Whiplash Associated Disorder – Adam Mann

Mark: Hi, it's Mark from Top Local. I'm here with Adam Mann of Insync Physio in Vancouver. Insync has been voted over and over best physiotherapists in Vancouver as voted by their customers. And Adam's an expert in all sorts of things. And today we're going to talk about whiplash associated disorder. What the heck is this? 

Adam: So whiplash associated disorder is basically in its classic form a hyperextension injury of the neck. But really it's just a rapid movement of the neck, which causes some strain of the very deep muscles inside of the neck that connect to some of the vertebraes.

Classic example is after motor vehicle accidents. So people get rear ended and they're neck hyperextends and then some of the muscles and stabilizing tissues in the front of the neck may get stretched and it's considered a very wide spectrum of injuries. So, yeah, that's basically whiplash.

Mark: So I'm sure it happened in many other things. If you're falling, in different sports or if you fall rock climbing and get it hyperextended backwards or skiing or hockey checked into the boards from behind, soccer, et cetera, et cetera. So, how do you treat it? 

Adam: So it really is quite complex. And that's the thing, you said it exactly. It doesn't have to come from a motor vehicle accident. It can come from a sports injury, any sort of rapid motion in the neck. And because the force, which is acting on the neck or the direction where the neck was moving, can cause particular muscles to be strained. And so overall the presentation is quite complex and it's case specific. 

Today I was going to talk about one case in particular where someone was T-boned, and they were hit from the side, so their neck was whipped over to the right side. And so they had experienced a whole bunch of pain just rating down onto the left shoulder and neck. So how did we treat it? Good question. 

The first thing we did was, we had to check some of the secondary injuries. So the assessment was quite complex because this person also received a bruised rib from the seatbelt and was experiencing what we call cognitive fog, which is a sign of a concussion. So when we assessed it, we want to make sure we weren't missing anything.

And so we ruled out a lot of the red flags that might occur. We did that through a thorough cranial nerve assessment, and we also looked at some of the ligaments in the neck to make sure that the neck was stable. We found that it was stable and then we could move on to the proper safe orthopedic treatment.

Mark: So, what does that consist of, safe orthopedic treatment? What do you actually do? 

Adam: Good question. So for this person in particular, it involved a little bit of manual therapy, so making sure that we could relax some of the tone of the muscles in the area. So in particular, the way I describe this, is that you have stabilizer muscles and these are posture muscles that help to make sure that we can move in a controlled manner.

And then we have moving muscles. This is an oversimplification, but, in general, those are the ones that we use for lifting and for moving. And in particular after this type of injury, I find that a lot of the muscles that are moving muscles really, really tense up and they try to take on the role of the posture muscles.

So the first thing that I found pretty effective is once we found this person was safe and physiotherapy was the right option, was to just kind of get those muscles to relax and then work on some of the deep neck flexors. So these are muscles that are really, really, really deep into the spine that you can't palpate or feel. And we work on stabilizing those. 

So we teach them an exercise where really we're just rocking the neck back and forth, quite gently in the pain free range. We do it in a way where we're not tensing up all the other muscles that would cause more injury. So that's the start of the treatment.

When we're talking about how we progress treatment from there, we have to deal with some of the other injuries that this person also suffered. So they had a bruised rib. So we worked on basically mobility in the chest area or the thorax. And we started eventually doing some basic concussion exercises, which would involve some eye tracking or vestibular movements.

And then from there, once we had strengthened the neck and we were able to gain more active range of motion, like mobility through the chest and through the neck, we were able to start some strengthening. 

Mark: So that's the protocol basically you followed, what's the general prognosis and in this case, how long did it take to get better, but what's more typical?

Adam:  So this was a complex case. So it took a little bit longer, took about, I'd say 12 weeks. Because it was a motor vehicle accident. It was an ICBC claim. So we actually were able to get a vestibular therapist to assist with some of the concussion related symptoms. And that can take a long time. So depending on how severe or significant of a concussion it is, it can take a year or two. But in this case, we were able to get that person's pain under control within 12 weeks and their range of motion back up to normal. And their concussion had subsided after about eight weeks. So that's the outcome of the case. 

Mark: And more typically with other folks?

Adam: Whiplash associated disorder is usually broken down into four categories. So the first category is just pain. The second category is range of motion and pain deficits. The third category is if there's actually a nerve injury, this person didn't have a nerve injury. So they were whiplash associated disorder two. And whiplash associated disorder four is actually like a fracture. So again, when we look at the categorization, she was a whiplash associated disorder two. And that was like a big spectrum. And I would say, you know, 12 weeks is quite typical, but if someone is a very minor whiplash associated disorder, it can be, you know, eight weeks, six weeks, four weeks. It's really a big spectrum. 

Mark: There you go. If you've had a whiplash injury in recent times, which is the best time to address any kind of injury. Or if it's been something that's been nagging and bothering you and you need some help, you want to get rid of that pain. Insync Physio, ask for Adam Mann. You can book online  at insyncphysio.com. They have two offices, Vancouver and North Burnaby. So if you want the Vancouver office, you want to talk to a human being (604) 566-9716 to book, or in Burnaby (604) 298-4878. Thanks Adam. 

Adam: Hey, have a good day.