Whiplash is an injury which results from sudden acceleration-deceleration forces on the neck.
The term encompasses a variety issues affecting muscles, joints, bones, ligaments, discs and nerves.
What Causes Whiplash?
Whiplash generally results from a traumatic event involving sudden acceleration-deceleration forces. The most common cause for whiplash is a motor vehicle accident. Other potential causes may include roller-coasters, bungy jumping or a sports-related collision.
What are the Symptoms of Whiplash?
Symptoms and severity of whiplash can vary significantly between people. The most commonly reported symptom is neck pain or stiffness. This can occur anywhere from immediately after the injury to several days later.
Symptoms may include:
- Neck pain or stiffness
- Shoulder pain, arm pain or upper back pain.
- Altered sensation
- Visual disturbances
- Hearing difficulties
- Difficulty speaking or swallowing
- Difficulty concentrating
How is Whiplash Diagnosed?
Whiplash is a clinical diagnosis based of your history of injury and clinical testing. Radiological tests may be useful to identify injury to specific structures such as a fractured vertebra, disc injury, muscles or ligaments.
Due to the traumatic nature of a whiplash injury; there is a risk of more urgent or sinister injuries which need to be ruled out before undergoing treatment. Your physiotherapist and GP are trained to detect anything abnormal which warrants further investigation, however please notify a health professional if you have (or develop) any of the following:
- Bilateral pins and needles
- Gait disturbances
- Progressively worsening weakness or sensation problems
- Pins and needles or numbness in the face
- Difficulty speaking or swallowing
- Drop attacks (falling without loss of consciousness) or fainting
- Bladder or bowel problems
Research shows the most effective way to treat your injury is with a combination of treatment options which are tailored to your individual dysfunctions. Research evidence supports various treatment approaches. Your best treatment direction should be guided by an expert in the rehabilitation such as a musculoskeletal physiotherapist who specialises in neck injuries or whiplash. Potential treatment methods for whiplash include:
- Continuing your normal daily regime: Acting Normal!
- Active treatment guided by your physiotherapist.
- Exercise to encourage flexibility, strength and good posture.
- Fine neck muscle and proprioception retraining programs guided by a physiotherapist.
- Acupuncture or dry needling for pain relief.
- Education on the injury: asking questions!
- Joint mobilisation or manipulation to loosen stiff joints.
- Medication to assist your pain, muscle tension or to assist you psychologically.
- Psychologist advice.
- Vestibular rehabilitation if dizziness is one of your symptoms.
- Soft tissue massage may assist for short-term muscle tension relief.
- Electrotherapy for pain relief and to assist early healing.
Most whiplash patients will start to feel better within a few weeks of the injury. Your physiotherapy treatment will aim to:
- Reduce neck pain, headaches and inflammation.
- Normalise joint range of motion.
- Strengthen your neck muscles.
- Strengthen your upper back muscles.
- Improve your neck posture.
- Normalise your muscle lengths and resting muscle tension.
- Resolve any deficit in neural tissue extensibility.
- Improve your neck proprioception, fine motor control and balance
- Improve your ability to cope with everyday activities, plus more stressful ones such as lifting.
- Minimise your chance of future neck pain or disability.
We strongly suggest that you discuss your specific whiplash injury after a thorough examination from a physiotherapist who specialise in whiplash associated disorder.
Will you get better? Yes. However whiplash injuries can take from a few days to several months to rehabilitate.
Just as the symptoms and severity of whiplash can vary from person to person, so can the recovery time. The good news is that research shows the large majority of whiplash sufferers recover with actively guided treatment.
There are many other factors which can impact on your recovery, including depression and trauma-related anxiety, so it is important to raise any additional issues with a qualified health professional to give yourself the best chance of recovery.
What is a Trigger Point?
Dr’s Travell and Simons defined a myofascial trigger point as a “hyperirritable spot in a skeletal muscle”. The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction and autonomic phenomena.
Myofascial trigger points are commonly seen in both acute and chronic pain conditions. Hendler and Kozikowski suggest that myofascial trigger points as the most commonly missed diagnosis in chronic pain patients.
Why Do Trigger Points Cause Pain?
According to Dr. Gunn, ‘Shortening in muscles acting across a joint increases joint pressure, upsets alignment, and can precipitate pain in the joint, i.e. arthralgia.’ Muscle release, massage or dry needling of the ‘shortened’ muscle band can cause an immediate palpable relaxation. A sense of release and increased range of motion is often experienced by the patient.
When used in conjunction with motor control retraining and postural and movement retraining, the release obtained from treatment can be long lasting.
How Are Trigger Points Treated with Dry Needling?
Over the years it has been shown that it is possible to deactivate triggers points by injecting them with a large number of varying substances, including saline (salt water) placebo. It has been subsequently suggested then, that only consistent factor is that the pain relief is obtained from the stimulation of the needle used for the injection itself, rather than the drug or saline solution used. This mechanical needle stimulation of the trigger point without the use of a drug is known as Dry Needling!
The needle sites can be at the epicentre of taut, tender muscle bands, or they can be near the spine where the nerve root may have become irritated and supersensitive. Penetration of a normal muscle is painless; however, a shortened, supersensitive muscle will ‘grasp’ the needle in what can be described as a cramping sensation. The result is a stimulation of the stretch receptor in the muscle (muscle spindle), producing a reflex relaxation or lengthening response.