RESOLVING WHIPLASH INJURIES PART 3 – SYMPTOMS, EXAMINATION & WAD CATEGORIZATION
Updated: Oct 14
Symptoms of a Whiplash Injury
The symptoms of a whiplash injury are varied, covering large regions of the body. Many of these symptoms do not come on immediately, often taking weeks to develop after the initial accident.
The most predominant symptoms after a whiplash accident are: (16)
Neck pain – This is the most commonly reported symptom.
Headaches – The second most commonly reported symptom, occurs in 50% to 75% of cases. These headaches usually manifest on one side of the head, and often begin at the base of the skull (occiput). The pain often radiates to the top of the head and frontal regions of the skull. (44)
Jaw pain – TMJ Temporomandibular Dysfunction commonly occurs after a vehicular accident.
Facial pain – This can be either direct or referred pain to the face.
Shoulder pain – This often presents as a rotator cuff injury.
Shoulder blade pain – This is pain between the shoulder blades - interscapular pain.
Additional Whiplash Symptoms (16)
Paresthesia’s - Paresthesia’s (abnormal sensations) of the neck, shoulders, upper back, and arms are common in 33 to 100% of whiplash patients. (49)
Balance problems – This is often upper cervical related.
Sleep disturbances – 39-89% of whiplash report disturbances in their sleeping patterns. (45)
Dizziness – Often related to the upper cervical area (48), dizziness can appear in up to 70% of patients who have chronic symptoms. (46) About 34% of patients with whiplash injury suffer from benign paroxysmal positional vertigo (BPPV), which can eventually lead to true vertigo. (47)
Fatigue – The degree of fatigue (in some cases) can be very severe.
Low back pain is common in whiplash cases.
Poor concentration, loss of memory - These could possibly be due to a concussion resulting from the accident.
Psychological changes - Depression and anxiety are common psychological changes .
Tinnitus - Ringing, buzzing, whistling, or other noises that are heard in one or both ears.
Visual disturbances – An example would be sensitivity to light (Adrenal stress). (48)
Weakness – 80 to 90% of patients experience weakness in the neck or upper extremity after a whiplash injury. (51)
PHYSICAL EXAMINATION PROCESS
It is imperative to perform a thorough physical examination after any motor vehicle injury. Delaying this could have significant consequences, both for resolving the injury, and if required, for seeking future compensation in cases of litigation.
The physical examination process should include (but is not limited to):
Comprehensive history covering previous injuries to the cervical spine, chronic illnesses, psychosocial problems, subjective complaints, mechanism of injury, and a whiplash disability questionnaire.
Subjective pain assessment using a Visual Analogue Scale (VAS).
Neck disability evaluation using a Neck Disability Index (NDI).
Orthopedic assessment including:
Inspection and Palpation.
Active Range of Motion/Passive Range of Motion – If the patient is unable to rotate the cervical spine to at least 45 degrees, then they should be X-rayed. A decreased initial range-of-motion and initial cold sensitivity (hyperalgesia) are predictive of ongoing disability. (25, 26, 28)
Specific tests (examples, but not limited to):
Distraction Test where you check to see if you are taking pressure off nerve roots with a decrease in symptoms.
Shoulder Depression Test – check for nerve root compression or foraminal encroachment.
Shoulder Abduction (Bakody’s Test) - Relief position from radicular pathology, usually C4‐5, C5‐6.
Valsalva Test – Indicative of possible spinal disc problem, tumor, stenosis, or osteophytes.
Bowel and bladder functional changes.
Cervical provocation symptoms (dizziness, nausea, visual disturbances).
Upper Motor Neuron Lesion (Romberg’s)
Diagnostic imaging is also very important to rule out possible fractures, and to diagnose the degree of soft-tissue damage. Depending on the case, this may include X-rays, CT scans, ultrasound and MRI.
Fracture or dislocation warrants immediate referral to an emergency medical department.
CT scans and MRI are typically not used for Grade 1 and Grade 2 WAD.
WAD RATING CRITERION
Whiplash Associated Disorders are rated according to the Quebec Task Force criterion. The rating given is used by insurance companies to determine the extent of coverage provided to the injured party. (27)
Grade of WAD - Classification
0 - No complaint about the neck. No physical signs.
1 - Complaint of neck pain, stiffness or tenderness only. No physical signs of injury.
2 - Neck complaint and musculoskeletal signs. Musculoskeletal signs include decreased range-of-motion and point tenderness.
3 - Neck complaint and neurological signs. Neurological signs include, decreased or absent deep tendon reflexes, muscle weakness, and various sensory deficits.
4 - Neck complaint and fracture or dislocation.
Part Four: In Part Four of “Resolving Whiplash Injuries” I will discuss conservative treatment of WAD and provide demonstration videos about how to address both soft-tissue and joint injuries.
Note: All references are at the end of RESOLVING WHIPLASH INJURIES Part 5
DR. BRIAN ABELSON DC.
Dr. Abelson believes in running an Evidence Based Practice (EBP). EBP's strive to adhere to the best research evidence available, while combining their clinical expertise with the specific values of each patient.
Dr. Abelson is the developer of Motion Specific Release (MSR) Treatment Systems. His clinical practice in is located in Calgary, Alberta (Kinetic Health). He has recently authored his 10th publication which will be available later this year.