Getting punched or shaken might cause whiplash. One of the injuries linked to shaken baby syndrome is this one.

iii. Contact sports: Collisions in football tackling and other sports can occasionally result in whiplash.

Diagnosis:

Examination: Your head, neck, and arms will need to be touched and moved by the doctor throughout the examination. You'll be required to move about and carry out easy tasks so that your doctor may examine:

i. The flexibility of your neck and shoulders

ii. The amount of motion that hurts or makes it worse

iii. Achy muscles in your back, shoulders, or neck

iv. Your limbs' reflexes, strength, and sensation

Imaging Test:

i. X-rays: Multiple-angle X-rays of the neck can be used to detect fractures, dislocations, or arthritis.

ii. Computerised tomography (CT): This specialised form of X-ray is capable of creating cross-sectional images of bones and displaying potential bone deterioration.

iii. Magnetic resonance imaging (MRI): This imaging technique creates precise 3D images using radio waves and a magnetic field. MRI scans can find some soft tissue injuries, such as harm to the ligaments, discs, or spinal cord, in addition to bone injuries.

Treatment: It includes:

i. Rest: After an injury, resting may be beneficial for a day or two, but staying in bed too long can hinder recovery.

ii. Applying heat or ice to the neck for 15 minutes approximately every three hours can make you feel better.

iii. Over-the-counter pain relievers: These include acetaminophen and ibuprofen, which frequently help to manage mild to moderate whiplash pain.

iv. Prescription drugs: Some antidepressants have been demonstrated to improve nerve pain, so they may be prescribed to people with more severe pain.

v. Muscle relaxants: Using these medications for a brief period of time may be advised to ease discomfort and relax tense muscles.

vi. Injections: You can reduce pain by administering an injection of the numbing medication lidocaine (Xylocaine) into sore muscles.

Physiotherapy Management:

It is advisable to perform a variety of stretches and motion exercises at home. With the aid of these exercises, you can regain neck range of motion and resume your regular activities.

Exercises could consist of:

i. Swinging your neck back and forth

ii. Sway your head from side to side                                                                                                                     

iii. Tucking your neck in close to your chest

iv. Shoulders rolling

Other treatment includes:

Massage –Massage can be used to improve circulation, reduce edoema, relax muscle spasms, and encourage healthy tissue repair.

Mobilisation –The therapist gently moves the joint and soft tissues during mobilisation to regain normal range of motion, lubricate the joint surfaces, and ease pain.

Strengthening exercise - Strengthening exercises are recommended to make the muscles in the neck and upper back stronger.

Ultrasound therapy – Ultrasonic therapy is used to lessen discomfort and speed up the healing process.

Manipulation – A thrust delivered at rapid speed and with a limited range is called a manipulation. It is utilised to eliminate a joint blockage, dissolve adhesions, and regain complete, pain-free motion. 

Interferential therapy - It has a range of therapeutic outcomes depending on the frequency at which it is applied. For instance, muscle or nerve pain relief

References:

1. https://www.aapmr.org/about-physiatry/conditions-treatments/musculoskeletal-medicine/cervical-whiplash

2. https://www.mayoclinic.org/diseases-conditions/whiplash/symptoms-causes/syc-20378921

3. https://www.amjmed.com/article/S0002-9343(01)00680-5/fulltext

4. https://my.clevelandclinic.org/health/diseases/11982-whiplash