10 Apr Whiplash injuries and Whiplash-Associated Disorder (WAD)
Whiplash-associated disorders (WADs) commonly occur usually as a consequence of a motor vehicle crash (MVC). According to research studies, up to 50% of people who experience a whiplash injury will never fully recover, and up to 30% will remain moderately to severely disabled by their condition. It is a costly condition due to the involved medical care, disability, lost work productivity as well as personal costs. There are medical and legal consequences of its diagnosis and resultant management.
WAD is one of the most debated and controversial painful musculoskeletal conditions, for the reason mentioned above. What makes that even more challenging is that the precise patho-anatomical diagnosis of WAD is not usually achievable, even with the use of standard imaging techniques.
Patients who encounter a whiplash injury and go on to develop chronic WAD tend to have decreased pain thresholds to various stimuli including mechanical pressure, thermal stimulation, electrical stimulation, and vibration. But there may or may not be actual tissue injury, at least demonstrable on imaging studies. The absence of tissue damage at the site suggests that there may be a central sensitization of nociceptive pathways as the main reason for pain hypersensitivity. This form of hyperalgesia (increased pain perception) has been shown in various research studies.
That is not to say that these patients are faking it – they really do perceive the pain, and for them it is as real as any other kind of pain. It can be medically explained by the theory of spinal cord hyper-excitability, with these patients having lower reflex thresholds than healthy subjects. This theory is not exclusive to WAD, and in fact is central to other pain syndromes, such as endometriosis, fibromyalgia, osteoarthritis, tension-type headache, temporomandibular joint pain, post-mastectomy pain, etc.
Whether associated with actual demonstrable tissue injury or not, the pain has been shown to be subsided with proper treatment. Chiropractic treatment for whiplash injuries is central to the overall management of whiplash injuries and WAD. The treatment plan depends on the severity of the original whiplash injury. The most common chiropractic technique is spinal manipulation, and the most commonly applied techniques for which are as follows:
- Flexion-distraction technique: gentle, non-thrusting spinal manipulation to help treat herniated discs with or without arm pain, with slow pumping action applied on the disc instead of direct force to the spine.
- Instrument-assisted manipulation: a non-thrusting technique performed with the help of a hand-held instrument, useful for older patients who have a degenerative spine disease.
- Specific spinal manipulation: a gentle thrusting technique stretches soft tissue and stimulates the nervous system to restore normal motion to the spine.
Other kinds of manual therapy to treat injured soft tissues are also applied as needed, and include:
- Instrument-assisted soft tissue therapy (Graston technique): an instrument-assisted technique used to treat injured soft tissues.
- Manual joint stretching and resistance techniques
- Trigger point therapy: direct pressure applied on the specific points to alleviate muscle tension.
Other approaches may include:
- Interferential electrical stimulation: low frequency electrical current to help stimulate muscles and reduce inflammation.
- Ultrasound: which can help decrease muscle spasms, stiffness, and pain in the neck.
These chiropractic techniques can be very effective in improving pain and inflammation and one’s ability to perform daily activities, and in fact minimize the chances of progression to chronic WAD.