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Mid Week MOT: Pain in the neck - Whiplash


The neck is the most mobile section of the spine, enabling good vision in an almost 180 degree field.

As such, it is supported by many ligaments and muscles, but still prone to injury as stability is sacrificed for mobility.

What is whiplash?

When a sudden acceleration or deceleration force makes the head swing forwards, backwards or side to side, the supporting structures of the neck are stretched, compressed and damaged. Spinal ligaments are sprained and muscles strained.

This can be as a result of a vehicle collision, a fall or push, a direct blow to the head or something like a bungee jump.

The resulting symptoms (in the absence of any bony injury) are classed as whiplash.

According to the Association of British Insurers, there are 1500 claims for neck injuries every day, costing £2 billion a year.

The UK has become the whiplash capital of Europe.

Whilst the very term whiplash conjures up thoughts of easy financial gain and over-exaggeration, the evidence to prove its existence is there.

Whiplash is an actual injury with actual symptoms and requires careful management to prevent chronicity.

Signs and symptoms:

Immediate pain in the neck region or pain that develops some hours later or the next day. This may radiate into one or both shoulders/arms.

Headache

Dizziness

Neck stiffness or muscle spasm

Jaw pain

Tinnitus

Lethargy

Memory loss

Irritability

Whiplash usually resolves within two to three weeks but symptoms can become chronic and debilitating, resulting in absence from work, loss of earnings and associated mood changes.

Treatment and outlook:

You should always seek medical help when you have been involved in an accident which caused you injury to your head or neck. The doctor or health practitioner will listen to the mechanism of the injury and decide whether further investigations should be carried out to exclude more sinister causes of neck pain. These may include plain x-rays, CT scans or MRIs.

If no fractures are present and the brain and spinal cord are undamaged, the normal recommended course of treatment (according to NICE guidelines), state that the neck should not be immobilised in a collar as was the previous line of treatment. This has been found to make matters worse, with muscles becoming shortened and stiff and eventually wasting (atrophy). The road back to recovery is therefore a lot longer and more painful.

Guidelines now recommend early mobilisation, pain relief and manual therapy.

It is essential that the patient is educated on the nature of the injury and that by moving the neck, no more damage will be done. It is this fear of further damage that can cause the condition to become chronic and starts the spiral into long term symptoms and behaviour changes.

You may be referred to physiotherapy for treatment if symptoms persist. Osteopaths can also provide good manual therapy to stretch and loosen muscles and mobilise the neck and shoulders. You may be given exercises to take home and to get you involved in your own recovery.

It may be helpful to use ice or heat packs to relieve pain and analgesics such as paracetamol, ibuprofen or codeine have been shown to be effective and safest in short term use.

You may need to make adjustments to your sleeping posture, such as reducing the amount of pillows, and to make sure your work environment is optimised especially if you are desk based.

Long term issues:

Not all whiplash injuries resolve quickly and if you are experiencing debilitating symptoms after 6 months from date of injury then this is classed as Late Whiplash Syndrome or Whiplash Associated Disorder.

There may be loss of function, insomnia, chronic pain and the psychological aspects of mood change, anxiety, attendance issues at work and fearful behaviours changing the way you engage with your life activities.

The treatment should include a multi disciplinary approach initiated by your GP and may involve psychological therapy such as Cognitive Behavioural Therapy, pain control with prescription muscle relaxants (amitriptyline) and nerve pain medications (gabapentin).

Emphasis is placed on reducing the focus on pain and dysfunction and encouraging return to full participation in life and work.

As stated at the beginning of this article, if you have had an accident then please get checked out, and seek help if your symptoms persist.

Resources:

https://cks.nice.org.uk/neck-pain-whiplash-injury#!scenario:1

www.abi.org.uk

As always, for osteopathy in High Wycombe or beyond, contact Lucy from OsteoFusion on 07833 321604 or visit www.osteofusion.co.uk.

Thanks for reading.


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