By Caitlin Chase and Mike Pappas, Exercise Physiologists, Osborne Park
Within WA if a motor vehicle accident was another driver’s fault, reasonable treatment for injuries is covered by the Insurance Commission of Western Australia.
Whiplash-associated disorders (WAD) are a result of rapid acceleration-deceleration forces, affecting up to 83% of patients involved in motor vehicle accidents. WAD’s can lead to a spectrum of severity of psychological and physiological injuries.
Recent studies have advocated for a multidisciplinary active management approach to improve long-term patient outcomes. Recent statistics outlined that 50% of individuals who have sustained WAD’s fully recover, 30% have persisting mild to moderate pain and disability, and the other 20% continue to have moderate to severe pain and disability.
WAD classifications and grading
Whiplash-associated disorders are classified into five grades based on the severity of symptoms and clinical findings:
- Grade 1 involves neck pain, stiffness, or tenderness without any positive findings on physical examination
- Grade 2 is characterised by musculoskeletal signs such as reduced range of motion and point tenderness
- Grade 3, patients also present with neurological symptoms, which may include sensory deficits, decreased deep tendon reflexes, and muscle weakness
- Grade 4 involves evidence of a fracture
- Grade 5 represents more severe or multiple fractures.
Importantly, with appropriate management and early intervention, patients with grades one to three WAD can expect near full recovery within 18-24 weeks.
Active management
There can be varying physiological changes in the cervical region in individuals who have sustained a WAD.
Under the surface, muscle behaviour and motor control impairment can arise between the fine muscle groups and the gross muscle groups. The musculature can undergo morphological changes such as loss of endurance at different contraction intensities, muscle atrophy, and loss of feed forward response.
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This can consequently lead to impaired function, posture and movement. Additionally, psychological injuries can be commonly associated with motor vehicle accidents, and this can impact physiological recovery.
Individuals involved in an accident can often experience symptoms of anxiety, depression and stress.
Active exercise rehabilitation prioritises safe early mobilisation and patient involvement in management of their injuries. This strategy aligns with the biopsychosocial model of care, which recognises the interplay of physical, psychological, and social factors in recovery.
In WAD of grades between one to three, proactive referral to an accredited exercise physiologist is a crucial part of the multidisciplinary treatment plan. Utilising experts in active rehabilitation to restore the physiological changes whilst also addressing the biopsychosocial flags.
An effective exercise rehabilitation protocol typically includes:
- Gentle range of movement (ROM) exercises that are completed early following a WAD injury, allowing for a reduction in muscle guarding and increased mobility
- Isometric exercises of the neck and surrounding structures allow for gentle dynamic strengthening and stability in the initial phases of the rehabilitation programme, targeting the muscle group imbalances
- Following this, dynamic movements involving resistance should be introduced to further build upon general functional movement.
Postural correction, ergonomic advice, and education on certain postures and movements that may contribute to symptoms and delay recovery. Additionally, providing education on the benefits of staying active and continuing to self-manage their rehabilitation ongoing.
Aerobic conditioning plays a vital role in conjunction with increasing strength and ROM of the neck as it can assist in enhancing overall function, improve psychological wellbeing, and aid in a return to work or recreational activities.
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Recent best practice guidelines advocate for early, active intervention. Progression of the rehabilitation program should be based on symptom severity, functional capacity, and psychosocial factors, tailoring to individual responses.
Multidisciplinary collaboration is encouraged, referring to required specialists and allied health professionals, to address all impairments and maximise the recovery for the patient.
Key messages
- Whiplash associated disorder has a spectrum of severity of psychological and physiological injuries
- Early active management with exercise improves outcomes
- Multidisciplinary collaboration is encouraged
Author competing interests- nil
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