Whiplash Associated Disorders (WAD)
What are Whiplash Associated Disorders?
Whiplash Associated Disorders or WAD, is a term used to describe the injuries commonly seen in motor vehicle accidents and within contact sports. More specifically, it’s used to describe the aftereffects of rapid-fire start/stop motions that are the hallmarks of whiplash.
The injury occurs in three stages:
Stage 1: the upper and lower spines experience flexion
Stage 2: the spine assumes an S-shape while it begins to extend and eventually straighten to make the neck curve inward again
Stage 3: shows the entire spine in extension with an intense sheering force that causes compression of the facet joint capsules
Studies with cadavers have shown that whiplash injury is the formation of the S-shaped curvature of the cervical spine, which induces hyperextension on the lower end of the spine and flexion of the upper levels, which exceeds the physiologic limits of spinal mobility.
Photo 1: Movements the head and neck go through during WAD, Stage 3, Stage 2, Stage 1.
Here is a short video that describes what happens physiologically during a motor vehicle accident.
WAD include a range of symptoms related to the head and neck. Based on the symptoms, and the severity of those symptoms, each patient is classified within a certain “grade” of WAD.
The Quebec Task Force classifies patients with WAD based on the severity of signs and symptoms, as follows:
Grade 1: The patient complains of neck pain, stiffness, or tenderness with no positive findings on physical exam.
Grade 2: The patient exhibits musculoskeletal signs including decreased range of motion and point tenderness.
Grade 3: The patient also shows neurologic signs that may include sensory deficits, decreased deep tendon reflexes, muscle weakness.
Grade 4: The patient shows a fracture.
The symptoms and injuries due to WAD can be very serious. It’s important that if you or a loved one has been involved in an accident, and with motor vehicle accidents in particular, to go to the emergency room and see a physician as soon as possible, even if you’re not experiencing any initial symptoms. After these kinds of accidents the physicians may want to take an x-ray of the neck to rule out the possibility of a fracture. Based on presented symptoms they may have suggestions or give specific restrictions to aid in the healing process. All of this is important information to bring to an initial Physiotherapy appointment.
What can be done to decrease and eliminate the symptoms if WAD?
Following a whiplash injury, the evidence from “Clinical Guidelines for Best Practice Management of Acute and Chronic Whiplash Associated Disorders”, “Guidelines for Management of Whiplash Associated Disorders”, and “Your Guide to Whiplash Recovery in the First 12 Weeks After the Accident” all suggest that “early implementation of active exercise has a positive effect on pain and disability.” It is best to seek advice from a doctor or healthcare provider before performing exercises.
Studies by Cervical Overview group exercises for mechanical neck disorders, The efficacy of conservative treatment in patients with whiplash injury: a systematic review of clinical trials, and the task force on neck pain and it’s associated disorders have recommended ”implementing range of motion exercises immediately results in reduced pain levels and improved function”. It bears repeating, you need to have been given the go ahead from your doctor, healthcare provider or physiotherapist, to avoid further injury.
According to task force on neck pain and it’s associated disorders they found that “some systemic reviews found that exercise (range of motion, neck, and scapular strengthening exercises) is beneficial in relieving neck pain in acute whiplash injuries”.
One systematic review by the task force on neck pain and its associated disorders “cautions that exercise may produce transitory increase in pain levels but is beneficial in the long run for reducing pain”.
A meta-analysis by conservative interventions provide short-term relief for non-specific neck pain: a systematic review concluded “specific exercises such as neck stabilization exercise showed significant short-term effects on pain levels in whiplash disorders”.
Randomized controlled trials (RCT) by grade II whiplash injuries to the neck: what is the benefit for patients treated by different physical therapy modalities?, generally “found that active exercises were more effective in reducing pain and improving function, especially when implemented early (within 96 hours) after injury”. References can be found at the bottom of this post.
The prognosis of WAD is unknown and unpredictable, some cases remain acute with a full recovery while some progress longer. Early interventions is always your best course of action.
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References
Acute Whiplash Disorders (WAD)
Cervical Overview Group Exercises for mechanical neck disorders
Clinical guidelines for best practice management of acute and chronic whiplash-associated disorders
Guidelines for management of whiplash associated disorders
Photo 1 Credit: MedicalNewsToday
Task Force on Neck Pain and it’s Associated Disorders
Your guide to whiplash recovery in the first 12 weeks after the accident