Issue link: https://www.massageandbodyworkdigital.com/i/68173
MYOFASCIAL TECHNIQUES a referral to a qualified specialist. In particular, clients with vertigo, nausea, or ocular discomfort that worsen with head movement should be referred to a physician for evaluation before any manipulation is performed, as this can indicate vascular, ligament, or spinal cord issues. These examples aside, the majority of whiplash effects are well within our power to ameliorate. HOT AND COLD WHIPLASH Metaphorically, it can be helpful to think of whiplash as having either "hot" or "cold" qualities. A recent whiplash (less than 3–6 weeks) will tend to show more hot qualities, while cold whiplash is typically older (although older whiplash can also be hot, or can turn hot if reinjured or worked insensitively). The table below summarizes differences between these two phases of the body's response. Although you can see elements of both hot and cold whiplash in the same client, it is important to differentiate the way you work with each type of symptom, as hot and cold whiplash can respond very differently to the same interventions. Hot whiplash is distinguished by being sensitive, fragile, and reactive, as the fight-or-flight responses of the autonomic nervous system are still aroused. The head and neck are typically immobilized by muscular spasm or hypertonus since the postural reflexes recruit muscular tension to provide the inherent structural stability that has been compromised by the injury. Because of tissue damage, inflammation will be a factor in a recent or unresolved whiplash. The tissue in injured areas will feel softer or puffy to your gentle palpation (though not always literally hot). Your client may respond to direct touch with guarding, uneasiness, or pain, which further increases sympathetic activation. In contrast, cold whiplash is typically older, less autonomically reactive, and restricted at the ligamentous or joint level (as opposed to muscularly spasmed). It is characterized by stubborn, dense, hardened tissue deep around the joints. HOT TIME SINCE INJURY PRESENTING SYMPTOMS MOBILITY RESTRICTION TISSUE QUALITY GOALS STRATEGY METAPHOR Usually recent. Pain, instability, spasm; guarded or careful movement. Muscular hyper-tonus (spasm). Inflamed, puffy, slippery; sometimes soft, sometimes hyper-toned; touch is often painful. Calm or soothe any unresolved fight-or-flight activation; encourage subtle motility; broaden client's focus beyond injury. Work primarily with nervous system; work within client's range of active motility; address myofascial restrictions only away from injured areas. Imagine working on a bare nervous system: use delicate, slow, gentle touch. Hot whiplash often becomes cold (restricted) once initial tissue damage has begun to heal; cold whiplash can become hot (reactivated) if worked too quickly or aggressively. We'll focus on hot whiplash in this article and cold whiplash in the next. WORKING WITH HOT WHIPLASH When working with hot whiplash, our primary goal is to calm our client's autonomic activation before trying to work with any tissue restrictions. To get a sense of this, imagine that you're working on an unprotected central nervous system. In a way, you are—after a traumatic event, our ability to filter out or tolerate intense experience decreases, leaving us feeling bare and unshielded. How would you touch a client who was nothing but a bare brain and spinal cord? Hopefully, very delicately and carefully—this is the ideal way to approach a recent or hot whiplash. Pace your work: because sympathetic reactivation can happen by working either too long, too fast, COLD More than 3-6 weeks since injury. Pain, immobility, inflexibility; restricted or stiff movement. Fascial hardening; ligamentous and articular restrictions. Hard, dense, rigid, especially at deep levels. Can be insensitive to light touch. Release tissue restrictions; restore lost gross mobility. Work with myofascial restrictions and movement barriers to restore mobility, both locally and globally. Imagine melting a glacier with the warmth, pressure, and patience of your touch. connect with your colleagues on massageprofessionals.com 111