WAD Whiplash Associated Disorders: Chiropractic Rehabilitation

Whiplash-associated disorders, or WAD, describe injuries sustained from sudden acceleration/deceleration movements. It is a common outcome after a motor vehicle collision but can also be caused by sports injuries, falls, or assaults. Whiplash refers to the mechanism of the injury, while WAD refers to the presence of symptoms like pain, stiffness, muscle spasm, and headaches. A WAD prognosis is unpredictable, with some cases remaining acute with a full recovery, while others progress to chronic conditions with long-term symptoms and disability. Early intervention recommendations include rest, chiropractic care and physical rehabilitation, massaging and stretching exercises, and an anti-inflammatory diet.

Whiplash Associated Disorders

Cervical hyperextension injuries happen to drivers and passengers of moving, slow-moving (less than 14 miles per hour), and stationary vehicles when struck from behind.

• The individual’s body is thrown forward, but the head does not follow the body and instead whips forward, resulting in hyperflexion or extreme forward movement of the neck.
• The chin limits forward flexion, but the momentum can be sufficient to cause cervical distraction and neurological injuries.
• When the head and neck have reached maximum flexion, the neck snaps back, resulting in hyperextension or extreme backward movement of the neck.

Pathology

Most WADs are considered soft tissue-based injuries with no fractures.

Stages

The injury goes through stages:

Stage 1

• The upper and lower spine experiences flexion in stage one.

Stage 2

• The spine takes on an S-shape while extending and eventually straightens, causing lordosis.

Stage 3

• The entire spine is hyperextending with an intense force that causes the facet joint capsules to compress.

Symptoms

Whiplash-associated disorders can be classified through grades by the severity of symptoms, including neck pain, stiffness, occipital headache, cervical, thoracic, and lumbar back pain, upper-limb pain, and paraesthesia.

Grade 0

• No complaints or physical symptoms.

Grade 1

• Neck complaints but no physical symptoms.

Grade 2

• Neck complaints and musculoskeletal symptoms.

Grade 3

• Neck complaints and neurological symptoms.

Grade 4

• Neck complaints and fracture and/or dislocation.
• Most cervical fractures occur predominantly at C2 or C6, or C7.
• Most fatal cervical spine injuries occur at the craniocervical junction C1 or C2.

Affected Spinal Structures

Some symptoms are thought to be caused by injury to the following structures:

• Cervical Spine
• Nerve roots
• Spinal ligaments
• Facet Joint Capsule
• Facet joints
• Intervertebral discs
• Cartilage
• Paraspinal muscles causing spasms

Causes of pain can be from any of these tissues, with the strain of the injury causing secondary edema, hemorrhage, and inflammation.

Joints

• Zygapophyseal joints
• Atlanto-axial joint
• Atlanto-occipital joint
• Intervertebral discs
• Cartilaginous endplates

Adjacent Joints

• Temporomandibular joint
• Shoulder complex
• Thoracic spine
• Ribs

Spinal Muscles

Ligaments

• Alar ligament
• Anterior atlanto-axial ligament
• Anterior atlanto-occipital ligament
• Apical ligament
• Anterior longitudinal ligament
• Transverse ligament of the atlas

Bones

• Atlas
• Axis
• Vertebrae C3-C7

Nervous Systems Structures

• Nerve roots
• Spinal cord
• Brain
• Sympathetic nervous system

Vascular System Structures

• Internal carotid artery
• Vertebral artery

Peripheral Vestibular System

Chiropractic Care

A chiropractor will identify areas of restricted joint motion, muscle tension, muscle spasm, intervertebral disc injury, and ligament injury.

• They will analyze posture, and spinal alignment, check for tenderness, tightness, and how well the spinal joints move.
• This will allow the chiropractic physical therapy team to understand the injured body mechanics and how the spine is operating to make a thorough diagnosis.
• The doctor will order imaging tests like an x-ray or an MRI to evaluate any degenerative changes that may have existed before the whiplash injury.
• Once the injury has been accurately diagnosed, the chiropractor will design a personalized treatment plan.

Spinal Adjustments

• Spinal manipulation is applied to areas of the spine that are out of alignment to realign the spine and activate the healing process.
• Flexion-distraction technique is a gentle technique that uses slower, less intense pushing motions on the discs used to treat disc herniations that often occur after a whiplash injury.
• Instrument-assisted manipulation utilizes special instruments to apply various forces or massage settings to the area.
• Targeted spinal manipulation targets specific areas to rework, release, and rebuild the structures.
• Massage Therapy stimulates the affected muscles to relax them from their tense state.
• A treatment plan may utilize:
• Instrument-assisted therapy
• Trigger point therapy
• Resistance-based stretches to rehabilitate soft tissue damage.

Our chiropractic team is ready to help you feel your best so you can return to normal activities and get on with your life.

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Automobile Injuries and Chiropractic

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References

Pastakia, Khushnum, and Saravana Kumar. “Acute whiplash associated disorders (WAD).” Open access emergency medicine: OAEM vol. 3 29-32. 27 Apr. 2011, doi:10.2147/OAEM.S17853

Ritchie, C., Ehrlich, C. & Sterling, M. Living with ongoing whiplash-associated disorders: a qualitative study of individual perceptions and experiences. BMC Musculoskelet Disord 18, 531 (2017). doi.org/10.1186/s12891-017-1882-9

www.sciencedirect.com/topics/medicine-and-dentistry/whiplash-associated-disorder

Sterling, Michele. “Whiplash-associated disorder: musculoskeletal pain and related clinical findings.” The Journal of manual & manipulative therapy vol. 19,4 (2011): 194-200. doi:10.1179/106698111X13129729551949

Wong, Jessica J et al. “Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration.” The spine journal: official Journal of the North American Spine Society vol. 16,12 (2016): 1598-1630. doi:10.1016/j.spinee.2015.08.024

Woodward, M N et al. “Chiropractic treatment of chronic ‘whiplash’ injuries.” Injury vol. 27,9 (1996): 643-5. doi:10.1016/s0020-1383(96)00096-4