What Is WAD? An Introduction to Whiplash Associated Disorders

What is WAD? An Introduction to Whiplash Associated Disorders

Whiplash is a term that is used fairly loosely to refer to a type of injury where a person’s neck is subjected to a sudden force causing it to rapidly accelerate and then decelerate. This motion often leads to various associated injuries ranging from minor strains and bruising to severe neurological damage and permanent impairment.

‘Whiplash’ is most common in motor vehicle accidents (MVAs) and many professionals such as insurers, solicitors and employers working with third party claimants should be familiar with the complaint.

In fact, due to the prevalence and notoriety of MVAs and journey claims, anybody working in any capacity within worker’s compensation will, therefore, often come across the term ‘Whiplash Associated Disorder’.

Because so many of our clients will come into contact with someone suffering from a whiplash associated disorder, in a very brief form, the current context of recommendation in relation to whiplash injuries is seen below to assist with understanding what a whiplash associated disorder actually is and, most importantly, what it implies.

Quebec Task Force

In 1991 the Canadian car insurance industry raised concern regarding the frequent use of the term “whiplash” for any neck injury relating to a motor vehicle accident and the inconsistent treatments which were being recommended and implemented.

The Canadian car industry decided to set up a task force of experts to investigate the following in relation to whiplash injuries:

◦   Risk and occurrence

◦   diagnosis,

◦   prognosis, and

◦   treatment recommendations.

A total of over 10,000 publications were reviewed and recommendations were made based on the evidence identified by these experts.

The result was a document entitled the Quebec Task Force Guidelines for Whiplash Associated Disorders.

Among the recommendations was a classification of the types of whiplash injuries;

◦   WAD O – No complaint about the neck. No physical sign(s).

◦   WAD I – Neck complaint of pain, stiffness or tenderness only /  No physical sign(s).

◦   WAD II – Neck complaint AND musculoskeletal sign(s). / Musculoskeletal signs include decreased range of motion and point tenderness.

◦   WADIII – Neck complaint AND neurological sign(s). / Neurological signs include decreased or absent deep tendon reflexes, weakness and sensory deficits.

◦   WAD IV     Neck complaint AND fracture or dislocation.

This classification system allows for consistency in research and also in supporting prognosis and treatment. Once diagnosis is provided and the classification of WAD is given, the next task is to identify standard recommendations to address the level of injury.

In our next post some of the criticism which has been applied to the Quebec Task Force will be discussed and we will outline what the WAD recommends in terms of prognosis and treatment.

We will also begin to look at how the industry has evolved internationally in response to the WAD classification and what it means within Insurance, Legal and Rehab settings.

This information was taken form Overland Health Website, you can visit their page for more information on  http://www.overland-health.co.uk/blog/

what is whiplash?

What Is Whiplash?

whip·lash

Web definitions

◦   an injury to the neck (the cervical vertebrae) resulting from rapid acceleration or deceleration (as in an automobile accident)

Whiplash is a term that describes injury to the neck that occurs as a result of a motor vehicle or car accident. The most common type of car accident is the rear impact, and most typically, the occupant in the vehicle that gets "rear-ended" (hit from behind) is at the greatest risk of injury, including whiplash.

What Is Now Known about Whiplash

Until recently, the reason for the extent of whiplash injuries was poorly understood. In addition, due to the legal and insurance issues, the veracity of complaints of neck pain and other symptoms by people who suffer from whiplash is commonly viewed as suspect.

However, recent research has helped clarify why occupants struck from behind experience more extensive whiplash injuries than those in other types of crashes. This new information is important for the physician treating whiplash pain, as it impacts the physician’s case management strategy.

Related Whiplash Symptoms/Conditions

Whiplash injuries can be quite complex and may include a variety of related problems, such as:

Joint dysfunction. As a result of the whiplash, one of the joints in the spine or limbs may lose its normal resiliency and shock absorption (referred to as the joint play), possibly leading to restricted range of movement and pain.

Disc herniation. A whiplash accident may injure the discs between the vertebrae, lead to small tears and cause the inner core of the disc to extrude through its outer core. If the disc's inner core comes in contact with and irritates a nearby spinal nerve root, a herniated disc occurs, with symptoms possibly including sharp, shooting pain down the arm and even neurological symptoms like numbness, tingling and muscle weakness.

