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Whiplash-associated disorder (WAD) is the term given for a group of symptoms that are caused by indirect trauma to the neck with an acceleration–deceleration mechanism, such as falls, car accidents or by direct trauma to the neck, for example from hyper-flexion/extension caused by falling objects or during sport events.

The annual incidence of whiplash trauma related to car accidents is reported as 2–3 per 1,000 inhabitants. A lot of these individuals recover, however there is still a significant number that develop chronic pain syndromes¹.

Illustration showing impact of whiplash on neck structures.

Suffering after neck trauma has been recognised as a large world health problem with a large percentage (up to 63%) of the injured individuals still reporting symptoms and disability months and years after the incident².

Impact of Whiplash on the body

Whiplash affects various areas of the cervical spine, depending on the force and direction of impact. In a whiplash injury, bony structures, ligaments, muscles, neurological pathways and other connective tissue may be affected.

In addition, secondary disorders can arise, such as oedema (swelling from excessive accumulation of watery fluid in cells, tissues, or main cavities), haematoma (small area of bleeding) and inflammation.

There may be up to 48 hours’ delay from the initial injury to the onset of symptoms. Other associated symptoms include cervical spine instability, neurological symptoms, dizziness, tinnitus, disturbances in standing balance, visual disturbances, difficulty sleeping due to pain and difficulty concentrating / poor memory.

After pain, dizziness is one of the most common complaints in persistent WAD; a symptom likely due to change in the nervous and musculoskeletal systems in the neck. ³ People with WAD may demonstrate alterations in joint position sense (JPS) – this is the ability to know where your joint is in space, even without visual feedback. With regard to the neck and JPS you should be able to find the mid-line when turning your neck side to side with your eyes closed. People with WAD find this difficult to do.

What to do after a neck injury

It is important to have a thorough spinal and neurological examination after any major incident where you suspect you or others have neck injuries. Whiplash can be an acute or chronic disorder. In acute whiplash, symptoms last no more than 2-3 months, while in chronic whiplash symptoms last longer than three months.

A physiotherapist can carry out the initial assessment to determine which structures have been affected and treat them accordingly, as well as refer you for further testing if necessary.
Physiotherapy can help with WAD as studies show that there is a decrease in pain intensity 6-8 weeks after physio treatment and rehabilitation, as well as having a significant, positive effect on neck disability. ¹

References
  1. Chranconovic B, Larsson J,Malmstrom EM, Westergren H, Haggman-Henrikson B. Exercise therapy for whiplash-associated disorders: a systematic review and meta-analysis. SJ Pain 2021 Sep;22(02):232-261
  2. Styrke J, Stålnacke BM,Bylund PO,Sojka P,Björnstig U.A10-year incidence of acute whiplash injuries after road traffic crashes in a defined population in northern Sweden. PM&R 2012;4:739–47
  3. Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. ManTher. 2008; 13(1):2–11.
  4. Mazaheri M, Abichandani D, Kingma I, Treleaven J, Falla D.A meta-analysis and systematic review of changes in joint position sense and static standing balance in patients with whiplash-associated disorder. Plos one 2021 April:1-28.