Whiplash, Neck Pain, Cervical Pain

This article is about Whiplash, neck pain and cervical pain

Whiplash Associated Disorder

neck pain treatment “Whiplash Associated Disorder (WAD)” is the name given to a group of neck pain syndromes most commonly resulting from injuries.

A variety of bony or soft tissue injuries occur and give varied symptoms from typical causes:

Acceleration and deceleration trauma to the neck
Vehicle injuries, usually rear or side impact
Sporting incidents such as in rugby, horse riding or diving

WAD is a common injury presenting in physio clinics, is often minor but can be very distressing and disabling. Many different tissues are injured in the incidents, giving many symptoms in many areas of the body, many bizarre to normal thinking. If it persists there can be severe complicating psychological factors.

Road accident statistics from insurance companies indicates perhaps 300,000 new cases of WAD every year. Numbers vary in other countries and there could be many reasons for this. Despite the number of UK accidents remaining static, the numbers of people presenting to Emergency Departments is increasing.

The Whiplash Book, by Prof. Kim Burton, Prof. Gordon Waddell and Tim McClune is available from HMSO at £2.50 each, but since they charge £3 post/packing for one booklet (!) I think a much better idea is to order, along with other items you might want, from Amazon.co.uk.

This will take you to the correct Amazon page, should you want a booklet. The Whiplash Book: How You Can Deal with…

If you have had a whiplash-type injury, the booklet gives practical guidance on how to manage your condition. Permanent damage is rare, but the booklet recognizes that some people are seriously affected, and clearly explains the signs which indicate you may be at risk.

Whiplash: The Mechanism of Injury

History of Whiplash

The word “whiplash” was first used in 1928 to describe an injury involving rapid acceleration and deceleration movements of the neck and upper thorax. As most of us know, this is commonest with a rear shunt vehicle accident.

The original ideas was that the impact moved the car and the body forward suddenly, leaving the head behind. This forced the head and neck into a full extended position. Then the head and neck moved forward violently into a fully flexed, chin on chest, position. As the joints and discs were forced back and forward, they suffered significant stresses of compression (forced together) or tension (stretching).

A New Mechanism Of Injury

Scientific studies have shown a different pattern of movement during these events. As the rear impact occurs, the sixth cervical vertebra (C6) moves back into extension before the upper neck starts to move at all. As C6 reaches the end of its extension range C5 starts also to extend. This gives a curve shaped like an “S”, with the lower neck in extension and the upper neck in some flexion.

This may change as the upper neck then extends, the whole neck then ending up in a C-shape facing backwards. All this happens in less than 200 milliseconds, a very short time indeed.

This explains why the C5/C6 spinal level is the worst affected level of the neck in these injuries. Typical injuries are disruption of the disc, stretching of the joint capsules and damage to the facet joints. The S-shaped position causes a shearing motion to the upper neck joints which could lead to upper neck pain and headaches.

The lower cervical spinal levels are thought to go further than the normal maximum extension movements in WAD, leading to the rear joints being rammed together and the front of the vertebrae being overstretched. Upper neck injury may be more common in higher speed impacts.

How Likely Are You To Get Pain?

Data on this question mainly comes from car insurance companies in the USA.

A third of people involved in a car accident experience neck pain (33% overall number)
A third of that number attend an accident and emergency department. (11% overall number)
A third of this number consult their GP or like primary practitioner. (3% overall number)
A third of this number consult their GP etc more than once. (1% overall number)
A third of this number develop chronic neck pain referred to as WAD. (0.33% overall number)

This last number (0.33%) works out at about one person in 300 develops chronic neck pain symptoms after a car accident.

How Long Will It Take To Recover?

Again, data comes from the USA, with these results coming from hospitals. This suggests how long most people will be likely to have their pain and the tendency to long term suffering.

60% of people say that their symptoms reduce after a month and that they go on to be without pain at three months from injury.
75% have recovered from their symptoms by six months.
85% have recovered from their neck problems after three years.
15% of people still report neck and other symptoms after three years from the incident.

These results also indicate that 4% of WAD sufferers still report severe pain after three years, indicating that WAD can be a long-term and very troublesome condition.

Cited Reference:
Moore A, Jackson A, Hammersley S, Hill J, Mercer C, Smith C, Thompson J, Woby S, Hudson A (2005). Clinical guidelines for the physiotherapy management of Whiplash Associated Disorder. Chartered Society of Physiotherapy. London.