Faulty movement patterns. It is believed that the nervous system may change the way in which it controls the coordinated function of muscles as a result of a barrage of intense pain signals from the whiplash injury.

Chronic pain. While often resulting in minor muscle sprains and strains that heal with time, more severe whiplash injuries may produce neck pain and other symptoms that are persistent and long lasting (chronic).

Cognitive and higher center dysfunction. In some instances, whiplash may affect the patient's mental functioning, possibly leading to difficulties concentrating, as just one example.

Manual Physical Therapy for Pain Relief

Many patients arrive at their first physical therapy appointment expecting to receive hot packs, ultrasound and instructions on how to complete a series of exercises. These modalities are warranted in many instances and most therapists would agree that exercise is needed to help restore muscle imbalances. However, many therapists now approach the restoration of function from a different perspective. These therapists are interested in why a muscle isn’t functioning properly and view back exercise not as the driving mode of recovery but as a complement to manual therapy. They may, for instance, look to restore proper sacroiliac or lumbar joint function to treat piriformis syndrome rather then directly manipulate the piriformis muscle through exercise.

Manual physical therapy is a specialized form of physical therapy delivered with the hands as opposed to a device or machine. In manual therapy, practitioners use their hands to put pressure on muscle tissue and manipulate joints in an attempt to decrease back pain caused by muscle spasm, muscle tension and joint dysfunction.

Manual Physical Therapy can Offer Pain Relief for Acute and Chronic Back Pain

Manual therapy can be helpful for the treatment of joints that lack adequate mobility and range of motion in certain musculo-skeletal conditions. This limitation can cause discomfort, pain, and an alteration in function, posture, and movement. Manual physical therapy involves restoring mobility to stiff joints and reducing muscle tension in order to return the patient to more natural movement without pain. Thus, manual physical therapy may provide back pain relief both for patients with chronic back pain involving joint problems, such as sacroiliac joint dysfunction , and acute back pain from soft tissue injuries such as a back muscle strain or a pulled back ligament. Although extensive clinical studies have yet to be performed on all areas of manual therapy, limited clinical data and patient reports support the assertion that manual physical therapy can be effective in relieving back pain for certain patients.

As a group, manual physical therapy techniques are aimed at relaxing tense back muscles and restricted joints in order to decrease back pain and increase flexibility. In general, manual physical therapy techniques employ the following types of movement:

•    Soft tissue work, including massage, which applies pressure to the soft tissues of the body such as the muscles. This pressure can help relax muscles, increase circulation, break up scar tissue, and ease pain in the soft tissues.

•    Mobilization/manipulation, which uses measured movements of varying speed (slow to fast), force (gentle to forceful), and distances (called ‘amplitude’) to twist, pull, or push bones and joints into position. This can help loosen tight tissues around a joint, reduce pain in a joint and surrounding tissue, and help with flexibility and alignment.

The following page covers the specific manual physical therapy techniques that are designed to alleviate low back pain related to muscle spasm, muscle tension and joint problems.

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Hydrotherapy

Hydrotherapy

Hydrotherapy, formerly called hydropathy, involves the use of water for pain-relief and treating illness. The term hydrotherapy itself is synonymous with the term water cure as it was originally marketed by practitioners and promoters in the 19th century. A hydrotherapist therefore, is someone who practices hydrotherapy.

Water cure has since come to have two opposing definitions, which can cause confusion.

(a) Water cure therapy  – a course of medical treatment by hydrotherapy

(b) water cure torture  – a form of torture in which a person is forced to drink large quantities of water.[1]

The sense used in this article is the first one, synonymous with the term hydrotherapy, and which precedes recorded use of the second sense.[a]

Hydrotherapy in general encompases a range of approaches and their definitions. These range from approaches and definitions which are either naturally distinct, or made so for marketing purposes, to approaches and definitions which overlap significantly, and which can be difficult to disentangle.

