Massage & Bodywork

March/April 2010

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WORKING WITH WHIPLASH, PART 1 Hot Whiplash For hands-on practitioners, there is good and bad news about whiplash. The bad news first: whiplash injuries puzzle and befuddle manual therapists. Not only do we regularly hear this from practitioners coming to our Advanced Myofascial Techniques courses, but a 2004 Advanced- survey asked 100 experienced bodyworkers which conditions they would most like to learn more about. The topic most frequently mentioned? Whiplash. More bad news: whiplash is common. Although estimates vary, several sources cite nearly 2 million new cases of whiplash per year in the United States alone. That means that for each massage therapist in this country, there are up to eight new cases of whiplash every year.1 Whiplash is also complicated— sufferers experience a wide array of physical, neurological, and psychobiological symptoms, which may not appear until weeks or months after the original injury. Symptoms can persist for months or years, and for a significant number of sufferers, get worse over time.2 Although there have been hundreds of studies on whiplash, and more are conducted each year, there is widespread disagreement on diagnosis, treatment, and even terminology3 ; most interventions for whiplash injury are "medically unproven"4 ; and the reasons for whiplash's intractability are only beginning to be understood. The psychobiological impact of whiplash has long been recognized, and significant numbers of whiplash sufferers experience anxiety, depression, or symptoms similar to posttraumatic stress.5 What's more, whiplash patients can be involved in legal or insurance difficulties, which may complicate and even hinder recovery.6 If this wasn't enough bad news, manual practitioners observe that whiplash symptoms can worsen after bodywork—almost as if their hands-on work had opened a Pandora's box of pain, soreness, and spasm. The aim of this article is to help you prevent this. The good news about whiplash? In spite of its complexity, hands-on body therapy can help. Skilled practitioners are getting very good results by using soft-tissue release together with neurologically based approaches. Gentle encouragement of motility, such as that provided by sensitive and competent manual therapy, in combination with moderate activity, is one of the most widely agreed-on conventional treatments for whiplash. (Immobilization and cervical collars, once the most common treatment, are now rarely used, as they have been observed to produce more problems than they resolve.7) An increasing understanding of the effects of trauma on the nervous system is expanding massage therapists' ability to help clients whose symptoms were previously only aggravated by hands-on work. THE EFFECTS OF WHIPLASH The effects of whiplash range from mild to severe, can change over time, and may include any or all of the following: • Tissue damage at the sites of injury, from local overstretching or micro-tearing of fascia, muscle, or nerve tissues, typically in the neck, shoulders, and back. Harmonic forces in the body, bracing reactions, and fascial connections can cause tissue injury and inflammation in unexpected, nonlocal areas anywhere in the body, such as the rib cage, limbs, or pelvis. • Instability or weakness from tissue damage, and from dissociation of the muscle spindle/Golgi postural reflex relationships in the injured muscles, resulting from overstretching.8 • Restricted motion as a result of either acute muscle spasticity and splinting reflexes, or from chronically adhered and shortened connective tissues, including the tissues around articulations. • Pain, anywhere in the body. Causes include direct tissue injury, neurologically referred pain, or autonomically associated pain (e.g., posttraumatic headaches). • Vertigo (dizziness) and balance impairment. Cervical instability can result in splinting and fixing of the neck and head (especially by the suboccipital muscles), which reduces the adaptive capacity of the vestibular system. Posttraumatic vertigo is also postulated to be related to sympathetic nervous system imbalance.9 • Sympathetic (fight or flight) activation of the autonomic nervous system (ANS) from the trauma of the incident itself; from direct injury to sympathetic nerve fibers in the neck (Image 2)10 ; or from ongoing sympathetic stimulation from vestibular and balance impairment. Symptoms can include sleeplessness, headaches, anxiety, or depression. Some of the more severe effects of whiplash, such as prolonged anxiety or depression, obviously necessitate connect with your colleagues on 109

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