You have been rear-ended by another car. You felt fine at the time, but the next day your neck was quite sore and tight when you woke up. You talked to your neighbour who said they thought you might have whiplash.
What is whiplash?
The term “whiplash” is often used to describe neck or shoulder injuries and pain following a car crash. Whiplash injuries occur when the head is rapidly moved forward and then backward. This motion can cause injury to the soft tissues (muscles, ligaments and tendons) and the bony structures (joints and vertebra) in the neck, back, and around the shoulders. Most often we relate whiplash to a car crash, but it can occur from falls, sports, or fun activities such as roller coaster rides.
You may also hear the injury referred to as a “WAD injury” by physiotherapists or other health-care workers. Whiplash-associated disorder (WAD) is the term given for the collection of symptoms affecting the neck that are triggered by a car crash.1 These different symptoms may include neck or back pain and stiffness, numbness or tingling in the arms, shoulder pain, dizziness, and headaches. You may also hear that you have been diagnosed with a WAD I, II or III injury. These numbers relate to the degree of injury experienced. WAD I and WAD II injuries relate to different degrees of injury to muscles, ligaments and joints. People diagnosed with WAD III injuries have symptoms that come from nerve injuries. WAD I and II injuries are the most common types of WAD injuries.
What should I do first?
Go to see your physiotherapist, doctor or other health-care provider for an assessment within 10 days of the crash.4
Early treatment has been shown to prevent or reduce long-term issues. Research also suggests that most recovery occurs within the first two to three months after your injury.2 Your physiotherapist will do an assessment to rule out any serious injury to the neck or back. This is done by taking a thorough history, completing a physical assessment, and asking standard questions that can direct the physiotherapist towards the best treatment path or identify if further assessment is needed.
Do I need approval from my insurance company before I can start treatment?
No. The Alberta Diagnostic and Treatment Protocols are rules that apply to WAD I and II injuries caused by car crashes in Alberta. The protocols outline treatment parameters for the different types of WAD injuries and are designed to prevent delays to accessing treatment. You do not have to get insurance approval to start treatment under these protocols.
Why did I not get sent for an x-ray?
If you show signs of a serious nerve injury or broken bone, your health-care provider may order an x-ray, but in most cases an x-ray is not necessary. Most often WAD injuries impact soft tissues rather than bony tissue and don’t show on an x-ray. In fact, the x-ray reports may confuse the picture as unrelated changes due to aging and overuse or past injury may be present. Don’t forget that x-rays expose you to potentially harmful radiation and should only be done if there are reasons to suspect nerve or bone injury.
I need a collar, right?
In the past, the usual advice was to rest and take anti-inflammatory medication. Often people would also be given a soft neck collar as well. However, over the last decade it has been shown that limiting the movement of the neck following injury is not effective and may in fact prevent good recovery of normal function.2 Using a collar leads to decreased neck movement, the tendency to not participate in normal activity and an overall sense of being hurt. For these reasons, collars are usually not recommended.
OK, so I don’t need an x-ray or a collar, what should I do?
In Alberta, the Diagnostic and Treatment Protocols guide the actions of physiotherapists and other health-care providers who provide care to people injured in car crashes.5 The treatment protocols were developed based on research about WAD injuries and recovery from them. They are used to guide treatment provided by all practitioners treating patients under insurance claims. The severity of the injury is identified and the treatment plans developed with you, the client.
Research suggests that “acting as usual” and participating in active exercise are the most effective treatment choices for the treatment of whiplash injury.1,2,3 Acting as usual means that you should return to your normal daily activities as soon as you are able to within your pain tolerance. This includes activities around the home, work activities and normal leisure activities. It probably does not mean doing all your spring cleaning, window washing and yard work in one weekend. Nor does it mean starting a new high-intensity aerobics class or going mountain climbing until your pain and symptoms have settled down and your physiotherapist recommends it.
Active exercises are more effective in reducing pain and improving function especially when started within 96 hours of the injury.1 Active exercises include exercises to move your neck, exercises to work on posture and the muscles that control your posture as well as general exercises to strengthen the muscles around your neck and back. Your physiotherapist will provide you with an exercise program that fits your needs and abilities. Always remember the following advice:
When you are performing the exercises, stop and contact your doctor or physiotherapist if you notice:
- Dizziness, light headedness, blurred vision, fainting or disorientation
- Sudden pain shooting down your arm, or numbness or weakness in your arm or hand
- Unusually severe neck pain
- Exercises consistently produce a headache, which persists4
Your physiotherapist will also provide you with information about what to expect throughout your recovery. Some key points include:
- Pain and stiffness are a normal reaction to being hurt
- Maintaining normal life activities is important to get better
- Staying active is important in the recovery process
- Choosing to limit your activity may cause a delay in recovery
- It is important to focus on improvements in function3
The Diagnostic and Treatment Protocols were developed so that patients can access immediate, appropriate care without financial barrier. However, you must see your health-care provider within 10 days to be assessed to be covered.
- Pastakia, K., & Kumar, S. (2011). Acute whiplash associated disorders (WAD). Open Access Emergency Medicine : OAEM, 3, 29–32. http://doi.org/10.2147/OAEM.S17853
- Sterling M (2014) Physiotherapy management of whiplash-associated disorders (WAD). Journal of Physiotherapy 60: 5–12
- Motor Accident AuthorityGuidelines for the Management of Whiplash Associated Disorders. Sydney: Motor Accident Authority (NSW) (2007) www.maa.nsw.gov.au [accessed 02.10.17]
- Information for Consumers – what to do after an Auto Collision: http://www.finance.alberta.ca/publications/insurance/automobile-insurance/automobile-collision.html#injuredwhattodo [accessed 17.10.17]
- Diagnostic and Treatment Protocols Regulation, Alberta Regulation 116/2014, Insurance Act: http://www.qp.alberta.ca [accessed 02.10.17]