Whiplash

Whiplash Associated Disorder is considered to be a variety of symptoms occurring as a result of bony or soft tissue injury caused by whiplash injury to the neck during:-

• an acceleration - deceleration mechanism or energy transfer to the neck
• a rear-end or side impact motor vehicle collision
• a sporting accident e.g. in diving or rugby (CKS NICE, 2015)

Prevalence

Within the UK it is estimated the incidence of WAD is around 500 cases per 100,000 of the population per year (CKS NICE, 2015).

Presentation

Symptoms may be very severe despite no specific abnormality being found on detailed clinical or radiological investigation. Soft-tissue injury is the most likely explanation (Binder, 2007).

Late whiplash syndrome is characterised by a variety of symptoms that persist for more than six months after an acute whiplash injury (Poorbaugh et al, 2008).
Common symptoms:

• Neck pain
• Neck pain that may refer into the shoulder or arm
• Muscular spasm
• Persistent headache
• Upper limb paraesthesia
• Dizziness, fatigue, paraesthesia or nausea (less common)
• Psychological and emotional symptoms

Consider supported self management and conservative treatment

Progressing as expected (up to 3 Rxs) before discharge or onward referral.

Consider general progression and escalation advice.

There is a great variation in recovery rates from individual studies due to methodological differences among studies.

MOORE, A., JACKSON, A., JORDAN, J., HAMMERSLEY, S., HILL, SJ., MERCER, C., SMITH, C., THOMPSON, J., WOBY, S., HUDSON, A., 2005. Clinical guidelines for the physiotherapy management of whiplash associated disorder. Chartered society of Physiotherapy: London. (Link here correct as at 12/11/2021)

BINDER AI. Neck pain. Systematic review 1103. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1103/overview.html. 2008 August. Accessed [link correct as at 12/8/21].

POORBAUGH, K., BRISMEE, J.M., PHELPS, V. and SIZER, P.S.,JR, 2008. Late whiplash syndrome: a clinical science approach to evidence-based diagnosis and management. Pain practice : the official journal of World Institute of Pain, 8(1), pp. 65-87; quiz 88-9. (Link here - link correct as at 12/8/21).