One such overlap pertains to spas. According to the International SPA Association (ISPA), hydrotherapy has long been a staple in European spas. It is the generic term for water therapies using jets, underwater massage and mineral baths (e.g. balneotherapy, Iodine-Grine therapy, Kneipp treatments, Scotch hose, Swiss shower, thalassotherapy) and others. It also can mean a whirlpool bath, hot Roman bath, hot tub, Jacuzzi, cold plunge and mineral bath. These treatments use physical water properties, such as temperature and pressure, for therapeutic purposes, to stimulate blood circulation and treat the symptoms of certain diseases.[

Hydrotherapeutic mechanisms and modern medicine

Modern medicine's successes, particularly with drug therapy, removed or replaced many water-related therapies during the mid-20th century. Nowadays, water therapy may be restricted to use in physical therapy, and as a cleansing agent. However, it is also used as a medium for delivery of heat and cold to the body, which has long been the basis for its application.

Hydrotherapy involves a range of methods and techniques, many of which use water as a medium to facilitate thermoregulatory reactions for therapeutic benefit. While the physiological mechanisms were initially poorly understood, the therapeutic benefits have long been recognised, even if the reason for the therapeutic benefit was in dispute. For example, in November 1881, the British Medical Journal noted that hydropathy was a specific instance, or "particular case", of general principles of thermodynamics. That is, "the application of heat and cold in general", as it applies to physiology, mediated by hydropathy. In 1883, another writer stated "Not, be it observed, that hydropathy is a water treatment after all, but that water is the medium for the application of heat and cold to the body". Thus, the "active agents in the treatment (are) heat and cold", of which water is little more than the vehicle, and not the only one".

With improved knowledge of physiological mechanisms, practitioners wrote specifically of the use of hot and cold applications to produce "profound reflex effects", including vasodilation and vasoconstriction. These cause changes in blood flow and associated metabolic functions, via physiological mechanisms, including those of thermoregulation, that are these days fairly well understood, and which underpin the contemporary use of hydrotherapy. Although standard anatomy and physiology textbooks make only passing reference, if any, to hydrotherapy, some of the best descriptions of the underlying physiology upon which hydrotherapy relies, are to be found in such textbooks. For example, one of the best succinct descriptions of blood redistribution (which is fundamental to the above-mentioned reflex reaction), quoted below, is from a standard textbook.

...by constricting or dilating arterioles in specific areas of the body, such as skeletal muscles, the skin, and the abdominal region, it is possible not only to regulate the blood pressure but also to alter the distribution of blood in various parts of the body.

British and other hydrotherapy establishments are discussed from another standpoint in a recent history of psychiatry.

Acupuncture treatment good for shoulder-hand syndrome

Source: http://www.ncbi.nlm.nih.gov/pubmed/22574575

Abstract

OBJECTIVE:

To assess the effectiveness of acupuncture therapy for shoulder-hand syndrome.

METHODS:

According to the requirements of evidence-based medicine, papers of randomized controlled clinical trials for shoulder-hand syndrome published in China from 2005 to 2010 collected by databases VIP, Wanfang, CNKI, collections of papers of academic conferences, etc. were retrieved by using key words of shoulder-hand syndrome, reflex sympathetic dystrophy, acupuncture, moxibustion. Then the collected documents were given with Jaded score, and analyzed by using software Manager 5. 0 Review Cochrane.

RESULTS:

A total of 100 papers were retrieved. Among them, 29 papers that met our inclusion criteria were given with Jaded scores (2 points for 2 papers, 1 point for the rest 27 papers, being low in quality). Twenty-one papers were brought into Meta analysis. These papers contain 1 768 cases of patients who were divided into three sets of groups according to the used intervention measures. Meta-analysis showed that simple acupuncture therapy is significantly superior to acupoint block therapy for relieving shoulder-hand syndrome [odds ratio (OR, 95% CI) 4.80 (2.02 to 11.41), P < 0.05]; electroacupuncture therapy is markedly more effective than simple acupuncture therapy [OR (95% CI) 4.60 (2.08 to 10. 17), P < 0.05]; and acu-moxibustion combined with other therapies is significantly more effective than simple acupuncture therapy [OR (95% CI) 3.31 (2. 30 to 4.77), P < 0.05]. The other 8 papers were not brought into Meta-analysis due to being different to the 21 papers in the intervention measures.

CONCLUSION:

Acupuncture can effectively relieve shoulder-hand syndrome in pain, wrist- and shoulder-joint motor, etc. But, larger size of samples and high quality randomized clinical trials are needed for providing more reliable conclusive evidence.