Whiplash is a fairly common condition that occurs when the neck is suddenly forced forwards and backwards, usually from motor vehicle collisions. Before 1928, whiplash was sometimes called “railway spine” as it was used to describe injuries that occurred to people involved in train accidents. Since 1928, much has been studied and reported about this condition and in 1995, the term, “whiplash associated disorders” (WAD) was introduced. The WAD classification of whiplash patients includes three main categories (WAD I, II, and III) and a few years later, WAD II was broken into 2 sub-categories (IIa & IIb). This occurred because some patients in the WAD II category took a longer time to heal than others. Here are the basic definitions of WAD I, II, III:
- WAD I: Patients have complaints but no objective findings, meaning we cannot reproduce your pain during our examinations.
- WAD IIa: Patients have complaints with objective findings but a normal range of movement of the neck and no neurological findings (normal strength and sensation ability).
- WAD IIb: Same as WAD IIa except here, neck movements are decreased.
- WAD III: Neurological abnormal findings (weakness and/or sensation) are present.
- WAD IV: Includes fractures and dislocations. Because of this unique difference, this category is often left out of the research that uses this category system to determine prognosis of the WAD case.
This system is very useful as it has the ability to predict the results in a case long before the conclusion of the case.
We have discussed the cause of whiplash in previous articles and what happens when we are hit from behind unexpectedly. In essence, we cannot guard against the abnormal forces that occur in the neck as it all happens faster than we can voluntarily contract our muscles. Also, the myth about no car damage = no injury is just that – a myth! In fact, in low speed impacts, when there is less damage to the car, it can mean greater force will be applied to the contents inside (the driver and any passengers) because the energy of the force is not absorbed by crushing metal (elastic vs. plastic deformity).
Symptoms of whiplash vary widely. The most common symptoms include neck pain and stiffness, headache, shoulder pain/stiffness, dizziness, fatigue, jaw pain, arm pain, arm weakness, visual disturbances, ringing ear noises, and sometimes back pain. If symptoms continue and chronic WAD occurs, depression, anger, frustration, anxiety, stress, drug dependency, post-traumatic stress syndrome, sleep disturbance, and social isolation can occur.
Diagnosis can be based on the history, physical exam, x-ray, MRI, and if nerve damage occurs (WAD III), an EMG. Treatment includes rest, ice (and later heat), exercise, pain management, and avoiding prolonged use of a cervical collar. Chiropractic treatment includes all of these options as well as manipulation, mobilization, muscle release methods, and patient education. A prompt return to normal activities, including work, is important to avoid the negative spiral into long-term disability.