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Whiplash - What Influences Recovery?

People vary so much in their response to injury such as whiplash. Trying to figure out what it is that determines how well people are going to recover is important.

If we can spot the people who are likely to turn out badly we can target our techniques and resources to try and minimise this group.

That way we can reduce the number of people who have long term pain and disability.

What Happens At The Time Of Injury

  • Rear end collisions are common, but do not seem to be associated with a poor outcome. To reduce the likelihood of neck damage, the headrest needs to be properly positioned.
  • Speed of collision seems an obvious candidate. The faster the crash, the more force involved. However, there is no strong evidence for this idea.
  • If your vehicle is of low weight when you are crashed into this increases the likelihood that you will get a whiplash injury. If a heavy vehicle hits you this has the same effect.
  • Wearing a seatbelt may increase the likelihood of getting WAD, but the evidence is not clear, and seatbelts have prevented so many awful injuries and deaths.
  • Poorly positioned headrest is thought to be harmful.
  • Looking to one side when you are rear-ended is also thought to increase the risk of WAD

The Effect Of Past Factors On The Outcome

People who get crashed into are not all fine and without pain before the event. We all have our own problems and health difficulties and they affect how well we respond to injury and how well we recover in the end.

  • Neckache or pain before the crash makes it more likely that you will have longer term problems and take much longer to settle.
  • If you are older this does not seem to be related to a poorer outcome.
  • Being female is not associated with a poorer outcome.
  • Degenerative changes present in the neck is thought to be associated with a worse outcome.
  • Having headaches before the event may be a risk factor also.

If you have some of these problems before the event, it is possible your recovery and long-term outcome could be affected for the worse. These cases need more input and supervision to do well.

Factors After Whiplash Which Affect The Outcome

The effects of whiplash are very varied. I have heard people say they had a bit of a stiff neck for a few days, while others say they had horrendous pain and disability which lasted for months or more. There are a few factors after the event which make a worse outcome more likely.

  1. A high initial pain intensity from the injury.
  2. A headache for more than six months after the event.
  3. There are neurological signs present after the injury. This includes weakness, abnormalities in feelings and altered reflexes.

The Risk Factors For Problems After Whiplash

People of all kinds have whiplash. They have different ages, physical conditions and medical histories. They may have pain conditions already in other areas of the body or in the neck. This at least partly accounts for the huge variation in how things turn out. Knowing the factors that are important before, during and after the event helps figure out the interventions which are appropriate at the right times.

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.


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