Whiplash Associated Disorder Flashcards
Definition
acceleration-deceleration mechanism of energy transfer to the neck
mainly from MVA - can be any other injury
MAY result in injury which MAY lead to variety of clinical manifestations
Biomechanics - Rear end collision
Immediate after collision - low cervical extension, upper cervical flexion Thoracic ramping - increased cervical extension from below Whole spine extension Pure rotation with translation - abnormal anterior opening - facet impact posteriorly Low cervical flexion Upper cervical extension Whole cervical flexion
Possible Tissue Injury
facet joint impact fractures facet capsule tears disc rim lesions annular tears anterior longitudinal ligament tears UCS ligament tears neural tissue injury muscle tears oesophageal, tracheal, cervical blood vessel damage
Symptom Presentation
neck pain headache face pain arm pain arm paraesthesia/anaesthesia thoracic pain lumbar pain psychological distress functional limitations limited ROM muscle spasm and guarding dizziness unsteadiness visual disturbances auditory disturbances cognitive problems includes PTS symptoms
Classification of Injury - QTS
0 - no complaint about neck pain - no physical signs 1 - neck pain - no physical signs 2- neck pain - MSK signs - reduced ROM and point tenderness 3 - neck pain - MSK signs - Neurological signs - reduced DTR, muscles weakness, sensory deficits 4 - neck pain - fracture and or dislocation
Red Flags
immediate, severe, neck and arm pain pins and needles numbness in arms or legs breathing difficulties difficulty supporting the head fixed deformity signs of UCS instability severely limited ROM unable to be upright
Prognostic Factors
high initial levels of pain and disability age distress PTSS self efficacy poor perceived recovery passive coping perceived injustice local and widespread hyperalgesia motor and ROM deficits poor sensorimotor control early intensive care involvement in compensation
Screening for PTSS
crash related avoidant behaviours - are you driving again? - are you confident and comfortable on the road? Instrusive thoughts - do you think about the accident often? - flashbacks/dreams Symptoms of hyper arousal - sleeping okay? - palpitations, SOB, altered appetite
Management - Psychology
Provide clear explanation
Provide clear and comprehensive treatment plan
- discourage excessive caution and protection
- be explicitly active
- emphasis importance of moving and loading
- encourage helpful behaviours
Stress Management
- Education on the stress response, when becomes maladaptive
- problem solving - explore their specific individual stressors
- relaxation strategies
- positive self talk
Management - General Function
- discourage bed rest and casts
- encourage gentle and graded activity
- encourage gentle exercise
- strategies to temporarily reduce mechanical load
- postural and ergonomic advice
Management - Local Function
Promote movement into directional preference - exercises to decrease and centralise pain Minimise peripheralising movements - task modification - education on load management Improve local muscle performance - FIND IT - movement away from extension - CONTROL IT - under extension load Sensorimotor Control - balance exercises - joint position training - occulomotor exercises
Management - Remote Function
Optimise thoracic function - promote movement into PD (extension) - improve muscle capacity to move independently into PD Address scapula mechanics - muscle extensibility - muscle recruitment - thoracic spine function
