Week 2 Whiplash P1

Whiplash Associated Disorder (WAD)

is a term used to describe a variety of symptoms that can occur following a whiplash injury, commonly associated with rear-end vehicle collisions. Symptoms may include neck pain, headaches, dizziness, and cognitive difficulties.

Understanding WAD

Classification of Trusted Factors Affecting Level of Injury

• Factors affecting injury severity in whiplash:

  • Gender: May influence the risk and severity of symptoms due to physiological differences.

  • Awareness

  • Age

  • Head restraint position

  • Impact velocity

  • Seat or occupant positioning

Signs and Symptoms

General Symptoms

• Pain is prevalent in nearly all patients, often accompanied by neck stiffness.

• Neck pain found in 92% of referred patients (Radinov et al, 1995).

• Headaches reported in 50-90% of patients (Sterling, 2011).

• Shoulder and arm pain experienced by 40-70% of patients (Sterling, 2011).

• Thoracic and lumbar back pain reported in 35% of patients (Sterling, 2011).

• Paraesthesia/Anaesthesia (primarily in upper limbs) reported by 20% of patients (Sterling, 2011).

Additional Symptoms- Neurological

• Balance and postural changes

• Unsteadiness and clumsiness

• Dizziness

• Visual disturbances

• Auditory disturbances (e.g., tinnitus)

• Temporomandibular joint pain

• Photophobia

• Fatigue

• Cognitive difficulties: loss of concentration and memory impairment.

• Possible link to underlying brain injury as cause is still unclear.

Quebec Task Force Classification of WAD

Grading System (1995)

• Grade 0: No neck pain or physical signs.

• Grade I: Muscle tightness, Neck pain, stiffness, tenderness; no physical signs.

• Grade II: Strain, Neck pain with musculoskeletal signs such as decreased range of motion or tenderness.

• Grade III: Disc injury, neck pain with neurological signs including reflex changes, muscle weakness, sensory deficits.

• Grade IV: Neck pain with fracture or dislocation.

Psychological Symptoms

Associated Mental Health Effects

• Symptoms may include:

  • Anxiety

  • Post-Traumatic Stress Symptoms (PTSD) (Dunne-Proctor, 2015)

• Study findings:

  • 40% of whiplash patients demonstrate psychological resilience.

  • 43% have moderate PTSD symptoms initially, with 17% experiencing persistent moderate symptoms for over 12 months (McCarthy S.).

Patterns of Recovery

Symptom Onset and Longevity

• Symptoms can manifest immediately or be delayed by 12-15 hours (Sterling, 2011).

• 50% of individuals may experience ongoing symptoms and not fully recover within one year post-injury (Sterling, 2011).

• Evidence shows limited improvement for symptoms persisting beyond three months (Kamper et al, 2008).

• Chronic WAD symptoms may include sensitivity to cold and are often associated with poor prognosis (Marcuzzi et al, 2015).

Chronic WAD and Rehabilitation

Cervical Dysfunctions in Chronic Cases

• Common cervical dysfunctions involve:

  • Increased cervical tone, including myofascial trigger points (Nijs et al, 2009).

  • Impaired cervical movement control (various studies).

• Note: Improvements in cervical function do not guarantee enhancement in overall patient health status, which complicates care.

Initiation and Maintenance of WAD

Contributing Factors

• Various factors linked to WAD include:

  • Sensorimotor disturbances (Treleaven, 2008)

  • Augmented central nociceptive processing (Jull Sterling et al, 2011)

  • Stress system responses and PTSD (Jull Sterling et al, 2011)

  • Psychosocial and sociocultural factors (Jull Sterling et al, 2011)

• The role of compensation in WAD recovery is debated in literature.

• Evidence suggests that mild traumatic brain injury may contribute to WAD (Findling et al, 2011; Cassidy et al, 2014; Hartvigsen et al, 2014).