What Every Therapist Needs to Know About "Whiplash" (WAD)
Whiplash - An Overview
"The sudden force will often stretch or tear the muscles and tendons of the neck"
Whiplash, more correctly known as whiplash associated disorders (WAD) is a term used, fairly loosely, to describe a neck injury where the head is either suddenly jolted backward and then forward, or forward and then backward, in a whip-like movement, or it may be suddenly and forcibly rotated depending on the angle of the neck when the incident occurs.
This sudden force can stretch and/or tear the muscles and tendons in the neck.
Most commonly this is as a result of a road traffic accident, but it can also be from a sports injury, a fall, or being struck on the head by a heavy object.
As the term whiplash covers a multiple of both symptoms and severities of injury, and with the rise in litigation following motor vehicle accidents, it was thought within the insurance industry that some standardisation was needed to define the type and severity of injury.
Quebec Task Force (QTF)
The Canadian car industry led the way, and established a task force of experts to investigate whiplash injuries.
Although it was originally devised to assist the insurance industry, the Quebec Task Force (QTF) criteria are often used as a standard format to define and describe whiplash injuries.
There have been updates, and various other groups have modified the criteria to develop their own standards, but the baseline descriptions are as follows:
| GRADE | DESCRIPTION |
| 0 | No complaint about the neck, no physical sign(s) |
| 1 | Neck complaint of pain, stiffness, or tenderness only, no physical sign(s) |
| 2 | Neck complaint AND musculoskeletal sign(s); musculoskeletal signs include decreased range of motion and point tenderness |
| 3 | Neck complaint AND neurological sign(s); neurological signs include decreased or absent tendon reflexes, weakness, and sensory deficits |
| 4 | Neck complaint AND fracture or dislocation, or damage to the spinal cord |
General Treatment Guidelines
Prior to QTF there was controversy within the massage world, with some advocating treatment for whiplash and others identifying whiplash as a contraindication.
The QTF allowed differentiation between the different levels of whiplash and therefore new treatment guidelines.
For a client with grade 4 whiplash massage is strictly contraindicated. To massage a dislocated or fractured neck would be dangerous at all levels and the person with whiplash needs referring to urgent medical care.
Grade 3 whiplash should also be referred to a medical practitioner to rule out any grade 4 injuries, as some of the symptoms may be similar.
The South Australian Centre for Trauma and Injury Recovery produced guidelines for the management of WAD, and this recommended massage for whiplash once the level of whiplash has been established for all but level 4.
Stages of Whiplash
In medical terms, whiplash is divided into four stages.
The acute stage is the first one to two weeks following the initial trauma. This is followed by the early subacute (weeks three to four), and the late subacute (weeks five to six).
At six weeks plus, the whiplash is considered chronic. While most people will recover fully from whiplash injuries the speed of recovery can vary from person to person.
Long Term and Recurring Symptoms
One study reports that up to 50% of patients will still have some symptoms after 12 months, others put this at 65%, whilst the UK NHS suggests just 12%.
Contraindications
For a grade 4 whiplash, massage is strictly contraindicated. If the client presents with any of the following symptoms referral to emergency medical services is necessary for a full checkup: blurring of vision, numbness in shoulders
and arms, pins and needles or tingling and/or weakness in the arms and legs, swelling in the back of the throat or a difficulty in swallowing, or any disturbance to bowel or bladder function.
A client presenting with grade 3 whiplash symptoms should be referred urgently to a medical practitioner to rule out any grade 4 injuries, as some of the symptoms will be similar and massage should wait until they have been given the all clear of severe injury.
Healing Massage
Massage has been used for thousands of years to treat a whole array of conditions and was traditionally passed down through families as part of everyday life.
With the increase in modern medicine two things have happened. Firstly the healing power of massage has been largely forgotten and sidelined, and secondly, with the growth of litigious cultures, the subject area has been politicized and many people have become too scared of "touch" for fear of litigation.
The article above is extracted from Maureen Abson's text "Healing Massage" - a work designed to both educate and empower the qualified massage practitioner wanting a ready reference book for - what may be in some cases - unfamiliar medical conditions.
This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
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