Neck and Back Pain Following a Road Traffic Collision - What to Expect from Your Chiropractor
Whiplash is a commonly discussed topic amongst health care providers today, discussing everything from best treatment protocol to delayed onset.
It has even been discussed amongst those of the highest prestige in the Houses of Parliament. With the UK being named Whiplash central of the world with over 80% of personal injury claims now being as a result of a whiplash injuries, it is no surprise that we commonly see these type of injuries as Chiropractors.
Most people will commonly associate Road Traffic Collisions as the most common cause of these injuries, which may be true, however it isn’t always the case.
Whiplash injuries can also be sustained from sports such as Rugby, Ice Hockey, Football and American Football. You only have to look back a few years to see how these sports have changed. Players have now become far more athletic and powerful and place so much stress throughout their spines when involved in, for example, a big rugby hit or when a footballer goes up for a head but amongst the aerial challenge is pushed in the back; both these type of incidents will place a great amount of stress through the ligaments, joints and musculature of the neck.
When looking at rugby in particular, Lark and McCarthy (2010) observed when carrying out ACROM (Active Cervical Range of Motion) research on rugby players, it was the forwards who had an ACROM consistent with those who had sustained an Acute Whiplash injury. What is also of significance is that most people only associate neck pain with whiplash- this again is also a common misconception; it has been known that people can suffer from “Lumbar Whiplash”, this is exactly the same as mechanism as the neck, a biphasic movement which Fast et al (2002) discovered can exert enough force through the spine in order to achieve significant damage to ligaments, tendons and musculature, however, forces placed through the spine by that biphasic motion are not enough to cause damage to bony structures.
So what happens if you have sustained a Whiplash Injury?
The circumstances can vary between person-to-person with insurance companies and solicitors often being involved the process of receiving treatment can take a bit of time.
In the immediate aftermath of the incident, as a patient you should attend the local accident and emergency. Here, they will examine you and attempt to clear you of any serious injuries (ie. Fracture, Concussion etc.). Should that be the case, they are likely to supply you with medication in order to aid the early symptoms of whiplash. This is usually along the lines of co-codamol and naproxen, often you will be told to attend the GP for further medication should this fail to control your symptoms adequately.
On some occasions, depending on circumstances and examination, you may receive an x ray at Accident and Emergency; again this is to rule out significant bony injury. You will not receive any further scans, such as MRI, during your time at the hospital unless they suspect any neurological damage, the reason for this is, currently, there is not enough evidence to suggest that soft tissue findings on a MRI scan are specific to those who have sustained a whiplash injury.
Providing you have been cleared for all significant injuries you are now able to present to a Chiropractor, Physiotherapist or Osteopath. However prior to doing so you can help yourself with home interventions such as using Ice (if you are not diabetic and do not directly contact the skin as it can often cause an ice burn) for 15 minutes every hour. It is common for you to feel worse the day following the incident, but please do not be alarmed by this.
What can I expect when I visit the Chiropractor for a Whiplash Injury?
Again, circumstances may be different from each individual case. Whiplash injuries differ in severity and present differently. The Quebec Task Force Clinical Classification of Whiplash (QTF Clinical Classification) described these presentations and grading:
However, regardless of your presentation the process will always be the same, the Chiropractor will always go through a detailed history with you, if you were knocked unconscious in the incident, it may be worth bringing someone who was with you at the time and remained conscious so that they can answer any questions the Chiropractor may have regarding time frames, as your memory will often, understandably, be distorted in these circumstances. The common questions will include the nature of the incident, be that a sporting tackle, or RTC (road traffic collision). In both circumstances, it is likely we would like to know more about the incident, for example:
What was the speed at which the impact occurred?
What was the speed at which you or your vehicle was hit?
Where was the location of the impact on you or your vehicle?
Were you able to stand or exit the vehicle at your own accord following the impact?
How were you standing/seating at the time of the impact?
Were you expecting the impending impact?
I am aware that this can seem like an interrogation, however the Chiropractor’s agenda is to only understand the incident to the best of their ability and to understand the forces that have been placed on your body at the point of impact.
At the initial presentation you may also be asked to answer a short questionnaire to evaluate your pain and attempt to quantify your current disability levels. Most commonly the Neck Disability Index and the Oswestry Questionnaires are used, however more recently other questionnaires have been developed such as the Bournemouth Questionnaire and the STarT Back questionnaire, which also provides the practitioner with a good source of information about your current presentation. It is also important that the practitioner asks about symptoms that you experience elsewhere, be that in the extremities such as hands and feet or headaches and if so the exact location of your headaches. You may also be asked about your bowel movements and your ability to pass water, these questions are arguably the most important, as changes to these bodily functions can indicate a serious event and is classed as a medical emergency.
Once the Chiropractor is happy that a thorough history has been completed, they will usually precede a full neurological and orthopaedic examination, this consists of testing your reflexes, dermatomes (skin sensation) myotomes (muscle strength) as well as special tests aimed at stressing different joints, muscles, tendons or discs. Unfortunately, this examination is provocative by nature, meaning the practitioner is looking to reproduce the pain of complaint. The examination aims to stress different structures that will give the Chiropractor an idea as to what exactly is causing the pain that you experience.
Once we have completed our examination and are satisfied that we are able to compile a diagnosis, the Chiropractor will sit you down and explain exactly what we feel has happened and what we plan to do about it. The treatment plans devised will always be tailored to each individual, however recent research has suggested that it can take an average of 8 sessions in order to achieve a significant improvement. Treatment can commonly consist of a combination of lifestyle advice, education about the complaint, acupuncture, spinal manipulative therapy, mobilisations, rehabilitation and exercise advice.
Following the initial consultation, it is common practice for the Chiropractor to correspond with the GP in order to inform them that you are now under their care and update them on a number of things such as examination findings, diagnosis and prognosis of your condition, this is also true of information that is to be released to any insurance company or legal firm, that may be involved with the case.
This however, will never be done without your consent to do so.
It is important to stress that the Chiropractor is always independent, and has no motive other than the patient’s health and wellbeing.