Physio Penrith Whiplash Related Neck Pain Treatment

Treatment of Whiplash Related Neck Pain at Sydney Muscle & Joint Physio Penrith

What is whiplash related neck pain?

Whiplash is an acceleration-deceleration mechanism of energy transfer to the neck. It may result from high velocity mechanisms of injury such as a motor vehicle collisions. The impact may result in bony or soft tissue injuries (whiplash injury), which in turn may lead to a variety of clinical manifestations.

The Quebec Task Force (QTF) classifies whiplash injuries in the following grades:

  • Grade 0- No complaint about the neck. No physical sign(s).

  • Grade 1- Complaint of neck pain, stiffness or tenderness only. No physical sign(s).

  • Grade 2- Neck complaint AND musculoskeletal sign(s). Musculoskeletal signs include decreased range of movement and point tenderness.

  • Grade 3- Neck complaint AND neurological sign(s). Neurological signs include decreased or absent tendon reflexes, weakness and sensory deficits.

  • Grade 4- Neck complaint AND fracture or dislocation.

What are the symptoms of whiplash related neck pain?

Symptoms of whiplash related neck pain include a mechanism of onset linked to trauma or whiplash, associated (referred) shoulder girdle or upper extremity pain, associated varied nonspecific concussive signs and symptoms, dizziness/nausea, headache, concentration or memory difficulties; confusion; hypersensitivity to mechanical, thermal, acoustic, odour, or light stimuli; heightened a defective distress.

Diagnosis of whiplash related neck pain?

At Sydney Muscle & joint Clinic Penrith our physiotherapists utilise key components of the SIRA "Guidelines for the management of acute whiplash associated disorders for health professionals". The initial assessment of whiplash related neck pain should in classification of the whiplash associated disorder grade according to the QTF definition. The whiplash associated disorders grade provides a good indication of the severity of the injury. However, also look at the VAS and the NDI. These latter two factors are important because research indicates that they are better predictors of prognosis than the WAD grades. For example, a VAS score greater than 5/10 and an NDI score greater than 15/50 are associated with a poor prognosis.

 

In the "Neck Pain: Clinical Practice Guidelines Revision 2017" the authors suggest that expected exam findings may include:

  • Positive cranial cervical flexion test

  • Positive neck flexor muscle endurance test

  • Positive pressure algometry

  • Strength and endurance deficits of the neck muscles

  • Neck pain with mid-range motion that worsens with end-range positions

  • Point tenderness may include myofascial trigger points

  • Sensorimotor impairment may include altered muscle activation patterns, proprioceptive deficit, postural balance or control

  • Neck and referred pain reproduced by provocation of the involved cervical segments

Guideline-based treatment of whiplash related neck pain?

Essential components of guideline-based treatment of whiplash related neck pain should include reassure and to stay active, return to usual activities, range of motion and low load isometric, postural endurance and strengthening exercises.

For patients with acute whiplash related neck pain our physiotherapists provide the following evidence based treatment:

  • Educate the patient to return to normal, non-provocative pre-accident activities as soon as possible.

  • Minimise use of a cervical collar.

  • Perform postural and mobility exercises to decrease pain and increase ROM.

  • Reassurance to the patient that recovery is expected to occur within the first 2 to 3 months.

  • Multimodal intervention approach including manual mobilisation techniques plus exercise (eg, strengthening, endurance, flexibility, postural, coordination, aerobic, and functional exercises) for those patients expected to experience a moderate to slow recovery with persistent impairments.

Our Penrith physiotherapists may provide the following for patients whose complaint/injury is perceived to be at low risk of progressing toward chronicity:

  • A single session consisting of early advice, exercise instruction, and education.

  • A comprehensive exercise program (including strength and/or endurance with/without coordination exercises).

  • Transcutaneous electrical nerve stimulation (TENS).

 

For patients with chronic whiplash related neck pain our physiotherapists provide the following evidence based treatment:

  • Patient education and advice focusing on assurance, encouragement, prognosis, and pain management.

  • Joint mobilisation combined with a progressive submaximal exercise program including cervicothoracic strengthening, endurance, flexibility, and coordination, using principles of cognitive behavioural therapy.

  • Transcutaneous electrical nerve stimulation (TENS).