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Cheatography

Whiplash Cheat Sheet (DRAFT) by

Biomechanics, Classifications, Exam, Hx

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Biomec­hanics

- Hypere­xte­nsion + Hyperf­lexion
- SCM most affected
- Myofascial damage
- Head rotates into hypere­xte­nsion, anterior cx muscles stretched - muscles at their tension limit - remaining forces put into the ALL and anterior fibres of the annulus fibrosis
- CN affected - 2nd
- Flexion - Damage in subocc­ipital region of the spine - muscles subocc­iptal and occipi­tof­ron­talis are more trauma­tised
- PTSD occurs

Mechanisms of Injury

- Rear end collisions mainly - linear + angular rearward motion of the head to the torso
Shear, compre­ssion, tension and torque
- Shearing is vertical in vertebral column + horizo­ntally on the spine, more likely to occur during the head extension and torso accele­rating forward stage, more likely at C5-C7
 
- Compre­ssion - head is accele­rated downward towards the spine/­tissues are compre­ssion during extension phase. Forced extension - applies compre­ssive forces to posterior structures and tensile forces to anterior structures
 
- Tension - Extension phase, anterior neck muscles, compre­ssion of posterior neck structures
 
- Torque Small force at the end can create a larger force at the base - rotational accele­ration of the head on the fulcrum at the top of the cx spine

Classf­ica­tions - WAD

0 - No Neck complaints and NO physical signs
Rarely presents to clinicians
I - Neck complaints of stiffness, pain or tenderness but with no physical signs
Very minor muscular damage
II - Neck complaints AND MSK signs
Limited ROM and point tenderness
III - Neck complaints AND Neuro signs
Decrea­sed­/absent DTR, weakness and sensory loss
IV - Neck complains AND fractu­re/­Dis­loc­ation
REFER IMMEDI­ATELY
most patients are Grade II WAD

Injury Severity

- There are factors and variables that could make people suscep­tible to severe injury:
- Angle of the collision - More of an angle = more suscep­tible
- Speed & Size of vehicles - Moving rear end collision
- Road conditions - wet/icy roads
- Occupant Head position - pt looking straight forward? Head turned? - Head turn = more severe
- Gender - women more than men, anatom­y/s­eating position
- Occupant awareness of impact - bracing
- Head Restraints - should be at back of the head touches anterior part, low restraints can act as a pivot during hypere­xte­nsion
- Seat Belts - Body held in place, momentum transf­erred to head and neck, head twists during flexion phase due to one shoulder being restrained
- Direct body impact - Head or other parts of the body hitting object during collision
- Loss of consci­ousness - Severe G forces
- Medical Hx - cx spine degene­ration, history of HA/chronic soft tissue pain can worse injury
- Pain onset - immediate onset of pain, more likely to have pain post injury

History

- Neck Pain - myofascial damage
TMD
Dysphagia
Dizziness
Deafness
Tinnitus
Nausea
Fatigue
Visual symptoms
Memory Loss
Poor Concen­tration
Superf­icial tenderness of the scalp
Pyscho­logical symptoms - anxiety, depres­sion, anger
PTSD- PTSD questi­onnaire - 4 or more on a seven point scale, refer to a mental health profes­sional

Examin­ation

- MAKE SURE IT IS SAFE
Cx spine orthop­aedic exam
Neurol­ogical involv­ement
Signs of myelopathy
Potential causes of other symptoms

Prognosis

Higher probab­ility of prolonged disabi­lity: Women, Multiple injuries, Older People, Rear end collisions
Delayed functional recove­ry: High initial pain intensity, More symptoms, Greater initial disability
Psyc­hol­ogical S&S Slower recovery - Passive coping style, Depressed mood, fear of movement

Management

Acute Phase (2wks after injury)
Education - explain, reassure, coping strats
 
Rest with mild, gentle ROM
 
Exercises should start within 4 days of injury
 
Cryoth­erapy
 
NSAIDs - 400-600mg 4 times a day for first 4 days
 
Gentle mobili­sation (away from painful & restricted ROM)
 
Soft Tissue Techniques
 
Encourage return to normal activities when possible
 
TENS
 
Subacute phase (>2-12 weeks)
Pain control - 1g Parace­tamol four times a day
 
Active exercise - DNF + posture training , Isotonic, Isometrc, Ice + Heat after exercise
 
Mobili­sation - traction/ gentle manipu­lation
 
Modalities (US, TENs)
 
Soft Tissue Techniques
 
Nutrit­ional Support
 
Advice and coping strats
 
Chronic (>12 weeks)
Manipu­lat­ion­/mo­bil­isation + active Exercise
 
Propri­oce­ptive retraining
 
Advice and coping strats
 
Streng­thening exercises
 
Extension retraction exercises for cx spine
 
Late Whiplash
Resist pressure to over treat and over invest­igate
 
Encourage return to normal activities
 
Motiva­tional interv­iewing
 
Reduce influence of compen­sation claims
 
CBT