Whiplash - can massage help?
First used in 1928 the term "whiplash" was coined. Whiplash describes neck injuries sustained in automobile accidents, a "whiplash" is an acceleration - deceleration injury to the head and neck. The term both describes the mechanism of injury and the possible consequences of the incident. Such as headaches, dizziness, jaw disorders or muscle and ligament injury. A more accurate definition was coined to separate these into "cervical acceleration / deceleration (CAD) injury" and "whiplash associated disorders" (WAD), the syndromes that occur as a result of the incident.
You don't need to be in a car accident to for this to happen. Mishaps in diving, contact and high speed sports can generate the same energy transfer to the neck. If the head and neck are quickly and forcefully moved forward then back (or any direction quickly) relative to the body there is a risk of injury. Such as straining muscle, spraining ligament, damaging joint capsules or Intervertebral discs, nerve roots or even fracture bone. Two factors are involved in the mechanism of injury in a motor vehicle accident, force vector and velocity change. Structures are most vulnerable when the lower part of the neck and upper back. When the back is in extension (backwards) and the upper neck is in flexion creating an unnatural shape. Voluntary responses take 250 ms to enact and postural reflexes about 100ms to respond. And 60 - 100ms after an impact the neck is passively overstretched or compressed before we can protect it. Symptoms have been reported after a change in velocity as small as
8km/hr in rear end collisions.
These collisons can be responsible for more long term effects or injury than other directions of impact. Injury location depends on the direction of force, for example, if the head is turned on Impact. One side of the neck is compressed, the other strained; or if the impact was from the side the seatbelt is not restraining the torso and the lower back can become involved. Pain may not be immediate, in fact gradual onset 48 hours after the event is most common. Symptoms may include neck pain, headache, dizziness, reduced mobility, in severe cases possible neurological symptoms, cervical spine fracture or dislocation. Classification systems exist to grade severity of injury. But if numbness, extreme muscle weakness, strong radiating pain or difficulty swallowing are present and dislocation or fracture are suspected, imaging and immediate medical assessment are required.
So what now? Your Remedial Massage Therapist or Musculoskeletal Therapist is qualified to assess the severity of your whiplash and refer if needed. If you think you've experienced a whiplash injury, its really important you are looked at quickly to identify issues as longevity of symptoms can be prolonged without appropriate care or rehabilitation.
Early on after injury, gentle pain free active movements (not stretching) to the onset of pain only can allow contractile tissue to withstand incrementally heavier workloads. Gentle movement can also prevent adhesions and scar tissue, so don't immobilize the area or use a neck collar unless instructed to. Immobilization allows tissue to heal in a shortened state, which can lead the muscles to form adhesions and encourage muscle weakness.
Your therapist will be careful not to remove too much protective spasm in the acute stage. Acute spasm can mask underlying issues, so your therapist will check for hypermobility or instability before any techniques is applied to the spine. If the injury is in our scope to treat we consider your stage of healing first before applying any treatment. We assess for signs and symptoms to create a strategy to help you through the healing process of this painful condition. We will talk you through a treatment plan which will likely include ongoing graded treatment as the healing progresses. Once pain during daily living is minimal, we work on increasing range of motion back to pre-injury. At the point where you are relatively pain-free and you can use your neck and back in the way you used to before injury, we will then look at ongoing maintenance treatment to ensure this continues long term.