Whiplash

Whiplash

What is whiplash?

A whiplash is a neck trauma that occurs as a result of an accelerated movement of the head. In most cases this involves a movement in which the head is moved from front to back or vice versa. A rear-end accident with a car is a good example of this. Symptoms that are reported immediately (< 4 weeks) and six months after the accident: (Source KNGF whiplash guideline)
Symptoms Immediately after the accident Six months later
Neck pain 90-100% 10-45%
Decreased movement of the neck 40-95% 14%
- -
Headache 50-90% 8-30%
Sensitive to light 30-80% -
Pain in shoulder and arm 40-70% 5-25%
Dizziness 20-70% 3-20%
The complaints that arise from whiplash trauma can be very diverse. What almost all people with a whiplash trauma report is that there is neck pain and reduced mobility of the neck within 24 hours. Complaints may only appear or return weeks to months after the accident. What are the causes? As previously indicated, rear-end collisions are particularly fearful because of the occurrence of whiplash-type neck injuries. However, it is not only collisions that cause whiplash, sports accidents and diving accidents are also a frequent cause of neck injuries. The consequences are very diverse, one person has no problems at all, another person has complaints for a number of weeks and yet another person may have persistent complaints that ultimately lead to dysfunction and participation problems at work and sports. There is still insufficient insight into the causes of these differences. A classification has been made into the complaints that occur after a whiplash injury. A distinction is made into four classes: Class 1: Neck pain and stiffness without physical abnormalities Class 2: Neck pain with limitation of movement due to muscle and joint injuries Class 3: Neck complaints with symptoms of nerve loss Class 4: Neck complaints with vertebral fractures It is striking that they are the same. range of complaints can occur in all 4 classes. There are clear indications that whiplash can in any case be compared to a tire injury. Full recovery from stretched or torn ligaments classically takes between six weeks and three months. In addition, in some cases indications have been found for relationships with a brain stem injury. There are also indications that the front and back of the brain may be affected as a result of the accident. The latter two mainly explain the neurological complaints that can arise as a result of such trauma.
What is the progression? Internationally, studies on whiplash complaints often refer to data from the Canadian research group Quebec Task Force on Whiplash Associated Disorders (QTF-WAD). This publication from 1995 is often used as a guideline in assessing the healing process. This study also provided data on the natural course, divided into different time phases after the accident: phase 1: up to 4 days after the accident: 50% still have complaints phase 2: 4 to 21 days after the accident: 35% still have complaints phase 3: 22-45 days after the accident: 25% still have complaints phase 4: 46-180 after the accident: 20% still have complaints phase 5: 3-6 months after the accident: 20-15% still have complaints phase 6: more than 6 months after the accident: 15% still have complaints. In summary, we see that the normal healing process in the first 3 phases leads to 75% being able to function normally again, but that after this period the healing process is very slow and a critical phase arises for the development of chronic complaints. However, these data must be qualified somewhat and it appears that the healing process in the first 3 weeks determines the degree of resilience. Most patients who still have complaints after 3 weeks experience at least a delayed recovery and reduced resilience in the long term. In addition, investigations are often based on whether a person has returned to work or not and no comparison is made with their functioning before the accident.New paragraph
What does the physiotherapist do? The physiotherapist will treat you according to the Whiplash guideline, which describes the physiotherapeutic diagnostic and therapeutic process for patients with whiplash. The aim of the diagnostic process is to identify the severity, nature and extent to which the complaints can be influenced. The physiotherapist can use a number of measuring instruments as measuring instruments. Examples of this are the VAS scale and the NeckDisability Index. Two tests are recommended for testing balance, standing on one leg and tightrope walking. Standing on one leg: The patient stands on one leg for as long as possible (maximum 30 seconds). You stand successively on the dominant leg and the non-dominant leg. The patient has two attempts for each leg. The arms are held along the body. The patient is allowed to move the trunk a little as long as his foot remains stationary. The number of seconds that the patient can remain standing is noted and is the final score.Tightrope walker: The patient walks step by step over a line of three meters (heel of one foot against the toe of the other foot.) After practicing once, the test is carried out as quickly and accurately as possible, with the physiotherapist recording the time with a stopwatch. For each error (if the foot is placed outside the line or if the heel does not meet the toe), 3 seconds are added to the final time. Finally, a total score is calculated (finishing time plus any additions). For this purpose, the average of two total scores is taken. The physical examination further examines the stability of the spine and the joint function of the entire spine. Furthermore, posture and muscle tension are examined and an inventory is made of what activities the patient can and cannot perform and what his participation is in sports and work. Before treatment, it is examined whether there is a normal healing process or a delayed healing process. A delayed healing process is characterized by: persistent pain; reduction in activities or decrease in participation; expansion of general complaints such as fatigue, depressive complaints, reduced ability to do things, etc. increasing fear of movement; lack of treatment results; increasing demand for therapy and medical examinations. During the therapeutic process, we look at which phase (see earlier) the patient is in and whether there is a normal course or a delayed healing process. In the first phase (up to four days), the pain is the priority and physiotherapy is limited to guidance and providing information about the nature of the injury and its natural course. It is recommended to exercise in a measured manner. Wearing a cervical collar is not recommended, various scientific studies have shown that measured exercise promotes recovery. In the second phase (four days to three weeks), functions are improved during normal recovery and the load can be slowly built up. Dosed exercise promotes the recovery process, the physiotherapist guides the patient in determining his limits with regard to duration, pace and nature of activities. Keeping an activity diary can be helpful in this regard. When training, the stability of the neck muscles is examined and balance and coordination exercises can be started. In the third phase (three to six weeks) the functions are further improved and the load increased. Pain should no longer be the focus and efforts are being made to return to normal participation at work and in sports and hobbies. Attention is paid to the influence of posture during work, household tasks and sports and the influence of static loads on the healing process. (reading a book, watching television, etc.) In the fourth phase (six weeks to three months), participation in work is in the foreground, the functions and skills and the resilience are gradually increased. Preferably, consultation takes place with the company doctor or occupational health and safety service. For complaints that last longer than three months, the chance of full recovery decreases and a decision can be made in consultation about an approach via a multidisciplinary team. What can you do yourself to reduce the complaints? Whiplash is a complaint that should be taken very seriously. If you experience neck pain, reduced mobility and/or headache within 24 hours after a (car) accident, it is wise to take the following measures. Always have x-rays of the neck taken to rule out orthopedic injuries and for your medical file! Rest for four days. Complete bed rest is not necessary, but try to avoid loads such as lifting, carrying, pushing, pulling, working overhead and extreme head movements. A cervical collar is not necessary. If you do receive one from the hospital or from your GP, never wear it for longer than four days. Use painkillers and muscle relaxants at fixed times and for a predetermined period (for example ten days). Never use medication based on pain. If you still experience complaints after four days, please contact your physiotherapist. Also contact your physiotherapist if you still experience some of the above complaints in the period that follows.
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