The stats say that 20% to 50% of whiplash sufferers continue to experience pain and disability sufficient to impact work and home activities one year following their MVA; and our experience supports these reports. Some of our more seriously injured clients continue to require care past the one year mark. Other clients will, during initial assessment, indicate that their symptoms started with a minor MVA, for which they either didn’t require or didn’t seek care. Have you considered, as I so often have, why it is that whiplash and other motor vehicle injuries take so long to heal?
If my family and close friends are an example, many people don’t seek care for minor injuries sustained in motor vehicle accidents. There is an early adrenaline rush which can mask and/or delay onset of symptoms. For others, life commitments and schedules may take precedence over pain. Some people are not injured at all. For so many reasons, not seeking treatment may seem the right thing to do. Yet some of these people fall within the 20% to 50% who still have symptoms a year later.
It is a frustrating place to be, a year on, and still not living the life you had pre-injury. There are several good reasons to explain this phenomenon, including:
- The extent of injury was underestimated in the early hours and days following injury; and during early assessment and diagnostic measures. The injuries which associate with your ‘whiplash’ injury can occur in any region of the body, from head to toe; and can involve any or all types of tissue (muscle, ligament, nerve, etc). In the most straight-forward of injuries, there is variability in healing time frames, based on tissue type. As an example, muscle can heal quickly in 4 to 6 weeks whereas nerve injuries can take months to repair. Also, the more numerous and serious the individual injuries, the more likely there will be a challenge to the normal healing process, as well as possible immune system dysfunction. Either or both of these occurrences can disrupt or stop the healing process.
- Pre-existing medical conditions can also interrupt healing. Pre-existing medical conditions, such as diabetes can disrupt homeostasis which is the baseline steady state operation of our bodies; and present a challenge to the immune system. In this way, a pre-existing medical condition can diminish the healing response which also relies on homeostasis and immune system function from which to launch the healing process.
- The role of poor alignment/posture in disrupting the healing process can be harder to appreciate. Most likely, you had poor posture/alignment before the injury, but no pain. Typically, especially without injury, it can take a long time for poor alignment to cause tissue break-down and pain. After injury, alignment becomes very important; any and all tissues heal best when they are in normal, neutral position, and without the strain created by poor position. This effect is magnified when other stressors are alsochallenging the healing process.
- Another important stressor is stress itself. While stress and anxiety have a great many grim consequences, within the context of post-MVA rehab, they can also be unappreciated for their significance. That is the point I want to make. Taken together or separately, any or all of the stressors mentioned above – the trauma itself, underlying medical condition, poor alignment, poor conditioning, and anxiety, etc can seriously tax homeostasis, immune system function and interrupt healing. Within a rehab context, the relevant stressors combine to present an image of failure to heal and chronic pain. When you know what to look for, it is possible to differentiate between acute and chronic pain presentations, and this is a key point in dealing with injuries that are very slow to heal. Within our clinic, we see you, our client, as the lead in your treatment plan. We hope this information inspires you to look critically at your own situation, ask lots of questions and continue to contribute to a collaborative treatment plan that will see you achieve your personal goals. Some points to consider as a team include:
- As time passes, the extent of tissue damage becomes more clear. Ask if the team’s evolving understanding of your injuries substantiates the time in recovery.
- If you have not appreciated the significance of stress and anxiety as important stressors, please bring them forward for consideration. Dealing with these stressors could be the balm that restores homeostasis and moves recovery forward.
- If there’s a chance an underlying medical condition is not accommodated within the treatment plan, your physician needs to be consulted, and adjustments made to your treatment plan, if necessary.
- If it is determined that the original healing process was interrupted, delayed or suspended, low intensity laser is the best modality to re-boot the healing process. Normally, it accelerates healing by an average 40 % faster than normal; minimizes scar formation, prevents adhesions within scar area and decreases risk of chronicity and re-injury. When used late in the rehab process, it re-starts the healing process, allowing normal healing to resume.
- Most directly under your control is the time-on-task you allocate to correcting poor alignment and improving strength and fitness. As these are major stressors to homeostasis as well as milestones within your rehab, owning these aspects of the treatment plan reap great rewards and best outcomes.
Considering all these things, you can achieve your treatment goals and great success, even after a year or more! Call 709-753-0155 or e-Mail firstname.lastname@example.org if you’d like info or help with your own post-injury journey.
A Sample Treatment Plan for Minor Whiplash
Main complaint is of minor tissue damage localized to one muscle, with pain, stiffness and tenderness. This correlates with the WAD 1 classification
Treatment Goals are:
- Pain management
- Restoration of flexibility, strength and alignment
- Return to pre-injury activities
|Week||Physiotherapy||Massage therapy||Acupuncture (optional)||Laser||Home Program|
– Assess to confirm extent of injury
– Establish plan
– Education re sleep positions, home ergonomics, etc
– gentle exercise
– initiate home program
– relax tissue tension
– assist local circulation
– sleep distrubed or – stress or anxiety reported
2 to 3 sessions
– Accelerate heal
– Pain relief
|– Modify sit and sleep positions – Consider task allocation & schedules – alignment checks – gentle mobility exercise|
|2||1 session||1 session||1 session||2 session||15 to 30 min|
|3||2 session||1 session||1 session||1 session||15 to 30 min|
|4||2 session Re-assess & update plan||1 session||1 session||1 session||15 to 30 min|
Minor whiplash injuries are important to treat, mostly to ensure they do heal well, with minimal scarring and in good alignment. Many do not require as extensive a treatment plan as is recorded above.
When our clients present with more complex injury; and/or have underlying medical or posture/alignment issues which tend to delay healing, their treatment plans are longer, sometimes much longer; a year or more. These plans are also very individual, because it is the nature of whiplash injuries to be unique to an individual, even when details of the MVA appear similar to those of other accidents. It is typical that laser, acupuncture and massage become less frequent, as exercise strategies increase.
The WAD Classification for Whiplash Injuries
WAD is an abbreviation for whiplash associated disorders. It was proposed by the Quebec Task Force and published in the journal SPINE, in 1991. It has become a standard of description for whiplash injuries for the medical profession, and society at large.
Many of our clients are referred with a WAD diagnosis; for example, on the referral form, your neck pain is not mentioned; rather you are diagnosed as a WAD 2 or a WAD 3. It sometimes occurs that the screening diagnosis done in Emerg, is not thorough enough to accurately determine a WAD level. A better understanding of tissue damage becomes clear over days and weeks. What the Emerg screening and early WAD designation does do, usually, is eliminate the most serious of the WAD injuries.
Also, WAD descriptors, although they are intended to be ‘associated’ tend to be used mostly with reference to neck injury. There are many other sites in the body that can be injured in an MVA; essentially any region can be injured. Fairly commonly, there are associated seat-belt injuries, back injuries, headache, concussion, and fractures of the lower limbs, etc The following is a summary of the WAD classification system.
Grade 0: No complaints of neck pain. No physical signs
Grade 1: Neck complaints of pain, stiffness or tenderness. No physical signs
Grade 2: Pain, stiffness and tenderness + physical signs, which may include a decrease in range, point tenderness, spasm, etc
Grade 3: Pain, stiffness and tenderness and possibly referral of pain + physical signs, including neural signs of diminished sensation and/or weakness of an extremity
Grade 4: Neck pain as above + fracture or dislocation of the neck
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