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Whiplash Injury
Chin
Ping Hong Raymond
![](3D"master04_background.gif")
Definition
<=
span
style=3D'font-size:88%'>nQuebec Task Force on
<=
span
style=3D'font-size:86%'>nWhiplash Associated Disorders (WAD) 1995
n=
Rear end o=
r side
impact Motor Vehicle Collision
n=
Bony or So=
ft
tissue Injury
<=
span
style=3D'font-size:88%'>nNot actually a pathological diagnosis
<=
span
style=3D'font-size:88%'>nA variety of clinical conditions from similar or in <=
span
style=3D'position:absolute;top:48.97%;left:3.71%;width:83.48%;height:48.97=
%'>fact not
similar, mechanism of injury=
<=
span
style=3D'font-size:88%'>nOften with concomitant head injury
Epidemiology – High Variation
nOne third of Australians
involved in Rear end collisions
nHalf of Injured American=
s in
RTAs
n12-18% reported persiste=
nt
symptoms 6 months
post injury (Greece, Lithuana 1%)
n5-15% one year later
=
;
nInsurance claims:
nSaskatchewan
85%, Quebec 20%
n
PE and Investigations
<=
span
style=3D'font-size:88%'>nPE:
<=
span
style=3D'font-size:86%'>nMidline tenderness
<=
span
style=3D'font-size:86%'>nFocal neurological deficits
<=
span
style=3D'font-size:86%'>nConscious desturbance
<=
span
style=3D'font-size:86%'>nIntoxication
<=
span
style=3D'font-size:86%'>nOther painful distracting injury
<=
span
style=3D'font-size:88%'>nX-ray
<=
span
style=3D'font-size:86%'>nHoffmann: 30,000 cases, miss 8/818 fractures
<=
span
style=3D'font-size:86%'>n2/8 have clinical significance
Over-investigations
<=
span
class=3DBB style=3D'position:absolute;left:-4.11%;top:.39em'>nCTs, MRIs: only if PE or=
X-ray
showed significant
findings
<=
span
class=3DBB style=3D'position:absolute;left:-4.0%;top:.39em'>nDeepen sick role: wrongf=
ul
attribution of benign findings to cause of symptoms
<=
span
class=3DB1B style=3D'position:absolute;left:-3.99%;top:.49em'>nEg. Degenerative disc, b=
ulging
disc, osteophytes
etc.
Objective Complications<=
/span>
nMuscular:
nChange of =
Muscles
fibres: Type 1 to Type 2
nDecrease in endurance and strength: easy fatiq=
ue
and discomfort
nMuscles at=
rophy,
muscles spasm
nDeep muscl=
es
dysfunction (concomitant hypercontractile superf=
icial
flexors)
nShoulder g=
irdle
dysfunction
nPoking chi=
n,
forward head posture
nSensory:
nHypersensi=
tivity
nDeteriorat=
ion of
Proprioception
Neck Disability Index –
Dr.= Howard Vernon
Dr.= Howard Vernon
1.
Pain Intensity
2.
Personal Care
3.
Lifting
4.
Reading
5.
Headache
6.
Concentration
=
7.
Work
8.
Driving
9.
Sleeping
=
10. Recreation
![](3D"slide0007_image006.gif")
Raw Score Leve=
l of
Disability:
0-4 No
Disability
5 - 14 Mild Disability
=
15 - 24 Moderate Disability
<=
/div>
25 - 34 Severe Disability
35 - 50 Completely Disabled
Treatment Options=
nVAS:
subjective, an elusive target
nNeck Disability Index: a=
measure
as well as
a problem chart
nPain Generators:
nIntervertebral
disc: controversial
nFacet:
manual therapy, injection therapy
nSurgery: very few litera=
ture,
controversial
n<=
span
lang=3DEN-US style=3D'font-family:\65B0\7D30\660E\9AD4;mso-fareast-font-fa=
mily:
\65B0\7D30\660E\9AD4;mso-fareast-language:ZH-TW;mso-special-format:lastCR;
display:none'>
Interesting Study for Ac=
ute
phase
nBorchgrevink 1998 Spine&=
#13;
nWAD
divided to 2 groups
nGroup 1: NSAID + Neck Co=
llar +
14 days SL
nGroup 2: NSAID + =
“Act Normal”=
; Advice
n6 months after: Group 2
significantly better
nMcKinney 1989:
nHome exercise, 2 years&#=
13;
nPeeters 2001 Spine
<=
/span>
nActive treatment prevail=
s over
passive treatments
n
Strategy of Acute Phase =
=
Management=
nIdentifying Red flags and severe injuries
=
nProvide best environment for tissue recovery&#=
13;
nPrevent Deconditioning
nNSAID and
Physiotherapy (Deep Muscles, Proprioception)
nActive home
exercise
nAct Normal=
nPrevent Deepening Sick Role
=
nAvoid
over-investigations
nAvoid arbi=
trary
attribution of investigations findings or making arb=
itrary
labeling
Muscles Reconditioning
nStrength and Endurance Exercise
nTraditiona=
l
nControvers=
ial in
terms of efficacy (Aker 1996, Kyellman 1999, Panel
2001)
nJull: Deep muscles reactivation and relaxing <=
/span>superfical=
flexors
hyperactivity)
nEarly days=
of
injury
nCranio-cer=
vical
flexing exercise monitored by bladder guage behind the neck&#=
13;
nShoulder girdle dysfunctions
nProprioceptive Dysfunctions:
nSwiss ball=
, Wobble
board, Eye Fixation Exercise
n
Other complications
nGeneral Stiffness – home exercise
nLocal facet stiffness – manual therapy
nPostural problems:
nPoking chi=
ns,
forward drifting of head positions
nCochrane Database Syst Rev. 2005 Jul 20;(3):CD0=
04250
nMulti-modal
program: incorporating
nMobilizing,
nmanipulation, and
neye fixation exercise
n
Physical Modalities
nNo evidence support
nDependence and sick role
nGood to act as adjunct for active treatment modalities
<=
span
style=3D'visibility:hidden'>n
What I do not know
<=
span
style=3D'font-size:88%'>nPsychosocial problem and strategy of management=
<=
span
style=3D'font-size:86%'>nNo Waddell sign
<=
span
style=3D'font-size:88%'>n3 categories of symptoms
<=
span
style=3D'font-size:86%'>nSomatic: headache, neck pain, dizziness
<=
span
style=3D'font-size:86%'>nPsychological: depression, change of personality
=
<=
span
style=3D'font-size:86%'>nCognitive: loss of concentration
Role of a Physician
nAvoid dichotomizing
nOrganic vs
Non-organic, interwoven
nDon’t make it worse
nManage
Expectation
nPerception of Control
nLoss: demotivated
<=
/span>
nGiven: reduction of Str=
ess
and Symptoms
nObsessive compulsive
behaviour
nFear Avoidance Behaviour: Withdrawal from work=
and
normal life
nPain not equal Tissue I=
njury,
Work against scar
<=
/span>
nReferral to expert
n
n
Conclusion
nProvide optimistic environment to heal by
nature
nTreat found and anticipated complications
=
n“Act Normal” advice
nSystematic muscles reconditioning
<=
/span>
nNeck: reac=
tive,
relax, strengthen
nShoulder g=
irdle:
attain functional position
nHead and N=
eck
posture
nPropriocep=
tive
training
nDo not dichotomize, Do our part of Management<=
/span>
' + ENDSHOW_MESG + '
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