{"id":8166,"date":"2021-10-30T12:59:00","date_gmt":"2021-10-30T10:59:00","guid":{"rendered":"https:\/\/www.physiotutors.com\/?p=8166"},"modified":"2023-05-05T15:14:30","modified_gmt":"2023-05-05T13:14:30","slug":"whiplash-treatment","status":"publish","type":"post","link":"https:\/\/www.physiotutors.com\/whiplash-treatment\/","title":{"rendered":"Management of Whiplash Associated Disorders"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Introduction<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Whiplash associated disorders are a common complaint in today\u2019s society. The main symptom of whiplash is neck pain although symptoms such as stiffness, dizziness, paresthesia\/anesthesia in the upper quadrant, headaches, and arm pain are frequently reported as well.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">International data suggests that approximately half of people sustaining a whiplash still report symptoms one year after the accident. Psychiatric disorders such as post-traumatic stress disorder, depression and anxiety are often associated and these individuals usually report higher levels of disability, pain and reduced physical function.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">More of a listener\/watcher than a reader? Make sure to watch this synopsis video on the topic.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Whiplash Associated Disorder (WAD) Topical Review | SYNOPSIS\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/HF9CM7AMTBc?list=PLO_peL93VBmnf2v3svkhsewBcfdaKuzNa\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Recovery<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Three general pathways of recovery are identified. You can see that if recovery occurs, it will take place in the first 2-3 months after the injury, as seen in this image below.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" width=\"1030\" height=\"858\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2021\/10\/Recovery-WAD-Sterling-2021.png\" alt=\"Recovery wad sterling 2021\" class=\"wp-image-8168\"\/><figcaption class=\"wp-element-caption\">From: Sterling (2014), Journal of Physiotherapy<\/figcaption><\/figure>\n\n\n<div class=\"quote-with-background\" style=\"\">\n    <div class=\"quote-with-background__in\">\n\n        <svg width=\"30px\" height=\"25px\" viewBox=\"0 0 30 25\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\">\n            <g id=\"Design\" stroke=\"none\" stroke-width=\"1\" fill=\"none\" fill-rule=\"evenodd\">\n                <g id=\"08-blog-redesign\" transform=\"translate(-191.000000, -2974.000000)\" fill=\"#7973FF\" fill-rule=\"nonzero\">\n                    <g id=\"Group-7\" transform=\"translate(80.000000, 2893.000000)\">\n                        <g id=\"\u201c\" transform=\"translate(111.000000, 81.000000)\">\n                            <path d=\"M6.4,25 C4.42666667,25 2.86666667,24.3743344 1.72,23.1230032 C0.573333333,21.871672 0,20.2609159 0,18.2907348 C0,17.2790202 0.173333333,16.2539936 0.52,15.215655 C0.866666667,14.1773163 1.49333333,12.513312 2.4,10.2236422 L6.48,0 L12.8,0 L10,12.5399361 C11.9733333,14.0841321 12.96,16.001065 12.96,18.2907348 C12.96,20.2076677 12.3466667,21.8051118 11.12,23.0830671 C9.89333333,24.3610224 8.32,25 6.4,25 Z M23.44,25 C21.4666667,25 19.9066667,24.3743344 18.76,23.1230032 C17.6133333,21.871672 17.04,20.2609159 17.04,18.2907348 C17.04,17.2790202 17.2133333,16.2539936 17.56,15.215655 C17.9066667,14.1773163 18.5333333,12.513312 19.44,10.2236422 L23.52,0 L29.84,0 L27.04,12.5399361 C29.0133333,14.0841321 30,16.001065 30,18.2907348 C30,20.2076677 29.3866667,21.8051118 28.16,23.0830671 C26.9333333,24.3610224 25.36,25 23.44,25 Z\" id=\"Shape\"><\/path>\n                        <\/g>\n                    <\/g>\n                <\/g>\n            <\/g>\n        <\/svg>\n       <div class=\"quote-with-background__content heading-three\">\n            <p><!-- wp:paragraph --><\/p>\n<h4 class=\"heading-two heading-four\"><span style=\"color: #ffffff;\">A clinical prediction rule was found for full recovery, being: neck disability scores under 32% with an age under 36 years.<\/span><\/h4>\n       <\/div>\n       <div class=\"quote-with-background__info\">\n                   <\/div>\n    <\/div>\n<!--    <div class=\"quote-with-background__background\">-->\n<!--        <svg width=\"100%\" height=\"100%\" viewBox=\"0 0 849 447\" version=\"1.1\" preserveAspectRatio=none xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\">-->\n<!--            <g id=\"Design\" stroke=\"none\" stroke-width=\"1\" fill=\"none\" fill-rule=\"evenodd\">-->\n<!--                <g id=\"08-blog-redesign\" transform=\"translate(-80.000000, -2893.000000)\" fill=\"#F1F5FD\">-->\n<!--                    <g id=\"Group-7\" transform=\"translate(80.000000, 2893.000000)\">-->\n<!--                        <polygon id=\"Rectangle\" transform=\"translate(424.500000, 223.500000) scale(-1, 1) translate(-424.500000, -223.500000) \" points=\"0 99.703192 849 -4.43831367e-13 849 347.296808 0 447\"><\/polygon>-->\n<!--                    <\/g>-->\n<!--                <\/g>-->\n<!--            <\/g>-->\n<!--        <\/svg>-->\n<!--    <\/div>-->\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">A common question will then be: can we identify the patients that will develop chronic symptoms, as well as those that recover fully?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A clinical prediction rule was found for full recovery, being: neck disability scores under 32% with an age under 36 years.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Predicting moderate to severe disability at 12 months was fairly possible with a neck disability score of more than 40%, an age above 34 years, and a score of more than 5 on the hyperarousal subscale of the posttraumatic stress diagnostic scale.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Below you can see other prognostic indicators of poor functional recovery.