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What Happens in a Whiplash Injury?

When a whiplash injury occurs after a rear shunt vehicle accident we usually think purely in terms of the acute injuries to the anatomical structures in the cervical spine or neck. This is an important issue but physiotherapists know that there is much more to it, as there are issues which occur in the nervous system which make the difference between the injury settling down quickly or becoming a long term or chronic pain problem. An injury sets off a chain of events in the nerves of the locally damaged areas; the next level nerves in the spinal cord and in the brain which leads to the central nervous system developing increased sensitivity to all incoming stimuli which makes it react more strongly.

A reduction both in the pain threshold and in the tolerance to pain in the neck has been found in patients with general neck pain of unknown origin and in those who have suffered whiplash. This amplified response is known as hyperalgesia, defined as an exaggerated painful response to a normally painful stimulus. This means that a painful stimulus, for example moving the hand after the neck joints have been injured, will be felt as pain but at a much more amplified level due to the nervous system changes. All whiplash injuries show a degree of hyperalgesia, now matter how mild or severe they are but this will settle in two to three months in those who recover or who remain with only mild symptoms.By making whiplash claims you may be able to get physiotherapy treatment paid by the insurance.

In patients who have ongoing problems with their necks after whiplash the hyperalgesia has been shown to continue, particularly in those people whose symptoms are more severe and which persist over time. The nerves in the locally damaged areas of the muscles and joints may be sensitised and patients with whiplash are known to suffer damaged structures in cases where pain and disability has continued. Another mechanism of pain amplification is the reaction of the nerves in the spinal cord which receive painful inputs from the damaged structures.

Physiotherapists are aware of the neural changes which occur in pain syndromes such as whiplash injury and target their treatments towards minimising the effects of central changes and towards returning the thresholds towards normal. Rest, exercise, massage, heat, mobilisation techniques and electrical treatments are all targeted at reducing pain and restoring normal neural input and function.


The information contained in this article was written with the help of an Edinburgh Physiotherapist

Author: Jonathan Blood-Smyth

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