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Exercise Can Hasten Whiplash Recovery

10 Jun

Whiplash-associated disorders (WAD) can be a challenging condition to manage, and the current data suggests that up to half of WAD patients may continue to experience pain and disability for up to a year following their car accident, slip and fall, or sports collision. Exercise therapy has long been considered a meaningful treatment option for many musculoskeletal conditions, but what does the current research reflect with respect to the role of exercise therapy for the WAD patient?

In 2021, researchers conducted a systematic review and meta-analysis that included 27 studies in order to gauge the effect of exercise therapy compared with other treatments, placebo interventions, or no treatment. They found that exercise therapy had short-term effects on neck pain and medium-term effects on neck-related disability, but they concluded that “the current evidence is weak” with respect to exercise as a sole treatment for WAD.

However, when used in combination with other treatments, exercise therapy can be quite beneficial to the WAD patient. In addition to the advice to stay active or even start exercising in some capacity (even if that means taking a short walk each evening to begin with), WAD patients may be prescribed more specific, neck/shoulder/upper back exercises to restore posture and strengthen the deep muscles that often become deconditioned in patients with the condition.

In addition to exercise recommendations, your doctor of chiropractic may employ a multimodal approach that includes manual therapies (massage, manipulation, mobilization, active release technique, trigger point therapy, and more); physical therapy modalities (electric stim, ultrasound, class IIIb and IV lasers, pulsed electromagnetic field, traction); patient education (including emphasizing the importance to resume normal activity as soon as possible); and ergonomic assessments (to minimize work stress and strain). When psychosocial barriers to recovery exist, your chiropractor may team with allied healthcare providers that offer cognitive behavioral therapy and other needed services.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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Picturing Chronic Whiplash

20 May

Whiplash-associated disorder (WAD) is a condition characterized by a collection of symptoms that can arise after the sudden back-and-forth movement of the head and neck—most commonly from motor vehicle collisions. It’s estimated that 2-3 million Americans experience whiplash each year and the current data suggests as many as half may continue to experience ongoing, chronic WAD symptoms lasting longer than a year. Unfortunately, there’s no clear way to identify which patient may be at elevated risk for chronicity but a 2022 study suggests it part of the answer may have to do with drawing a picture.

In the study, researchers provided 205 chronic WAD patients with electronic diagrams of the human body and asked them to draw or fill in where they feel pain on their body. The patients also completed a Neck Disability Index questionnaire. They repeated the process a year later. The research team identified an association between perceived pain and disability (from the questionnaire responses) and the degree to which the patient’s pain was widespread (from their drawings). 

This widespread pain is indicative of central sensitization, which is described as greater sensitivity to pain, even stimuli that isn’t normally painful. The system in the body that relays pain signals to the brain is the nervous system, and these signals must pass through the neck. This suggests that a nerve injury or an injury that interferes with the nervous system’s function may be a driving risk factor for chronic WAD. Interestingly, a systematic review that looked at health data from more than 390,000 WAD patients found evidence that a third of grade II WAD patients show signs of nerve injury, which would classify them as grade III WAD and necessitate a more comprehensive treatment approach. Other risk factors for chronic WAD include high initial pain and disability, current low back pain at time of whiplash event, history of neck pain, new onset headaches, post-injury anxiety, and cold hyperalgesia (high sensitivity to cold). 

Doctors of chiropractic are trained to assess patients with whiplash injuries and to provide a conservative treatment approach that not only addresses the patient’s pain and disability, but also to educate them on the importance of maintaining their usual activity as best they can and to reassure them that they can get better—both of which are important for reducing the risk for persistent, ongoing symptoms. If necessary, they will team up with allied healthcare providers to provide the patient with the best possible chance for a satisfactory outcome.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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Nerve Injury Often Missed in Whiplash Patients  

25 Apr

While the literature published on the topic of whiplash-associated disorders (WAD) is voluminous, it’s still somewhat of a mystery why some individuals can walk away from a motor vehicle collision without injury and others can experience chronic, persistent, and disabling symptoms. One area in which researchers have focused their efforts in recent years is on the extent that nerve injury occurs during a whiplash event, and when it occurs, whether it’s being detected early in the course of treatment.

