Whiplash is a common injury. It mainly occurs following a car accident, especially when hit from behind.
It can cause symptoms immediately or symptoms may occur a few days or weeks later.
Symptoms people experience include:
- Neck pain
- Headaches
- Shoulder and arm pain
- Mid and lower back pain
Although this varies between individuals.
Anatomy
The neck region is formed by 7 bones, these join from one level to the next by a joint on either side. Ligaments are non-elastic tissue, which connect the bones together.
There are two main types of muscle in the body. The deeper muscles are shorter and aid posture against gravity, whilst the superficial muscles produce movement.
A whiplash injury can put strain on all or some of these soft tissues.
Healing
After the soft-tissues are injured there is bruising, swelling and inflammation. Inflammation is useful at this stage as it attracts cells which remove the damaged tissue. In later stages, inflammation produces cells which lay down scar tissue aiding repair of the damaged tissue.
How you can help
Initially: First 7-10 days
Treatment in the initial 10 days aims at speeding up the phase of inflammation and preventing the healing process from slowing down.
- Rest from pain producing activities
- Support the head (and arms if helpful) when resting. If sitting, sit tall, a small rolled towel supporting the low back may also be beneficial.
- Ice, i.e. frozen peas / gel pack, wrapped in a damp towel, or heat (hot water bottle / heat pad) may settle the pain and improve circulation. Ice is generally more effective during the day as the tissues have become inflamed and hot, whereas heat helps to warm up the body when the circulation is slower, for example at night and first thing in the morning. It is recommended that you use the ice pack for about 20 minutes, every 3-4 hours.
- Pain free movement is very important at this stage, as it helps to improve the circulation, and reduce the formation of adhesions, which may restrict movement later on.It is recommended the following exercises are done pain free 3-5 repetitions SLOWLY, hourly.
- Turn the head to the right and left
- Tip the head down to the right and left
- Look up and down
- Turn your body to the right and left
Repair Phase: Up to 21-28 days
At about 7-10 days after the injury the tissues are at there weakest: the damaged tissue is only just being produced, after this time the scar tissue is being laid down rapidly. Mild tension through the healing tissue will allow a strong scar to be formed.
The movement exercises are progressed:
- 5-10 repetitions, repeated 2-4 hourly into mild pulling or pain.
- The ice and heat should be used as necessary. The use of ice at the end of the day may be beneficial.
Remodelling Stage: 3-4 weeks to 12 months
At about 3-4 weeks after the injury, the scar is refining itself along the lines of stress. The exercises progress to reflect this, 10 repetitions, 3 times daily into mild pain with the aim to restore full movement. If it feels tight but NOT particularly painful, firm pressure, by pushing the head with your hand may help release the tightness.
You are unlikely to need ice and heat at this stage.
Finally: 12-24 months
The remodeling phase lasts about 12-24 months after the injury. Continuing the stretches will prevent the scar tissue from tightening, causing problems later. The suggestion is to stretch 1-2 times daily for about 2-3 months, then 3 times a week until 12-18 months.
Resuming normal daily activities
The exercises are gradually built up in number and strength over 3-4 weeks. Your general activity level should mirror this progress; for example, initially avoiding increasing activity level until by about 6-12 weeks you are able to do most daily activities comfortably.
If you find a particular activity painful at this time, you may find it helpful to do less of it, or to break it down into its components. This will improve the strength and flexibility as well as your confidence before re-trying the activity. It is better to attempt what you know you can achieve and build it up rather than to do too much and feel pain afterwards. This same approach should be taken when restarting sporting activities and hobbies.
Good posture is important, as poor posture places additional strain on the weak healing tissues. Finally a balanced diet, plenty of water and adequate rest will help provide the ideal conditions for healing to occur.
Chronic pain
This is pain experienced after the anticipated time of tissue healing. Ligaments and muscles heal over 3-12 months following injury depending on the severity, your age, etc. Nerve tissue takes longer. As well as experiencing ongoing pain, your activity level may also be reduced compared with previously.
Symptoms after this time may be produced by stiffness or weakness of the damaged tissues, or there may be other influences, for example:
- Emotional trauma of the accident
- The degree to which the injury has impacted upon your work and home life
- Financial difficulties
- Stress of court proceedings
These stressors cause a chemical reaction which can irritate the previously damaged tissue. This can increase symptoms.
Physiotherapy involves an assessment of your ongoing symptoms; manual techniques and exercises can be used to restore full movement and reduce stiffness. Reduced strength can be addressed using a progressive exercise regime.
For the few patients suffering longer lasting symptoms, severe pain or pain for no obvious reason, physiotherapy can help with rehabilitation with the aim of restoring quality of life.
When to seek further help
This information should help you recover from your injury. You should seek professional advice from your GP or Chartered Physiotherapist directly if you are unable or are unsure about how to carry out the exercises or what your activity level should be.
For more information or advice please get in touch with us.
For physiotherapy appointments and home visits and to book pilates please call Kate on 07956 372891 or email: katewhiteland@gmail.com