Whiplash Injury and Whiplash Associated Disorder (WAD)
Due the very large number of vehicle journeys undertaken each day across the country there are a correspondingly large number of vehicle accidents or road traffic accidents RTAs. Rear shunt accidents, where a vehicle hits the back of a stationary or slow moving vehicle in front, are some of the commonest accident types and can result in what is known as a whiplash injury. The neck is a particularly vulnerable structure in such an accident, as it is unsupported by the seat and the heavy brain and skull is stuck on top of a narrow bony and muscular structure.
Studies have shown that the forces involved in a rear shunt accident can be transmitted to the neck and damage many of the anatomical structures such as the facet joints, ligaments, discs and nerves within the cervical spine. The forces have been shown to be concentrated on two main areas, with the joints between the second and third cervical vertebrae and the sixth and seventh cervical vertebrae being most vulnerable. So sources of pain can commonly be the C2/3 and C6/7 facet joints although other structures may be involved.
Whiplash injuries vary greatly in severity from a minor ache which goes in hours or at most a day or so, to very severe pain and disability which remains over a very long, sometimes chronic, period. The initial medical evaluation is extremely important as severe injury to the neck can result and patients can present with unstable fractures with risk of spinal cord injury. X-rays and a careful medical examination will include the cranial nerves, movements of the neck, the muscle power and nerve supply to the arms and the upper thoracic spine.
Once the patient is diagnosed the treatment for whiplash injury consists of painkillers which should be strong enough to control much of the pain, rest, wearing a collar if helpful for a couple of days and referral to physiotherapy. Many people recover well with advice to keep active and reduce the level of their normal daily activities, to avoid resting significantly. Information booklets can be useful, outlining the mostly non-serious nature of the injuries, the high probability of getting better completely, the management advice for activity, resting, painkillers can continuing with normal day to day activities. Early manipulative treatment may not be appropriate but if the patient has not improved greatly over a month a visit to a physiotherapist may be helpful.
Author: Jonathan Blood-Smyth
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