Whiplash: introduction to the injury
What is it?
Whiplash or Whiplash Associated Disorders (WAD) is the most common car accident injury. 83% of individuals report WAD symptoms resulting in a $3.9 billion annual economic cost. WAD is defined as a bony or soft tissue injury resulting from an acceleration-deceleration mechanism of energy transfer to the neck. In 1995 The Quebec task force developed a WAD classification based on severity, which is still accepted today. Although there are five grades, approximately 93% of patients are classified as WAD II.
Grade 0: No complaints or physical signs of injury.
Grade 1: Complaints of neck pain or stiffness, with normal range of motion.
Grade 2: Complaints of neck pain or stiffness, with decreased range of motion.
Grade 3: Complaints of neck pain or stiffness, with severely decreased range of motion and neurological symptoms.
Mechanism
Recent literature suggests that whiplash injuries may occur from abnormal physiological movement, i.e. movement into a position that is beyond what the structure is designed for. How does this happen? As the vehicle is struck the resulting force travels through the car toward the occupant. This energy causes the individual to move and slow down in a particular manner and that is often broken down into four phases. For the general purpose of this discussion lower neck extension, an s-shaped neck curvature, full extension/hyperextension, and hyperflexion are possible positions of the neck which can be experienced in combination with acceleration or deceleration forces. These combinations of forceful extension and flexion movements generate compressive, tensile, or shearing forces on the body's soft tissues, bones, disc, or nerve structures and with enough force can create injury.
Symptoms
Whiplash can be complicated to manage as there is a wide range of symptoms. symptoms including but are not limited to, neck stiffness, neck pain, shoulder pain, jaw pain/dysfunction, headaches, visual disturbances, arm pain, paresthesias, problems with memory, concentration, and or psychological distress.
Treatment
A treatment recommendation that can be globally applied is difficult because WAD mechanism, symptoms, and their effect vary dramatically and research on best practices continues to evolve. However, it is widely accepted that rehabilitation should include progressive conservative, active, and behavioral interventions in the acute stage.
Conservative forms of treatment are non-invasive care including but not limited to, Physical Therapy or Chiropractic care.
Active forms of treatment include but are not limited to functional mobilizations, range of motion, strength, postural, aerobic, or balance exercises
Behavior interventions include but are not limited to hurt vs harm education, act as normal, self/home care, cognitive behavioral therapy,
Recovery
The prognosis from WAD is often quite good but still quite varied as many factors influence recovery. In general, recovery can be days and weeks to months and sometimes longer, research has demonstrated the vast majority of recovery progressions occur within the first three months. Following 3 months improvements can still occur but at a slower pace.
In conclusion, WAD is a common but sometimes complex injury that has a good prognosis if managed well within the first few months. For an adjuster, there are many steps involved with the evaluation of a car accident, reported injuries, and their care pathway. There is now technology available that minimizes manual effort and human error in these steps allowing the adjuster to be informed and engage in more meaningful tasks.
