When you hear “whiplash” – most people immediately think of a motor vehicle accident.
Although this is a common cause of whiplash, it can also occur with other mechanisms such as concussion sustained during sport, falls or physical abuse.
Concussion occurs with 70g of force to the neck, whereas a whiplash only requires 15g of force, so anyone who sustains a concussion should also be managed for a whiplash injury.
Whiplash is an acceleration-deceleration mechanism of energy transfer to the neck.
It can result in bony or soft tissue injury, which can manifest as neck pain, as well as an array of other symptoms including stiffness, headache, dizziness, fatigue and even cognitive problems such as difficulty concentrating or remembering things.
Collectively, these symptoms are as known as:
or WAD for short.
According to the Melbourne Whiplash Centre, 50% of people suffering whiplash will recover in 6-12 weeks.
Unfortunately, 25% will have mild ongoing pain, and another 25% may have moderate to severe pain that persists.
Physiotherapy can be a helpful treatment to assist with the recovery and resolution of symptoms, and may make all the difference in having a successful outcome.
Your physiotherapist at RHP will conduct a thorough assessment based on the symptoms being experienced, and formulate an individualised treatment plan that helps provide relief, but also works towards long-term resolution and prevention of further bouts of neck pain and WAD.
One good point to remember is that you only get once chance to optimise the early healing of an injury, and whiplash is no different. With this in mind, we must respect the underlying pathology, so although we want our patients remaining as active as possible, it is often appropriate for a period of rest for the neck to allow symptoms to settle, before reloading back to normal activity.
How Does Physio Help?
Just like a sprained ankle needs physiotherapy for an optimal outcome, whiplash also requires the same level of care and rehabilitation. Take a look at the types of treatments physiotherapists find effective in treating whiplash:
- Joint Mobilisation
- Dry Needling
- Neck Strengthening Exercises
Joint mobilisations are an effective way to improve segmental mobility in the neck, and can also help to desensitize the area to movement.
By gently moving each segment of the neck individually, it can restore motion to the injured segments, but also teach the brain that it doesn’t necessarily need to hurt when those joints are moved.
Massage, trigger point release and stretching are techniques that can help to reduce muscle tone and spasm, as well as improve muscle length. After an injury, muscle spasm and trigger points can develop as a protective mechanism, to help stabilise the area.
These trigger points often cause referred pain into the head/face, arms and thoracic area, and the muscle spasm will prevent normal movement of the neck, shoulders and back. Addressing this in physiotherapy can alleviate pain in a variety of areas and reset the tone of the muscles to allow better muscle function.
Dry needling is a technique that uses solid small-filament needles to desensitise and deactivate myofascial trigger points. It is NOT acupuncture, although it does use the same type of needle.
It can be effective in managing whiplash, as it can give more dramatic and longer lasting effects compared to traditional manual techniques, particularly if there is also neural sensitivity.
Dry needling may not suit everyone, but when used appropriately it can have powerful benefits.
Neck Strengthening Exercises
Neck strengthening is the most important aspect of whiplash rehabilitation.
Neck weakness can feel like your head is too heavy, or neck pain may develop with higher load activities such as exercise, housework or even prolonged computer/ phone use.
Developing a headache towards the end of the day is also a sign of neck weakness, as the tired muscles can’t adequately support the head anymore.
The muscles which need to be addressed are the deep neck flexors, that help to tuck the chin and stop the classic forward head posture.
The long cervical extensors (at the back) also need to be targeted as they hold the head up against gravity.
The neck rotators are very important for daily life, allowing us to turn the head, and if the whiplash occurred from a side impact (such as a T-bone incident) there is usually dysfunction with turning or side flexing which needs to be specifically targeted with exercise.
Lastly, shoulder blade stability may need to be considered, as the shoulder blades share the load between the spine and the rest of the body, as well as having a major role in keeping good posture.
Exercise 1: Chin Tuck
Imagine something was in front of your face, and you are drawing just your face away from it (like you are giving yourself a double chin).
Do this with your own muscle as far as you can, then use 2 fingers on your chin to help it back into more of a stretch.
Resist the urge to go up or down with your chin – it is just a straight back movement.
Complete (4 x 20 secs) 4 times/day.
Exercise 2: Prone Head Lift
Lay on your tummy, with your hands by your side, and rest your forehead on a small folded towel.
Keep your chin tucked, and gently lift your head off the towel. Ensure you do not lift your chin, so that your spine stays straight.
Hold for 5 seconds, relax and repeat. Aim to reach 30 repetitions, however start well below this and gradually build up so as to not overdo things.
Exercise 3: Push Back at Wall
Cup the elastic in a wide band around the head.
Place your hands at head height on the wall, with elbows bent and the elastic slightly loose.
Bring your head back into the neutral position, chin slightly nodded and head aligned with your body. Straighten your elbows to tension the elastic, maintaining the neutral position of the head and neck.
Bend your elbows to release the tension on the elastic, then repeat the exercise.
Exercise 4: Pure Rotation in Quadruped
Kneel on the ground with the upper back sagged between the shoulder blades in a neutral position, slightly rounded, but not a ‘cat curl’. Keep the chin tucked and the head hanging.
From this position, turn the head to one side. Do not allow the chin to poke or the mid neck to collapse forward or tilt as you turn.
Return the head to the starting position again and repeat on the opposite side.