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" width=\"1020\" height=\"1028\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2021\/10\/Prognostic-indicators-WAD-Sterling-2021.png\" alt=\"Prognostic indicators wad sterling 2021\" class=\"wp-image-8169\" srcset=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2021\/10\/Prognostic-indicators-WAD-Sterling-2021.png 1020w, https:\/\/www.physiotutors.com\/wp-content\/uploads\/2021\/10\/Prognostic-indicators-WAD-Sterling-2021-150x150.png 150w\" sizes=\"(max-width: 1020px) 100vw, 1020px\" \/><figcaption class=\"wp-element-caption\">Sterling (2014), Journal of Physiotherapy<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Clinical examination<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At your first consultation the pain and disability should be reported because of its consistent prognostic capacity. The visual analogue scale and neck disability index can be of use here. Keeping an eye out for psychological issues is recommended. Examples are an inability to sleep due to thoughts about the accident or avoiding driving due to fear. For more information about measuring psychological issues, check out this table.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Much of the clinical examination is in line with the neck pain guidelines, found <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29228289\/\" target=\"_blank\" rel=\"noreferrer noopener\">here<\/a>. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Classifying whiplash associated disorders is possible with the Quebec Task Force classification. Most patients will fall in category number two. Identifying specific structures at cause is impossible in most cases. Imaging is therefore only required when grade 4 disorders are suspected. The Canadian C-spine rule or Nexus rule are valid tools for elevating this suspicion.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" width=\"1050\" height=\"798\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2021\/10\/Classification-WAD-Sterling-2021.png\" alt=\"Classification wad sterling 2021\" class=\"wp-image-8170\"\/><figcaption class=\"wp-element-caption\">Sterling (2014), Journal of Physiotherapy<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with whiplash associated disorders often report diffuse symptoms of sensory loss or gain and generalized muscle weakness. This is frequently due to altered nociceptive processing, and not necessarily a neurological compromise.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Previous research has found inferior performance on tests of motor control involving the cervical flexor, extensor and scapular muscle groups when compared to asymptomatic control participants; changes in muscle morphology of the cervical flexor and extensor muscles; loss of strength and endurance of cervical and scapular muscle groups; and sensorimotor changes manifested by increased joint re-positioning errors, poor kinaesthetic awareness, altered eye movement control, and loss of balance. That is a mouthful, you can read up about the assessment of these issues in <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18804003\/\" target=\"_blank\" rel=\"noreferrer noopener\">Jull et al 2008<\/a>.<\/p>\n\n\n<div class=\"cta\" style=\"\">\n    <div class=\"cta__in\">\n        <div class=\"left\">\n            <div class=\"cta__content text-color-light\">\n\t\t\t\t\t\t\t\t\t<h2 class=\"own-size\">Orthopedic Physiotherapy of the Spine<\/h2>\n\t\t\t\t\t                <p>This course will enable you to become confident in screening, assessing and treating the most common pathologies in the cervical, thoracic and lumbar spine based on the very latest evidence.<\/p>\n                                        <div class=\"cta__button\">\n                                <a href=\"https:\/\/study.physiotutors.com\/course\/orthopedic-physiotherapy-of-the-spine\/\" class=\"button button-five\" target=\"_self\">\n                                    Learn More                                <\/a>\n                            <\/div>\n                                    <\/div>\n        <\/div>\n                        <div class=\"right\">\n                    <img decoding=\"async\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2023\/01\/Spine-online-course.png\" alt=\"\"\/>\n                <\/div>\n                <\/div>\n<\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Management<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Now, how do we manage these patients? Advice to stay active and picking up where they left off in their activities should be one of the first things to do. And exercise should work, right? Kinda, but not much, and effects do not seem to hold up long. Exercise therapy generally has small effect sizes for whiplash associated disorders. At least it\u2019s better than a soft collar or rest. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The type of exercise does not seem to matter so we could just scale up whatever the patient likes between range of motion exercises, McKenzie exercises, postural exercises, and strengthening and motor control exercises.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Manual therapy can be added as long as the patient benefits from it, measured with validated outcome measures. However, the quality of evidence is low.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">As you&#8217;ve probably heard, there are few effective treatments for whiplash associated disorders. More research is needed.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Reference<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24856935\/\">https:\/\/pubmed.ncbi.nlm.nih.gov\/24856935\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Whiplash associated disorders are one of the toughest conditions to manage as a physiotherapist. Do you know what to do?<\/p>\n","protected":false},"author":46,"featured_media":8167,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[193],"tags":[1758,1748,1756,1760,1070,1076,219,1746],"tracking_tag":[],"class_list":["post-8166","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-head-neck","tag-accident","tag-associated","tag-car","tag-disability","tag-exercise","tag-management","tag-manual-therapy","tag-whiplash"],"acf":{"sections":[{"acf_fc_layout":"featured-related","heading":"Related blog posts","subheading":"","content_editor":"","featured_or_related":"related","posts":null,"button_type":"internal_link","button_label":"","button_style":"button-one","button_internal_link":"","button_anchor":"","button_url":"","button_file":null}]},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Management of Whiplash Associated Disorders - Physiotutors<\/title>\n<meta name=\"description\" content=\"Whiplash associated disorders are one of the toughest conditions to manage as a physiotherapist. 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