As one of the most frequent conditions seen in our Pure Physiotherapy clinics, whiplash or whiplash associated disorders (WAD) typically occur following a road traffic collision. The neck and upper back regions are most injured due to the mechanism of injury, which involves the neck being subjected to rapid acceleration which strains the soft tissues including muscles, ligaments and tendons. The neck complex goes through a contrecoup movement which throws it back and forth multiple times, explaining the severity of issues that are usually reported.
Resulting from the rapid acceleration and stretch these structures go through, the symptoms occur because of microscopic tears and inflammation. The body reacts by dilating blood vessel in the area which sends more fresh, oxygenated blood to the damaged areas to help with healing. The affected muscles also go into a spasm which means they become sore and over-active which limits movement and function to varied levels based on severity. Due to this spasm, the muscles in the neck are typically reported as feeling ‘tight’ and ‘sore’. The ‘tight’ sensation is because these muscles want to avoid being lengthened and stretched from the recent microtrauma which happens at cellular level and explains the soreness.
Stiffness in the neck is common first thing in the morning because when you’re static whilst sleeping, these muscles can increase in tone which is why it is important to keep the neck moving as much as possible throughout the day. Also, because of this acute spasm, the muscles in the neck can also feel sore towards the end of the day because they are more active than normal, meaning they can fatigue quicker as they work hard to support your head.
These are all normal symptoms to be expected which you may not feel within the first 24 hours as they typically develop 48-72 hours post-accident. It is usually the case for whiplash injuries to get worse over the first couple of weeks before symptoms begin to settle. Again, a normal presentation. The symptoms should start to settle over the first 3-6 weeks which is a typical timeline for the acute phase to last.
In the acute stage of WAD, the management is focused on promoting your bodies’ healing whilst maintaining function and movement. The professional guidelines by NICE recommend that during the first 4-6 weeks the optimal management is as follows:
As your pain begins to settle whilst you maintain movement and function with the above recommendations, the next aim – if there is any movement limitation, is to achieve full range of motion in the affected areas. Your Physiotherapist at Pure can help support this goal with hands on soft tissue mobilisation & manual therapy coupled with exercise progressions and further self-management advice. We will also provide you with education on your injury to help you understand your symptoms and how your recovery plan will help. Self-management and home exercises form a crucial part of your rehabilitation because it is important for you to have things to do daily to support your recovery and return to full function.
Upon achieving full movement and function, our Physios at Pure will progress your individualised exercise plan to increase the strength of the neck and upper back muscles. This is an important part of your rehabilitation as this will develop robustness to ensure you manage well during typical positions and movements you perform in everyday life. If your muscles are strong, they can work at a lower level to help support your head and neck. This individualised strengthening program will form the basis of your ongoing self-care plan to ensure your symptoms remain well managed and that the previously damaged structures become strong and resilient.