Traditionally, WAD patients are classified the following way: WAD I—pain, stiffness, or tenderness of the neck as the only complaint with no physical exam findings (full range of motion and no muscle guarding or tenderness on examination); WAD II—pain, stiffness, or tenderness of the neck with soft tissue injury signs, loss of range of motion (ROM), and/or point tenderness of the neck (e.g., a sprain/strain neck injury); WAD III—pain, stiffness, or tenderness of the neck along with neurological signs sensory deficits, motor weakness, and/or decreased or absent deep tendon reflexes; WAD IV—pain, stiffness, or tenderness of the neck along with dislocation or fracture with or without spinal cord injury.

As you can expect, treatment guidelines can vary based on how WAD is graded. A systematic review of 54 studies that included more than 390,000 WAD patients and 900 individuals without a history of WAD (who served as controls) concluded that this classification system may need updating. The researchers found that about a third of WAD II patients—the most common WAD level—showed signs of neuropathic pain, though they had not been diagnosed as such. 

The authors stress the importance of a careful INITIAL clinical examination as the presence of nerve injury/pathology may alter the treatment recommendations given to the acute WAD patient such as a wait-and-watch method that is commonly recommended after the initial examination. Researchers point out that compared to other chronic pain conditions, people with neuropathic pain experience greater interference with function and activity tolerance as well as worse quality of life and emotional wellbeing assessments—each of which is associated with an increased risk for chronicity.  

Doctors of chiropractic are trained in the diagnosis and management of WAD using a multimodal approach that embraces spinal and extremity manipulation, mobilization, and other manual therapies; exercise training tailored to the individual patient; nutritional counseling for reducing inflammation and promoting healing; various PT modalities including ultrasound, electrical stimulation, laser, and pulsed magnetic field; acupuncture and/or dry needling; and more. In more severe cases, doctors of chiropractic can also co-manage treatment with the patient’s medical physician, specialist, or other healthcare providers.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org

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A Different Perspective on Chronic Whiplash

30 Mar

It’s estimated that up to 50% of whiplash associated disorders (WAD) patients will continue to experience long-term symptoms that interfere with their ability to carry out activities of daily living. According to experts, the economic burden associated with chronic WAD may exceed $42 billion each year. As such, many studies have sought to better understand whiplash, both from the mechanisms of injury to why some patients recover and some don’t. 

With respect to chronic WAD resulting from a motor vehicle collision (the most common cause of whiplash), factors associated with the crash itself like speed, impact direction, awareness of collision, and airbag deployment do not appear to be significantly linked to an elevated risk for chronicity. On the other hand, researchers have found that higher self-rated pain and disability, fear of movement, catastrophizing, passing coping, and low expectations of recovery are indicative of failure to fully recover. 

In a 2017 study, researchers reframed the trauma of a motor vehicle collision as an event that is both potentially injurious and distressing. When an acute injury occurs (in this case whiplash), there is often damage to various anatomical structures in the head, neck, and/or upper-mid back. Additionally, there is also a stress response associated with the overall incident (including subsequent events like a trip to the hospital and dealing with the insurance company and legal system) that can interfere with the healing process. When the combination of psychological vulnerabilities and neurobiological processes exceeds a person’s given threshold, their risk for chronic WAD rises.

This finding highlights the importance of treating the whole patient when it comes to WAD as it can affect both the body and mind. In addition to therapies delivered in the office to help the soft tissues in and around the neck to heal, doctors of chiropractic and other healthcare providers need to educate the patient and assure them that they will recover and encourage them to carry on their normal activities within pain tolerance. If necessary, the patient may need a referral to a mental healthcare professional to address psychological factors that can impede recovery. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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The Chiropractic Treatment Approach for Whiplash

22 Jul

Whiplash associated disorders (WAD) describes a constellation of symptoms (neck pain, headache, mental fog, radiating arm pain, mid- and/or lower-back pain, neck and upper back stiffness, muscle spasms, fatigue, anxiety, memory loss, etc.) that can result from the sudden forward and backward whipping motion of the head and neck. While motor vehicle collisions are most often associated with WAD, such an injury can also stem from a sports collision, fall, and physical abuse/trauma. Since the condition is a common reason individuals are referred for chiropractic care, let’s take a look at how WAD is diagnosed and managed.

