Background:
Mode of Injury (MOI) = Trauma – usually road traffic accident (RTA), but can be as a result of rides, sports, abuse.
Pain mechanism = Nociceptive local / Nociceptive referred.
Pathomechanics = Myogenic
Predominantly occurs in RTA and is an acceleration-deceleration-acceleration force which is too quick for the muscles to handle.
Usually, cars a hit from front/side or the back. Majority of the injuries is micro-trauma.
This type of accident can lead to a coup contra coup, which in turn results in symptoms such as concussions/dizziness.
Patients usually report into a&e 24-hours after the incident due to DOMs & adrenaline.
Quebec scale is used to measure the severity/type of whiplash:
Grade 0 = No complaints about neck & no physical signs.
Grade 1 = Complaints about neck (stiffness) but no physical signs.
Grade 2 = Patients experience neck & MSK signs.
Grade 3 = Patients experience neck and numerological signs.
Grade 4 = Patients have a fracture – in this instance, patients should NOT undergo physio intervention until appropriate.
Symptoms:
Concussion
Dizziness
Forgetfulness
Pain
Stiffness
Swelling
Bruising
Cervicogenic headaches
Aggravating factors:
Movement
Carrying things (such as bags)
Sleeping
Getting dressed
Easing factors:
Ice
Heat
Medication
Stretching
Epidemiology:
Females 33-44 have an increased chance of long-term neck pain.
20-40% of whiplash can lead to chronicity.
The minimum speed a whiplash can occur is 6mph.
8/10 claims are usually whiplash.
3 months of healing time.
Prognostic factors:
Age
Gender
Speed
Type of car
Seatbelt situation
Position of car
Model/year of car
Head-restraint position
Body position on impact
Assessment:
Observation =
Postural changes
Decrease ROM particularly in neck and shoulders
Bruising
Tenderness
Compensating
Altered movement
Facial expressions
Loose clothing
Clearance examination =
Shoulders
Thoracic spine
Cervical spine (special questions – 5 D’s & 3 N’s)
Movement / Palpation =
Active / Active assisted / Passive / Resisted ROM may be reduced.
Pain may be increased.
Spasms may be present.
Decrease quality of movement.
End-feel = Stiff / spasm
Neurogenic =
Dermatomes
Myotomes
Reflexes
Neurodynamic =
Median nerve test
Ulnar nerve test
Axillary nerve test
Special Test =
Distraction
Flexion
Extension
Rotation
Functional Test =
Arm at the back of head
Arm behind lower back
Arm across opposite shoulder
Differential Diagnosis:
Cervicogenic headache
Fracture
Disc herniation
Ask A Physio
Spend less time suffering and more time doing what you love. Our Ask A Physio service is a free and confidential service designed to provide you with advice and information on your problem before you book an appointment.