Whiplash Diagnosis

Whiplash is, by definition, the rapid acceleration followed by deceleration of the head causing the neck to “crack like a whip” forwards and backwards at a rate so fast that the muscles cannot react quickly enough to control the motion. As reported last month, if a collision occurs in an automobile and the head rests are too low and/or seat backs too reclined and the head moves beyond the allowable tissue boundaries, then “whiplash” injury occurs.

When gathering information from the patient, this portion of the history is called “mechanism of injury” and it is VERY IMPORTANT, as it helps us piece together what happened at the time of impact. For example, was the head turned upon impact? Was the impact anticipated? What were the weather conditions (visual, road conditions)? What was the direction of the strike (front, rear, side, angular, or combinations of several)? Did a roll over occur? Was a seat belt used (lap and chest) and were there any seat belt related injuries (to the low back/pelvis, breasts/chest, shoulder, neck)? Any head impact injuries with or without loss of consciousness (if so, how long)? Any short-term memory loss and residual communication challenges (post-concussive syndrome)? All of the answers to these questions are very important when determining the examination path, establishing the diagnoses, and determining the treatment plan.

We also discussed last month the WAD classification or, Whiplash Associated Disorders, which was coined in 1995 by the Quebec Task Force. Types I, II, and III are defined by the type of tissues injured and the history and examination findings. In 2001, the Quebec Task Force found that WAD II (loss of range of motion or ROM/negative neurological findings) and WAD III (both ROM loss and neurological loss) carried progressively greater risk of prolonged recovery compared to WAD I injuries (those with pain but no loss of motion or neurological findings).

Establishing a strong diagnosis allows for accuracy in prognosis and treatment plan recommendations. For example, in WAD II & III injuries, flexion/extension x-rays are needed to determine the extent of ligament damage as normally, the individual vertebrae should not translate or shift forwards or backwards by more than 3.5mm. Similarly, the angle created between each vertebra in flexion & extension should be within 11 degrees of the adjacent angles, and if that’s exceeded, ligament damage is likely to have occurred. So often, ER records describe little to no information about the historical elements reviewed in the 1st paragraph and if x-rays were taken, they rarely include flexion/extension stress x-rays.

Headaches are another component of WAD. Here, the first three sets of nerves that exit the uppermost levels of the spine (C1, C2, and C3) innervate the head. When a patient describes headaches that start in the upper part of the neck and radiate up into the head, the distribution of the pain by history can tell us which nerve(s) are most affected. In the examination, applying manual pressure to the base of the skull can reproduce pain when a nerve is injured. Tracking these findings on a regular basis can tell us how the condition is healing. Chiropractic is at the forefront of diagnosis for WAD!

Dr. James Sheehan Dr. James Sheehan is an expert in the treatment of neck and back pain.

You Might Also Enjoy...

At-Home Exercise for Whiplash Associated Disorders

There is plenty of research supporting chiropractic care as an excellent approach for managing whiplash associated disorders (WAD). While the in-office treatment aspect of care—spinal manipulation, mobilization, soft tissue therapy, massage, modalities,...

10 Telltale Signs It’s Whiplash

If you’ve been in a car accident or suffered an injury to your neck and are experiencing pain or discomfort, take a moment to learn the signs to see if you might have whiplash.

How Chiropractic Care Can Ease Headache Pain

If chronic headaches are disrupting your life and traditional treatments haven’t brought you the relief you need, chiropractic care may offer a solution. Read on to learn how chiropractic care can ease your headache pain.

Are You at Risk for Osteoporosis?

If you’re worried about osteoporosis, understanding your risk of developing this debilitating bone disease can help you take steps now to prevent future problems. Take a moment to learn more about osteoporosis.

Things to Consider Before Knee Joint Replacement

When it comes to a condition like chronic knee pain, there are many treatment options available to reduce pain and improve function, including chiropractic care. However, there are cases when a patient may opt for total knee arthroplasty (TKA).