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Whiplash: Diagnosis & Treatment

by Dr Simon Petrides MB BS DO DM-SMed Dip Sports Med FFSEM (UK&I)
Musculoskeletal & Sports Physician | The Blackberry Clinic, Milton Keynes

Prevalence
Most cases of Whiplash Associated Disorder (WAD) result from car accidents. About 20% of car accidents are rear end collisions and these are the ones that typically cause whiplash type injury. About one person in fifty is hurt every year in a car accident and the resultant medical and insurance implications run into many millions of pounds annually. This is not helped by the increasingly litigious culture in which we live.

When struck from behind, a car will accelerate forwards followed about 100 milliseconds later by the torso and shoulders. The head, because of its weight, lags behind and is then catapulted forward. This applies force of up to 100lbs to the head, producing maximal hyperextension well beyond the physiological limit.

The direction of impact has an influence since a higher velocity change is required for tissue damage in a front or side impact, compared with a rear impact, collision. Poorer prognosis is likely if the neck is rotated at the time of impact.  

Well positioned head restraints do not prevent WAD type injury, although they have been shown in some studies to reduce the incidence and severity if positioned close to and level with the head. Seatbelts, although they reduce the risk of fatal injuries, may actually increase the severity of WAD. This may be due to an increase in force between the torso and the head when the vehicle is jolted.

Symptoms of WAD

  • Headache
  • Tiredness
  • Neck pain and stiffness
  • Paraesthesia
  • Low back pain
  • Dizziness
  • Poor concentration
  • Blurred vision
  • Visual disturbance
  • Irritability
  • Sleep disturbance
  • Noise sensitivity
  • Forgetfulness
  • Anxiety

A number of these symptoms have been collectively called the Barré-Lieou Syndrome. In 1925, Jean Alexandre Barré, MD, a French Neurologist, and in 1928 Yong-Choen Lieou, a Chinese physician, each independently described a syndrome with a variety of symptoms thought to be due to a dysfunction in the posterior cervical sympathetic nervous system. The posterior cervical sympathetic syndrome became known as Barré-Lieou Syndrome.

Symptoms that characterise the syndrome include headache, neck, facial, ear and dental pain, tinnitus, vertigo (dizziness), nausea, vomiting, blurred vision, watering of the eyes and sinus congestion. Other symptoms may include swelling on one side of the face, localised cyanosis of the face, facial numbness, hoarseness, shoulder pain, dysaesthesia of the hands and forearms, muscle weakness and fatigue. These symptoms correlate very closely with those experienced after some whiplash type injuries and may indeed be part of the spectrum of WAD.