Bismillahirahmanirahim.
Definition and Introduction.
Imagine yourself
driving when a car behind you rear-ends your
vehicle. The impact pushes your car forward. It takes about 100
milliseconds for your body to catch up to the forward movement.
Your shoulders travel forward until they are under your head, and
Your neck extends forward as your head tilts slightly down toward
Your steering wheel. You step on the brakes, bringing the car to
an abrupt halt. The sudden stop throws your head and neck
backward, and they bounce against the headrest.
In a matter of seconds, you've experienced the classic mechanism of
injury for
whiplash.
Anatomy Of lessons
l
7 cervical vertebrae:
·
C1 =
Atlas
·
C2 = Axis
·
C7 = Vertebra Prominens
·
C3-C6 = Typical vertebra
l
Ligaments assist stability
and allow mobility:
·
Anterior longitudinal ligament
·
Ligamentum nuchae – protects the joints
posteriorly
·
Ligamentum flavum – important as very elastic
and assists in the neck’s return to upright posture from flexion.
·
Posterior longitudinal ligament
l
Intervertebral discs:
·
Help transmit load
·
5mm thick (thinnest of all the discs)
·
Collagen content is higher in the cervical
nucleus and exists for a relatively short period of time
Information
Whiplash neck
sprains are common
About 2 in 3
people involved in car crashes develop neck pain.
Even slow car
bumps may cause enough whipping of the neck to cause symptoms.
Less commonly,
whiplash neck sprains can occur with everyday activities such as jolting of the
neck when you trip or fall.
80% of patients
reporting symptoms following a car crash will be better within 3-4 weeks
Mechanism Of whiplash.
·
At the moment of impact the
head is first thrown backward as the vehicle is suddenly jolted forward, often
without warning.
·
This is followed by rebound
flexion of the neck, often so extreme that the chin reaches the sternum, and by
a second extension movement.
·
There will be a strain of the
deep muscles and ligaments of the cervical spine.
·
If the head happens to be
turned to one side at the moment of collision, there will also be a strain of
the lateral muscles (mainly trapezius) on the side to which the head is turned.
Signs & Symptoms
·
Often there is no severe pain
initially and the patient may think they have escaped injury. This is because
it can take a while for inflammation to build up around the injured muscles
·
However, within hours of the
injury, sometimes as late as a day or more later, there is increasing pain and
‘stiffness’ in the back of the neck, often with pain also to the top and back
of one or other shoulder.
·
The neck pain is usually
accompanied by severe headache, which may be persistent. Other symptoms can
include blurred vision and tinnitus (these may be caused by the impact of the
brain being moved from side to side)
What will you do
·
When a patient is brought into
A&E having sustained whiplash, the neck is x-rayed, if there is any
suspicion of a fracture, the patient will remain in collar and blocks until
reviewed by an orthopaedic consultant, sometimes this can be the next morning.
·
If the patient is still painful
on palpation over the suspicious area, an MRI scan will be done to rule out
more serious injuries.
·
Once serious injury has been
ruled out and the collar and blocks have been removed, the
·
physiotherapist can see the
patient
Physiotherapy Management
1.
The patient may have been lying
flat for quite a while and it is important to help them sit up gradually.
2.
Give advice on posture,
sleeping positions etc. warn the patient that often the pain gets worse before
it gets better
3.
Advice re ice if required
4.
Advice re regular ROM
exercises, as pain allows, and importance of doing them. OPD if required
5.
Sometimes, if in severe pain
patients will be given a soft collar to take home, important to tell them this
is only for a couple of days max and they need to remove regularly to exercise.
Outcome
·
Over 75% of people with
whiplash get better over a few weeks
·
In about 1 in 4 cases there is
still some pain or stiffness after six months
·
A few people develop continuing
symptoms after whiplash trauma – “whiplash syndrome”
·
In a very small number of
people symptoms can persist for months if not years
Technique of Prevention
72% of front
seat drivers fail to adjust their head restraints correctly or have head
restraints incapable of offering any protection.
To be effective,
a head restraint must be as close to the back of the head as possible (touching
is best) and the top of the head restraint should be as high as the top of the
head
wallahuaklam..
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