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Whiplash

  1. What is it?
    • It is an acceleration-deceleration injury to the head and neck.
  2. Affected structures
    • Strain : suboccipitals, rotatores, multifidi, semispinalis cervicis, longissimus cervicis, upper trap, levator scapulae, rectus capitis, longus capitis, longus colli, SCM, mylohyoid, omohyoid, supra and infrahyoids and platysma, scalene
    • Sprain 
    • Facet joint irritation
    • Cervical herniated disc
  3. Treatment plan
    1. Acute
      1. Hydrotherapy : cold
      2. MLD
        1. Nodal pumping on just superior to the clavicle, lateral to the SCM, then at the proximal lymphnodes in the neck and axilla
        2. Proximal MLD, no distal
      3. GTO
        1. Just to reduce the spasm, not remove it.
        2. I&O, PNF(isometric agonist contraction)
      4. Contraindication
        1. on-side work
    2. Early subacute
      1. Hydrotherapy : cold/warm
      2. MLD
        • Perform proximal to the injured tissues to prevent congestion through the injury
      3. GTO, I&O
      4. PNF(agonist contraction)
        • SCM, scalenes, upper trapezius, levator scapulae, posteior cervical muscles
      5. Trigger points
      6. Swedish massage : On-site work
        • Grade 1 : thumb and fingertip kneading with pain tolerance
        • Grade 2 and higher : just light stroking and vibration with pain tolerance
      7. ROM
        • PR ROM : pain free, mid range
      8. stretch injured muscles are introduced last
    3. Late subacute
      1. Hydrotherapy : cold/hot. if acute inflammation recurs —> cold
      2. MLD : little, since the edema diminishes in this stage
      3. Trigger points on hypertonicity muscles
        • Posteior muscles : upper trapezius, levator scapulae, splenius cervicis and capitis, semispinalis capitis, suboccipitals, cervical multifidi and rotators, middle and lower trapezius, rhomnoids, latissimus dorsi, thoracic erector spinae
        • Anterior muscles : SCM, scalenes, infra and suprahyoid muscles, mylohyoids, omohyoid, pectoralis, subclavius, rotator cuff muscles, intercostals and the diaphram
      4. Friction on hypertonicity muscles
      5. PNF on hypertonicity muscles
        • Suboccipitals
        • longus colli : isometric agoinist contraction
      6. Passive stretch
        • no overstretching, especially the larger posterior cervical muscles, since these muscles need to be strong to balance the tight, shourt SCM muscles and prevent head-forward posture
      7. ROM
        • mid to full PR RO
    4. Chronic
      1. Hydrotherapy : deep moist heat(hydrocollator, or wax)
      2. Trigger points, friction, passive stretch, ROM(PR ROM)
      3. Joint play
  4. Remedial exercise & Self-care
    1. Acute and early subacute :
      1. AF ROM of the neck to the onset of pain only
    2. Late subacute
      1. AF ROM
      2. Strengthening
        • Submaximal isometric pain-free AR exercise for the posterior cervical muscles
        • Some anterior neck muscle strengthening is avoided at this time
      3. Gentle stretching on tight muslces(ex, SCM, pectoralis) to the onset of pain only, not full stretchin
    3. Chronic
      1. Strengthening
        • Isotonic AR exercise for the posterior and lateral neck muscles.
        • If the posterior cervical muscles are stronger, then start isometric exercise of anterior neck muscles(SCM and hyoids)
      2. Stretch
        • Suboccipitals : chin tuck exercise —> not to continue this exercise for more than 6 weeks, since cervical lordosis is flattened through the action)
        • Stretch for Scalenes and uppe trapezius
        • Avoid prolonged stretching of the larger posteior muscles by pulling the head into flexion

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