Whiplash: Why is this Taking So Long?

Whiplash treatment and management is a topic of great discussion! Many different types of tissues can be injured in a whiplash event, which can lead to a multitude of symptoms. This is why the label “Whiplash Associated Disorders” (WAD) was born! The rate of healing for each type of tissue varies, thus the length of time for resolution for some tissues can be quite long. This is a partial list of the symptoms that can occur as the result of a motor vehicle collision: 1) neck pain; 2) headache; 3) radiating pain (from neck to head, to the shoulder blade, arm, hand); 4) generalized hypersensitivity; 5) numbness or tingling; 6) muscle weakness; 7) jaw pain and dysfunction; 8) visual disturbances; 9) loss of position control of the head and neck; 10) dizziness (vertigo); 11) post-concussive symptoms—loss of memory, difficulty concentrating and staying on task, depression and/or anxiety; 12) middle and/or low back pain; 13) carpal tunnel syndrome and/or double crush syndrome, and more! To make matters even more complicated, the onset of symptoms can range between immediately following the collision to days, weeks, or even longer!

Back in 1983, researchers attempted to determine the length of time it would take for recovery or to determine the extent an injured person might improve based on certain findings gathered at the time of the motor vehicle collision (MVC). This original work was then taken one step further and a “point value” was assigned to each symptom and/or exam finding, thus allowing us to place the injured person into a “prognostic group” based on the number of points (the greater the points, the more severe and longer the recovery). About a decade later (1995), the next “classification” of whiplash injury simplifying the process was published by the Quebec Task Force placing the patient into one of four Whiplash Associated Disorder “grades.” This included Grade 0: no injury; Grade 1: neck pain, stiffness/tenderness but no exam findings; Grade 2 (most common): same as Grade 1 but WITH exam findings (motion loss, muscle spasm) but NO neurological findings (numbness, weakness); Grade 3: same as Grade 2 but WITH neurological findings; Grade 4: neck complaints WITH fracture or dislocation or spinal cord injury. The first three grades were later found to be reliable in terms of determining who were more likely to suffer long-term problems (WAD grade 3 being the most likely). However, based on inconsistencies with the WAD classification system, it is now reported that recovery from whiplash is determined not only by the degree of physical symptoms and signs, but also the psychological trauma that occurs as a result of a MVC. It is reported that motor dysfunction (movement loss), cervical spine mechanical problems, and psychological distress are ALL present soon after injury in many whiplash injured people, irrespective of recovery. But those who do not get better present a more complex picture that includes a more widespread sensory hypersensitivity (like that seen with fibromyalgia), which indicates “central” (brain) pain processing problems and acute post-traumatic stress reaction (these may also be present soon after injury). Hence, the discussion of mild-traumatic brain injury, post-concussive syndrome, and post-traumatic stress disorder ALL may be involved and, it is these that make “…getting over a whiplash injury” so challenging for some.

Doctors of chiropractic provide a comprehensive approach in the assessment and management of patients who have suffered a whiplash injury.