Your doctor of chiropractic will ask you to complete initial paperwork that includes the usual biographical data as well as questionnaires specific to the event that caused the WAD injury. The physical examination will include various movement tests to help them determine the pain generator(s) and whether or not there is neurological injury. X-rays taken from the front, side, and at the end range of motion may be used to assess ligament integrity. If necessary, advanced imaging—a CT scan or MRI, for example—may be ordered to provide a clearer picture about damage to the soft tissues (such as the disks).

The current treatment guidelines for WAD recommend therapies that promote restoration of motion and for patients to continue activity as much as “normal” since immobilizing the neck (by wearing a cervical collar, for example) can actually delay recovery and prolong a return to normal activity. Doctors of chiropractic are trained to employ a number of manual therapy options for reducing pain and disability to facilitate the healing process. In-office treatment may also include massage and physical therapy modalities like electric stim, ultrasound, laser, magnetic field, and more.

A chiropractor may also prescribe specific exercises for the patient to perform at home to strengthen the deep cervical muscles and to improve the patient’s range of motion. To manage pain and inflammation, the patient may also receive instruction on the application of heat and/or ice, as well as recommendations for natural anti-inflammatory agents like ginger, turmeric, bioflavonoids, or to reduce their intake of processed foods, which can promote inflammation in the body. If brain injury is present, chiropractors frequently partner with other healthcare professionals who specialize in such matters. Often, a team approach will offer the best outcomes in more complicated cases.

Since studies have demonstrated that WAD patients who delay care are more likely to develop chronic symptoms, it’s important to receive a thorough examination of the neck and associated soft tissues sooner rather than later.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Initial Treatment Approach for Whiplash-Associated Neck Pain

24 Jun

While neck pain is one of the most common reasons patients seek chiropractic care, the underlying cause of neck pain can vary. In some patients, the cause may be unknown or it may be the accumulation of years of poor posture, bad ergonomics, and an unhealthy lifestyle. In other patients, such as those who experienced a whiplash event in a rear-end automobile collision, the cause is well known and better understood. Is neck pain related to whiplash associated disorders (WAD) different than other types of neck pain, and what’s the best initial approach for those with traumatic vs. non-traumatic neck pain?

In a 2020 study, researchers compared the initial presentation of 22 patients with mechanical neck pain (non-traumatic) and 28 patients with grade I or II WAD-related neck pain with or without loss of range of motion but no neurological sensory deficits, motor weakness, and/or decreased or absent deep tendon reflexes.  

A review of participant-provided assessment data as well as examination findings revealed the WAD patients exhibited higher neck-related disability, felt pain over a larger area, and had a lower pressure pain threshold over the tibialis anterior (the muscle next to the shin bone).

In the next phase of the study, each patient received two treatments a week for three weeks that included soft tissue techniques targeting trigger points in the cervical region, spinal mobilization, muscle energy techniques, manual traction, and specific cervical spine exercises. This is the type of multimodal approach a patient may receive from their doctor of chiropractic to restore normal motion to the cervical joints as well as to strengthen the deep cervical muscles that often become deconditioned following an injury to the cervical spine and associated tissues.

The researchers hypothesized that due to greater symptom severity and sensitivity to pain, the WAD patients would not respond as well to care. However, patients in both groups reported similar overall improvements in pain and disability following just six treatments. The findings suggest that a multimodal approach can benefit both types of neck pain patients. However, those with WAD may require more office visits to reach maximum improvement. Treatment guidelines encourage patients to utilize conservative options first, of which chiropractic care is an excellent choice. In the event an individual develops neck pain, either from whiplash or non-traumatic origin, it’s important to seek care sooner rather than later, as delaying care can increase the risk the condition becomes chronic and more difficult to manage.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.
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