Whiplash Associated Neck Pain
What is whiplash associated disorder (neck pain)?
Whiplash Associated Disorder (WAD) are the clinical manifestations that result from a whiplash injury, that occurs with sudden acceleration or deceleration of the head and neck relative to other parts of the body, typically occurring during motor vehicle collisions.. This could be either soft or hard tissue injury about the neck, shoulder and arms.
Common symptoms of whiplash associated disorders include headache, stiffness, shoulder and back pain, numbness, dizziness, sleeping difficulties and fatigue.
What are the grades of whiplash associated disorders?
Grade 0 - No complaint about the neck; no physical sign(s).
Grade 1 - Complaint of the neck pain, stiffness of 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.
Recommendations for assessment and diagnosis
1. Taking patient history - at the initial visit, our physiotherapists take patient history with whiplash associated disorders irrespective of grade. Following visits, our physiotherapists take note of any changes or developments since the previous presentation and history.
2. Physical examination - in line with guidelines our physiotherapists conduct a focused physical examination that includes:
Observation (particularly of head position/posture)
Palpitation for tender points
Assessment of range of motion including flexion (chin to chest), extension, rotation and lateral flexion.
Assessment of associated injuries
Assessment of general medical condition(s), include psychological state (if appropriate).
3. Plain radiographs - at initial visit physiotherapists should use Canadian C-Spine Rule to determine whether X-ray of the cervical spine is required for diagnosis of fracture or dislocation and to avoid unnecessary exposure to X-rays.
4. Tools for the initial assessment - at initial visit our physiotherapists utilise the following:
Classify the WAD grade using the QTF classification (as above)
Assess pain using the VAS
Assess disability using the Neck Disability Index (NDI)
Recommendations for prognosis
Recommendations for treatment - New Guidelines (2014)