Wednesday, June 9, 2010

Resolving Whiplash Injuries with Active Release – Part 4

The most predominant symptoms after a whiplash accident are:
  • Arm pain – This can be due to nerve compression or referred pain from the facet joint or disc.
  • Facial pain (either direct or referred pain)
  • Headaches – The second most common symptom, headache is usually on one side of the head and begins at the base of the skull (occiput). This pain often radiates to the top of the head and frontal regions.
  • Jaw Pain – TMJ problems are common.
  • Neck pain – The most common symptom.
  • Nerve entrapment syndromes.
  • Shoulder blade pain (interscapular pain).
  • Shoulder pain (rotator cuff).
Whiplash injuries also cause:
  • Balance problems (often upper cervical related).
  • Difficulty sleeping.
  • Dizziness (often upper cervical related).
  • Fatigue (this can be severe).
  • Low back pain.
  • Poor concentration, loss of memory.
  • Psychological changes, such as depression.
  • Tinnitus (ringing, buzzing, whistling, or other noises heard in one or both ears).
  • Visual disturbances (sensitivity to light – this can be stress induced, adrenal stress).
  • Weakness.
Chronic whiplash and whiplash-associated disorders: An evidence-based approach Journal of the American Academy of Orthopedic Surgeons October 2007;15(10):596-606 Schofferman J, Bogduk N, Slosar P.

Treatment of Whiplash Injuries with ART

Early Intervention

After major injuries such as fractures have been ruled out, treatment can begin. For the first 72 hours ice should be used to reduce pain, inflammation, and swelling. See our section on the correct procedures for icing. After this initial acute stage, implementation of ART procedures should begin as soon as possible.
Early implementation of treatment procedures can prevent acute injuries from becoming chronic problems. In the case of whiplash injuries research has show that 15 to 40% of individuals who have had these injuries develop chronic neck pain. Early intervention can help you avoid becoming one of these statistics.
Chronic whiplash and whiplash-associated disorders: An evidence-based approach Journal of the American Academy of Orthopedic Surgeons October 2007;15(10):596-606 Schofferman J, Bogduk N, Slosar P.

Scar Tissue Forms Fast

Also considering how quickly fibrotic tissue (scar tissue) forms in damaged tissue (7 days), early intervention becomes essential. For example, research has shown that after a hyper-extension hyper-flexion injury a muscle called the anterior scalene often becomes fibrotic.
The anterior scalene extends from the vertebra of the neck to the second rib (TP’s C3-C6 to scalene tubercle first rib, anterior surface second rib).
When this muscle becomes fibrotic it can cause compression on a network of nerves called the brachial plexus. This can create a syndrome called neurogenic thoracic outlet syndrome (NTOS) which creates neck pain, headaches, altered sensation (paresthesias), and weakness in the shoulders, arms, wrists, and hands.

It is interesting to note that brachial plexus compression injuries often do not show up for 7 to 37 days after the injury. If manual therapy procedures, such as Active Release Techniques are implemented soon enough scar tissue formation in areas such as the anterior scalene can often be avoided, along with all the consequences of syndromes such as NTOS.

Diagnosis of thoracic outlet syndrome Journal of Vascular Surgery Volume 46, Issue 3, September 2007, Pages 601-604. Richard J. Sanders MD, Sharon L. Hammond MD and Neal M. Rao BA
Biomechanical and histological evaluation of muscle after controlled strain injury Am J Sports Med 1987 15: 9 Pantelis K. Nikolaou, Beth L. Macdonald, Richard R. Glisson, Anthony V. Seaber and William E. Garrett, JR
Symptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries J Bone Joint Surg (Br) 2001 Mar;83(2):226-9 Ide M, Ide J, Yamaga M, Takagi K

See Part 5 – Resolving Whiplash Injuries with Active Release where we will cover addressing the kinetic chain. 
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1 comment:

  1. A whiplash injury cannot always be diagnosed immediately, usually the pain occurs in after 24 hours or in a day or two. In claiming for a whiplash injury claims, be sure to secure all the medical documents, one of the most important document in pursuing a whiplash claim.