The term whiplash refers to a sudden forward (acceleration) and backward (deceleration) movement that results in hyperextension of the cervical spine. This process can injure the various soft tissues in proximity of the neck, which can lead to a wide collection of symptoms that fall under the umbrella term whiplash associated disorders (WAD). While this description may seem simplistic, the condition is anything but, and it be quite a challenge for healthcare providers to manage. In fact, the current research suggests that between 20-50% of WAD patients will continue to experience some degree of life-interfering pain and disability a year following their initial injury. Let’s look at why WAD can be a challenge and what can be done to produce the best outcome for the patient.
One difficulty with WAD is that there is no objective test that can diagnose the condition. Instead, diagnosis is heavily based on the patient’s presenting signs and symptoms. To complicate matters, many WAD symptoms can occur or overlap with other conditions, including mild-traumatic brain injury. This can be further complicated by the presence of a pre-accident condition that aggravates symptoms (like osteoarthritis), and/or other biopsychosocial factors (like pre-existing anxiety, depression, poor coping strategies, illness/disability perception, and more).
Additionally, there are post-injury factors that can prolong symptoms or increase the risk of chronicity. For example, a 2021 study reported that when soft cervical collars are used in emergency departments (EDs) in patients with acute whiplash injuries following a motor vehicle collision, there is an increased risk of delayed recovery. The group of authors noted that closer collaboration between clinicians in EDs is needed to minimize collar use. Prolonged inactivity or a reduction of movement to avoid injury can also have a negative effect on recovery.
Once a diagnosis is made and the patient’s case is better understood, treatment can commence. The current research supports a multimodal treatment approach, which involves the application of several therapies concurrently to achieve the best outcome for the patient. According to a well-respected guideline published in 2016, manual therapies (manipulation or mobilization), range of motion home exercise, and supervised graded strengthening exercise should be considered for WAD patients with recent-onset neck pain (less than three months). For WAD patients with neck pain that persists for three months or longer, the guidelines recommend manipulation with soft tissue therapy, high-dose massage, supervised group exercise, supervised yoga, supervised strengthening exercises and home exercise, and structured patient education/advice including stress management.
Chiropractic care is often recommended as the first treatment approach for the WAD patient, and patients are often advised to seek care as soon as possible.