Whiplash

Scenario

A patient presented to the chiropractor after a motor vehicle accident at
Caringbah, Sutherland shire NSW. They had neck pain, stiffness and headache.

What is it?

Often called a hyper flexion/extension injury or an acceleration/deceleration injury.
Whiplash is usually associated with rear end vehicle collisions.
Research suggests most injuries occur after a low speed rear-end collision

What are the causes?

An S-shaped curve is produced in the cervical spine due to the seat pushing the mid back (thoracic spine) forwards and upwards. This disrupts the normal mechanics of the region, stressing the soft tissues (muscles, ligaments, joint capsule) and the joint itself (facets).

What are the symptoms?

  • Neck pain
  • Cervical Muscle spasm
  • Decreased ROM
  • Swelling
In addition, the following may also be present:
  • Headache – associated with cervical facets and injury/irritation to greater occipital Nerve
  • Dysphagia – Due to oesophageal injury and retropharyngeal haematoma
  • Upper limb pain - Radicular or referred
  • Possible associated injury to shoulder girdle
  • Whiplash is a common cause of thoracic outlet syndrome.
  • Inability to lift head from pillow:  Proprioceptive disruption and pain from neck flexors
  • Jaw (TMJ) pain and dysfunction as the mandible is strained open or hyper extension
  • Upper limb weakness due to nerve root injuries
  • Vertigo - May be caused by abnormal cervical muscle tension input to balance centres.  Or by injury, at impact, of labyrinth
  • Possible associated tinnitus
  • Chest/breast pain due to pressure of seat belt on impact
Onset of symptoms:
  • Many people have no symptoms immediately at the time of the accident.
  • There may be a delay in the onset of symptoms
  • Of those who sustain a whiplash injury, 65% will get symptoms within 6 hours, 28% will get symptoms within 24 hours, 7% will get symptoms within 72 hours
  • Most patients will have symptoms, which persist more than 6 month
Note:  “Lap lash”- Describes forward motion of unrestrained shoulder on impact causing possible clavicle fracture, acromioclavicular dislocation and/or rotator cuff tears

Whiplash and Neck Pain