Whiplash (Whiplash Associated Disorder)
Whiplash is usually associated with neck pain that occurs after a motor-vehicle accident (MVA). However, whiplash is more accurately described as an acceleration-deceleration force on the neck which may occur in a rear-end or side impact motor vehicle collisions, a slip on ice, a hit from behind while playing hockey, soccer, football, or rugby and even the trivial fall off a bike can result in a whiplash. The acceleration-deceleration forces often result in injuries to the muscles, ligaments and joints of the neck and other spinal areas. However, sometimes they result in no injury or pain at all.
Often anterior (front) neck pain is associated with whiplash injuries and the treatment and strengthening of the front neck muscles is paramount to making sure you get better after this type of injury.
A thorough evaluation and possibly diagnostic images are required to provide a patient with a diagnosis. The mechanism of injury There are five grades of WAD and the greater the number, the greater the severity.
What are the symptoms associated with Whiplash Associated Disorder?
Whiplash associated disorder (WAD) is the term used to diagnose neck pain and stiffness after a trauma to the head and neck. Sometimes individuals experiencing these acceleration-deceleration injuries report symptoms such as headaches, aching in the arms or feelings of being lightheaded.
Symptoms may appear immediately after the incident or have a delayed onset of a few hours or days. The nature of injury and the number and severity of symptoms vary between different people. The symptoms are associated with the diagnosis provided to you:
Grade 0 WAD
- With this diagnosis you will have been in an accident, but you will not feel any neck pain, stiffness, or other physical signs or symptoms.
Grade I WAD
- With a Grade I WAD diagnosis, you will be experiencing neck pain, stiffness or tenderness only, and you should not be experiencing any other physical signs.
- There are often no signs of major pathology (such as muscle tearing or injury to the discs and/or joints) and little hindrance to daily activities.
- You will also feel tenderness of your neck, shoulder and maybe jaw muscles as well as stiffness, but no significant neurological complaints (no numbness or tingling) or signs and symptoms of major structural pathology (e.g. fracture, dislocation, infection, etc.)
- Often further imaging or laboratory investigation is not required.
- It is important to remain as active as possible and avoid neck immobilization if you suspect having a grade I WAD, however to be certain of your diagnosis, contact me for a detailed evaluation.
Grade II WAD
- With this diagnosis, you may experience a decreased range of motion and point tenderness in your neck.
- There are no signs of major pathology, but your neck pain will interfere with daily activities such as limiting your head and neck movements.
- Quite rarely are there signs and symptoms associated with any major structural pathology or spinal nerve root compression, but you may need imaging or laboratory investigations to be certain.
Grade III WAD
- This is when the severity of symptoms begin to increase and you will be experiencing neck complaints along with neurological signs such as decreased deep tendon reflexes, weakness and sensory deficits.
- Neck pain with neurological signs or symptoms are always present.
- If you are experiencing weakness and/or numbness and tingling please contact me immediately or go to your nearest emergency department within a day after the trauma.
- Certain tests (provocation tests) can be used to rule out a radiculopathy (symptoms associated with a nerve being compressed) and can be done at the office.
- If you have severe pain down your arm or in your neck and major neurological deficits right from the time of the accident/trauma, or if your symptoms are getting worse, you may need a Computer Tomography (CT) or Magnetic Resonance imaging (MRI) to determine the extent of the injury.
Grade IV WAD
- THIS IS A MEDICAL EMERGENCY AND NEEDS TO BE MANAGED AT A HOSPITAL
- This is a very severe and serious neck injury. Patients will experience neck complaints with a fracture or dislocation, and possibly injury to the spinal cord.
- This is when you have neck pain with signs of major pathology. For example, you would experience neck pain and/or its associated disorders along with signs or symptoms of major structural pathology, such as extreme pain, loss of use of limbs, inability to hold neck up, feeling of instability.
What is the outlook (prognosis) for a bout of Whiplash Associated Disorder?
- The outlook is usually good in most cases of WAD 0-II.
- Symptoms commonly begin to improve after a few days with WAD I. But, the time it takes for symptoms to decrease varies based on the person and history of the condition. If symptoms are still present after three (3) days, I recommend that you have it looked at by a health care professional.
- Chronic and persistent neck pain occurs in some individuals diagnosed with WAD I and II. Chronic neck pain will result in the pain coming and going with some exacerbation ("flare-up"). Often these "flare-ups" are due to repetitive stress placed on the tissue as seen with poor postures or if there are underlying issues or weakness. In these situations it may be best for you to engage in some form of active rehabilitation program.
- When neurological symptoms are associated with a WAD III diagnosis, then an orthopaedic surgeon and/or neurologist may be required to aid in the management of your condition. Some WAD III diagnoses can be managed conservatively without any further consult with a surgeon as long as the therapists has experience with this form of trauma and you are seeing improvements with your symptoms within the first few visits.
- Grade IV WAD diagnoses require surgical consultation and often surgery is required to stabilize the spine when fractures are involved. It is best to go to the nearest emergency department if you believe you may have this severe of a WAD.
What are the treatments for Whiplash Associated Disorder?
The aim of therapy is to maintain pain free mobility of the spine for WAD 0 - WAD III and immobilization for WAD IV diagnoses.
For WAD I - WAD III, conservative management may include the following:
Neck Stability Exercises are very important, however, it is imperative that the correct diagnosis is made to ensure that there are no exacerbation of your symptoms.
Good Posture will aid in preventing an exacerbation of your symptoms, but it is best to have an accurate diagnosis of the condition prior to engaging in any exercise program.
Pain Medication - it is best to speak to your medical doctor or a pharmacist to determine the best form of medication for you.
Specific treatments may vary and you should go back to see a health care professional if:
the pain becomes worse.
the pain persists beyond 3-5 weeks.
you start experiencing numbness, weakness, or pins and needles in one or both of your arm and hand, or if pain travels along your back.
What about driving?
In order for you to drive safely (ride a bicycle or motorcycle) you must be able to turn your head quickly. Therefore, I recommend that you do not drive until you are able to move your head freely and you are free of pain.
If you have been in an accident, and would like to be evaluated, Call the Clinic Now
CAUTION: The above is only a guide and should not be used as a substitute for being evaluated by a regulated health care professional that has experience in managing whiplash associated disorders. If you have any questions about your condition, please feel free to contact me at your convenience. If you feel that this is a medical emergency, please visit your closest hospital emergency department.