Massage & Bodywork

September/October 2011

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WHIPLASH-ASSOCIATED DISORDERS Clients who complain about a combination of headaches and chronic musculoskeletal pain are five times more likely than those without complaints to have been involved in a motor vehicle collision (MVC).1 Persons experiencing pain after an MVC have an increased risk for chronic recurring pain from different anatomical sites,2 possibly reflecting central nervous system sensitization.3 While the validity of whiplash- associated disorders (WAD) are frequently questioned due to litigation and the prevalence of psychiatric disorders,4 compelling evidence is accumulating that underscores the complexity and severity of WAD in comparison to other mechanical neck disorders (MND).5 A fundamental component of a therapist's intake is to investigate potential origins of symptoms, especially when presented with complex, unexplained conditions. Connecting the dots to previous MVCs can be a significant element of treatment. Help clients understand the complexity of whiplash injuries, no matter how minor the original trauma, and the prevalence of chronic WAD and its many faces. This may abate the frustration of poor health in the absence of visible or explainable injury and move the client toward a path to recovery. HOW PREVALENT IS WAD? According to the latest National Highway Traffic Safety Administration Research Notes, there were 5.5 million motor vehicle crashes reported in 2009, resulting in 1.5 million injuries and nearly 31,000 fatalities.6 This statistic accounts for reported injuries, collisions severe enough to generate traffic reports that document visible trauma, or injuries severe enough for a hospital visit. Countless low-impact, rear-end collisions go unreported due to minor car damage and no immediate trauma. Days later, many of these drivers and passengers find their way into massage and bodywork clinics complaining of a stiff and sore neck, or other symptoms they thought would just go away. If weeks go by before seeking care, the pain has typically crept into their low back, and is often combined with an unrelenting headache. Months later, numbness and tingling in the arms and hands may become problematic; by then the car crash is a distant memory. Of those who experience pain after car crashes, 15–40 percent develop chronic pain.7 Nearly one in four peripheral nerve syndromes are caused by motor vehicle collisions; 90 percent occur in drivers who had their hands on the wheel at the time of the tune in to your practice at ABMPtv 117 collision.8 While 43 percent develop symptoms within one day of the MVC, many of these conditions, such as carpal tunnel syndrome or brachial plexus syndrome, do not materialize for weeks, months, or years.9 Many clients seek care under the pretext of other seemingly unrelated conditions; WAD is more prevalent than we may think. MECHANISMS OF INJURY Despite a large number of rear- end collisions and a high frequency of whiplash injuries reported, the mechanisms of whiplash injuries are not completely understood. One of the reasons is that the injury is not necessarily accompanied by obvious tissue damage detectable by X-ray or MRI.10 Understanding the biomechanics of whiplash can help elucidate the mechanisms of injury. Whiplash injuries are generally considered to be a soft-tissue injury of the neck with symptoms such as neck pain and stiffness, shoulder weakness, dizziness, headache, and memory loss.11 There are two components to the trauma: muscle damage and ligament damage. Both occur primarily in the hyperextension phase of whiplash. In a rear-end collision, the first action is hyperextension. Unless stopped by a well-positioned headrest, the head has a long way to go before colliding with the back of the seat. As the head goes into hyperextension by forcefully contracting, the anterior neck muscles react to the rapid

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