DEFINITION

Whiplash is an injury to the vertebrae of the neck or their supporting ligaments and muscles marked by pain and stiffness and is often the result of sudden acceleration and deceleration, such as in a car accident. Whiplash injury normally occurs in rear end motor collisions, but may also result from front end or sideways crashes.

DESCRIPTION

Whiplash occurs when the head is suddenly thrust forward and then backward while the body remains stationary. This movement causes the ligaments and muscles of the neck to pull and strain, possibly pinching nerves. Sometimes the joints and discs are injured. The extent of the injury depends on the severity of the accident as well as the position of the head and body at the time of the injury. Whiplash injuries are divided into four categories (90% of whiplash injuries fall into the first 2 categories): Grade I: Neck pain, stiffness or tenderness only. Grade II: Neck symptoms and musculoskeletal signs (reduced mobility, point tenderness). Grade III: Neck symptoms and neurological signs (absent reflexes, numbness or tingling in arms or shoulders). Grade IV: Neck symptoms and fracture/dislocation (determined by X-ray).

Other symptoms which may be present in all grades include deafness or ringing ears, dizziness, headache, memory loss, difficulty swallowing and temporomandibular (jaw) pain.

TREATMENT OPTIONS

It is very important to be checked by your Doctor if you are experiencing pain following a car accident. If neurological signs (tingling or numbness in fingers or arms) are present, your Doctor may order an X-ray to exclude a fracture or dislocation. Approximately 90% of Whiplash injuries are minor and will resolve within within a few days. Treatment depends on the grade of Whiplash injury and is as follows: Grade I: - Simple analgesics only such as paracetamol. - Return to normal activity immediately. Grade II: - Stronger non-narcotic analgesia (NSAIDS such as ibuprofen) may be taken for no longer than 3 weeks. - Soft collar and rest may be used for no more than 72 hours. Grade III: - Narcotic analgesia may be prescribed for severe pain, but only for a very limited time. - Soft collar and rest may be used for no more than 72 hours. Grade IV: - Spinal fracture or dislocation requires immediate referral to hospital. - Treatment will be under the care of a neurosurgical specialist.

In Grades I, II and III the emphasis is on a fast return to normal activity. Unlike other sprains or strains, rest and immobilisation is NOT recommended except for severe pain, and then only for the first 3 days. Overuse of a soft collar can result in difficulties with balance and ongoing problems with nerve function and stiffening of the neck muscles. Range of movement and muscle strengthening exercises may be recommended by a physiotherapist. If symptoms persist for more than 6-12 weeks, referral to a rehabilitation or chronic pain clinic is recommended. Up to 1 in 4 people will experience Late Whiplash Syndrome, where symptoms persist in patients for six months or more. These individuals may experience other symptoms such as pins and needles, pain radiating to the lower back and anxiety and depression. The majority of these cases improve within a year.

PHARMACIST'S ADVICE

Ask your Pharmacist for advice on Whiplash pain. 1) Ask your Pharmacist about non-drug methods of pain relief. A heat pack and warming liniment to the area may help to ease the pain. 2) Ask your Doctor or Pharmacist for advice regarding the dose of a pain relieving medication. 3) Never take pain relievers which have been prescribed for another person. 4) Have regular exercise after a physical examination and approval by a Doctor. Walking and swimming are examples of gentle exercise which may help to reduce pain, particularly in the joints, muscles, ligaments and tendons of the body. It is advisable, after checking with your Doctor, to have 20 to 30 minutes of gentle and continuous exercise each day. Regular exercise may help to prevent joint stiffness, muscle wasting and pain to some degree. 5) If a soft collar is advised, ask your Pharmacist for suggestions. Remember a soft collar should not be worn for more than 3 days. 6) Consider taking some supplements if the diet is inadequate.

VITAMINS/MINERALS/HERBS

Vitamins and minerals may only be of assistance if dietary intake is inadequate. - Magnesium is required for nerve and muscle function. It relaxes smooth and skeletal muscle and reduces nervous tension. - Calcium may help relax muscles and prevent muscle cramps. - B Group vitamins (particularly vitamin B12 and vitamin B6) may reduce pain and muscle tension. - Selenium is thought to reduce muscle pain. - D-Phenylalanine is thought to reduce pain and anxiety. - Valerian, scullcap, St. John's wort and chamomile are all thought to reduce muscle and nerve pain and act as a relaxant.

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