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Tuesday, December 22, 2015

Whiplash injuries sign


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

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                     

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.

·         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

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