The whiplash as a result of a collision accident is well known to everyone. But are whiplash only possible in car accidents? No, it also comes with falls in sports. 25% of cervical spine injuries happen in sports.
The whiplash as a result of a collision accident is well known to everyone. It is particularly dangerous if there is no neck rest. In 2008, there were 2, 293, 663 traffic accidents, which resulted in 413, 524 injuries. But are whiplash only possible in car accidents? No, even in falls in sports, something in snowboarding or ball sports, the accident typical for a whiplash injury is possible. 25% of cervical spine injuries are sports injuries.
What does the accident process look like in detail?
The formation of a whiplash can be divided into 3 phases:
1st phase: Translation of cervical spine segments C0 / C1 and C1 / C2
2nd phase: hyperflexion of cervical spine segments C0- C3
Phase 3: Hyperextension of cervical spine segments C5-C7
In a fall in sports, this is the impact on the ground with the displacement of the head joints, the flexion in the upper cervical spine and the impact of the head on the floor, ie the extension. The floor limits the extent of the extension, in a car without a headrest a much higher range of motion is expected in the extension.
Which structures are affected?
Structurally, it may involve involvement of bones, ligaments, muscles and vessels. The extent of structural involvement and injuries also depends on the head position in the accident. When the head is set in the rotational position as well as the side tilt, the extent of the injury is much stronger.
There are 2 common divisions of acceleration trauma.
Classification of the Quebec Task Force:
- Grade 0: no neck complaints, no pathological findings
- Grade 1: neck complaints without pathological findings
- Grade 2: neck complaints and muscular findings
- Grade 3: secondary symptoms and neurological findings
- Grade 4: neck complaints and fracture or dislocation
Classification according to Erdmann:
- Grade 1: no symptoms 12-16 hours, then neck and back headache, "soft tissue trauma", duration: 1-2 weeks
- Grade 2: direct neck and back pain, paresthesia arm / hand, sore and painful mouth, duration: several months
- grade 3: initial unconsciousness, symptoms as in grade 1 and 2, plus fractures, dislocations and nerve injuries, duration: months to years
- Grade 4: High cross section, brain death
What are the typical symptoms?
Typical symptoms of whiplash include head and neck pain, which may be immediate or transient, dizziness, difficulty in swallowing, difficulty sleeping, blurred vision, tinnitus, and / or feelings of numbness. The causes here are of different origin. There are traumatizations of active and passive structures such as: intervertebral discs with internal ruptures or necrosis, bleeding in the Unovertebral joints, capsular rupture, cartilage damage and / or luxations in the area of the facet joints, fractures of the vertebrae, muscle fiber tears or tears or disorders of the blood circulation of the arteria vertebral.
How is aftertreated?
The aftertreatment is initially differentiated between patients with a low complexity and those with a high complexity of the symptoms. Complexity includes complaints of pain, tension and a limited amount of movement. Symptoms become complex as soon as a neurology or fracture is present.
Here, the active, symptom-oriented therapy approach is chosen because the patients have a good prognosis and there is virtually no risk of chronification. Oriented to the wound healing phases and the motor skills of the patient, the patient is only provided with an orthosis, when a bearable pain occurs, the patient is unable to hold his head, or through the passive support clear symptom relief occurs.
In the inflammatory phase, in addition to the symptom treatment, exercises for motor control can be started.
Based on the pain history, active practice is started at the latest during the proliferation phase. Increasing local joint stability through static stability, dynamic stability to reactive stability is also dependent on the course of pain.
In the remodeling phase, it should be possible to completely strengthen without pain.
The focus of treatment here is rather on the multidisciplinary care, that is, the psychological changes are paid a little more attention. In addition to physiotherapy and training therapy, the patient is cared for behavioral therapy and informed about risk factors and pain. Some studies showed that education about pain led to a reduction in pain symptoms. (1)
The points of clarification include:
- Pain neurophysiology
- Influence of pain - chronic pain
- pain management
Furthermore, significant improvements could be achieved and the ability to work improved. Pain reduction is not the focus and the main treatment point for the complex symptoms.
In summary it can be said that the complaints are never to be underestimated, since there is almost always a soft tissue injury. A treatment is therefore also recommended at grade 0, to prevent complaints can build up. Stabilizing strength training plays a major role and should be continued beyond the treatment.
Also Read: Sports Injury: The Concussion