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Whiplash

Whiplash

Acceleration-deceleration injury to the head and neck
  

Quebec task force classification

Grade0: ZERO complaint, No physical sign
Grade1: Complaint of neck pain, stillness, or tenderness only
Grade2: Neck complaint of pain, stiffness or tenderness, MSK signs of decreased ROM
Grade3: Neck complaint of pain, stiffness or tenderness, Neurological signs decreased or absent of DTR, weakness and sensory deficit 
Grade4: Neck complaint and Fx or dislocation

Acute

SXS
Facet jt irritation, C/S lig sprains, hematomas
T/S, L/S may also be affected
They may be apprehension with AROM or PROM
Difection of impact influences the structures
In most cases, there is NO pain or restriction in ROM immediately following the injury. Pain and stiffness develop gradually in the larger cervical mxl over 24-48H
Heat, edema and spasm also develop over this time frame with more severe injury
Mxl guarding and spasm are likely in SCM and multifid at C4 to C6
Neurological sxs may appear within 72H

 Observation
May be little to observe, over 24-48H, sxs may develop, Edema at the lesion site, some redness, Bruising:Red, black or purple, gap may be visible in the contour of the SCM mxl

 Palpation
Heat to touch, local tenderness, firm edema, protective mxl spasm presents

 Special test

AROM, any other testing is CI
Isometric testing of affected mxl reveals minor to insignificant loss of strength and some discomfort

 TP
Hydrotherapy: cold
Decrease edema with lymphatic drainage, decrease sympathetic nervous system firing in the context of a relaxation massage, diaphragmatic breathing, start with arms and/or trunk, NO NM tech in neck and shoulder area yet!

Subacute

SXS
Edema, Heat, inflammation are still present but reduced from acute stage
pain in the injured mxl diminishes,Adhesions are developing around the injury site, Protective mxl spasm diminishes instead, TrP develops, Neurological signs such as numbness or tingling in arms, are present with nerve root fractioning or TOS

Pain, edema, inflammation are diminishing, Sharp pain is changing into dull achy pain which may refer to head, less tender in neck mxl, ROM is improving but still reduced, Protective mxl spasm is changing into TrP, Hypertonicity of the mxl in affected mxl and their synergist and antagonists, Adhesions are maturing around the injury

 Observation
Edema diminishes, Gap in the SCM contour is still apparent
Bruising if visible, changing from purple and black to brown,

 Palpation
Local temperature drops down, local tenderness, edema is less firm, adhesions are present as healing progress, mlx spasm turns into hypertonicity and TrP may develop

 Special test
AROM,  ARROM,  Isometric testing
Vertebral artery test, Swelling test, DTR, Upper limb tension test, Spurling test, Cervical distraction test, Adson's test, Wright's hyperabduction test
TP
Hydrotherapy: heat/cold contrast
Proximal lymphatic drainage, reduce hypertonicity from trunk and shoulder girdleGTO release may be used on tendon of affected mxl in neck and shoulders, TrP of neck and shoulders, pain free PROM could be performed, gradually increase ROM

Chronic

SXS

Deep aching vague pain, pain may refer to head, H/A may worsen by activity, Chronic spasm in multifidi, Tissue may be cool d/t ischemia, ROM is reduced especially upper C/S, possible hyper mobility in lower C/S, may lead to DDD or OA in C/S

Observation
Habituated antalgic head-forwarded posture may be observed, scapulae may be protracted 

 Palpation
May be cool to touch d/t ischemia, Tender to touch, adhesions in neck mxl, palpable gap or alteration in SCM, hypertonicity & TrP may present

 Special test
AROM, ARROM, Mxl strength testing

Vertebral artery test, Swelling test, DTR, Upper limb tension test, Spurling test, Cervical distraction test, Adson's test, Wright's hyperabduction test

TP
Hydrotherapy: Deep moist heat
Reduce sympathetic nervous system firing, treat compensatory structures, reduce hypertonicity and TrP in neck and shoulder mxl, reduce adhesions

Self care


 Hydrotherapy, Self massage, Remedial exercise (from ROM to mxl strengthening exercise), lengthen shortened mxl

Tx frequency and outcome

Shorter more frequent tx in acute and early subacute stages
2-3tx/week, 30minutes each

 Longer less frequent tx in chronic stage
1tx/week, 60minutes each

 Referral for Acupuncture, Chiropractic, Physiotherapy should be considered

Quebec task force prognosis

Grade1: Usually resolves less than 3 wks if not, refer for specialist/MD
Grade2: Usually resolves in 4-6 wks
Grade3: No specific tie frame is given
Grade4: No time frame is given, client is in surgical care


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