My aim with this blog is to present some information which is useful whether you are medically trained or not; so breeze through the jargon that means nothing to you do NOT get bogged down with terms. The term whiplash has been hijacked by the claim culture “system” the same thing happened to “RSI – repetitive strain injury” ; sooner or later it seemed to get outlawed and the claims have largely disappeared. The same could happen to whiplash …. because of a few making good (bad!!) money out of claims. This affects the majority of genuine injuries seeking help.

Whiplash Associated Disorder (WAD) :

Whiplash is an injury usually to the  neck area but can affect any part of the back or even shoulders. It is due to a forceful, rapid back-and-forth movement of the body, the nature of the injuries depend also on the direction of impact, whether the car was spun or rolled. Whiplash most often occurs during a road traffic accident, however the injury can also result from a sports accident, physical abuse or other trauma.

Common signs and symptoms of whiplash include neck pain, neck  stiffness and headaches. Pain may be referred to other areas and tenderness felt widely as well. For most people the whiplash  symptoms will  recover within a few months after a course of pain medication, exercise and other treatments.

Some people, however will continue to experience chronic neck pain and other ongoing complications including psychological & emotional effects along with aches and pains that are difficult to adequately explain. Whilst the stats are VERY MUCH in favour of a happy recovery. It is still a miserable time.

For a more technical summary of Whiplash see the attached document  (below in red) by the IASP (THE international ” go to” pain people ).

WHLASH01

It is quite detailed and technical so “don’t get confused”  or bogged down. Remember what I always say  “like what you like , ignore what you don’t”

THE recognised grading system for whiplash used in medicine is called the Quebec Task Force Classification (see below): There have been updated suggested revisions of this with 7 categories (Michelle Sterling, 2004. In manual Therapy, 9,60-70)

Québec Task Force

The Québec Task Force (QTF) has divided whiplash-associated disorders into five  grades:

• Grade 0: no neck pain, stiffness, or any physical signs are noticed
• Grade 1: neck complaints of pain, stiffness or tenderness only but no physical signs are noted by the examining physician.
• Grade 2: neck complaints and the examining physician finds decreased range of motion and point tenderness in the neck.
• Grade 3: neck complaints plus neurological signs such as decreased deep tendon reflexes, weakness and sensory deficits.
• Grade 4: neck complaints and fracture or dislocation, or injury to the spinal cord.

There appears to be some common risk factors of developing a difficult to shift whiplash pain, they are similar risk factors for any pain being difficult to shift. This type of pain is called  CHRONIC PAIN.  later  BLOGS on  this ….

Risk Factors: for  chronic symptoms like pain & stiffness. The table below shows the factors which do and appear not to relate to the chances of developing an outcome or prognosis of chronic pain: The box on the left shows the ones most likely or possible to lead to chronic symptoms; possible only! 

There are loads of these “risk factor lists” but the one here is a reasonable example:

Managing Whiplash early on: (1st 12 weeks): Have you been checked out ?? Maybe at the scene, by your GP, at A/E or by your therapist; do you need to ? SELF ASSESS ..

Amazingly most people suffer only soft tissue injuries to the neck, low back or shoulders. Major nerve or bone damage seems uncommon. Although  the injuries are more like a sprain or strain type injury they often strangely take longer than would be expected and with an tendency to vary between good periods and bad quite randomly. The thing to take from this is slight quirkiness is that it is normal (not easily explainable but quite normal). In this 1st 12 weeks you need to do the basics WELL. 

Move & Soothe !

I know this seems too simple. first week or two look after your posture, use pain relief which should include heat or ice (whichever works for you), simple rubs and creams, move you neck or injured part through an gradually increasing range of movement, try to get on with work or chores. Your work may need to be involved some employers won’t want you there unless you are 100% or unless cleared medically to be there.

Video Series: Exercises for Whiplash

Learn 3 Neck Stretches and Exercises

http://www.spineuniverse.com/conditions/whiplash/video-series-exercises-whiplash

(with permission from spine universe)

The link above (in RED)is quite useful for some simple exercises early on. There are three videos. They will talk about holding some positions for 20 seconds but this should built towards and I would suggest 3-5 second holds. They should not be painful – “pleasant stretchy pain” that get easier as the days go by. Done twice a day ideally.

Managing Whiplash when it is going on & on ….. (after week 12):

There is a lot of help out there. Have you had Physio? if this hasn’t worked for you there are specialist pain rehabilitation teams accessible via your GP

 For the most part the healing process in the majority of whiplash injuries which as we have already said are soft tissue based (ligament, muscle and tendon based) are now HEALED.  They might need toughing up a bit more, stretching, loosening “unspasming” but this is the prettying up or “painting and decorating” stage of healing. BUT YOU STILL HURT ! pain  without purpose – pointless BUT certainly agony, miserable, terrifying AND  REAL.

YES there may also be psychological factors, sociological, financial, personal life changing factors that could be part of your whole experience of the pain you still feel. Mind & Body – always together not one or the other ….

 ARE there some mis-diagnosed, mis -managed, misunderstood whiplash problems YES there are …..but they are very, very few, MORE usually they are  impossibly complicated. BUT this BLOG is about the majority HEALED but STILL HURTING. 

THE CONCEPTS:

You are on staircase to a better life EVEN with your pain – REALLY ! well yes probably:  plan for the worst. YOU  have to get on with life – to live – You can & YOU will….

1. PLAN – small steps. Plan your activity whether it is housework, a walk or whatever. Think  like an ATHLETE but you are you’re own coach: what are you going to do? how much? & for  how long. NOT UNTIL IT HURTS LIKE HELL – WRONG

2. PACE – make your activity achievable, small victories are best.

3. GRADED EXPOSURE – gradually increase your exposure to activity, chores and exercises (walking, gentle keep fit, tai chi, yoga, Pilates  – are reasonable early suggestions) plan the exposure NO leaps into the unknown

4. PLAN – review the success of your 1st step – plan the next step: slightly more slightly less or repeat the same.

There will be some UP’s and some DOWN’s – you will not get it right all the time. Increases in PAIN are to be expected and will most often be FOR NO REASON – so don’t over analysis.

Do not get controlled by the good day / bad day swing door – do Too much on the Good days and do nothing on the bad !!  Sometimes called the under activity / over activity trap.

FIND A LEVEL THAT YOU CAN DO REGARDLESS

Do what you planned, Stick to the plan NOT more Not less. Build in rest – this might be a lie down but could easily be a lighter activity. But PLAN it – DO IT.

There is light at the end of the tunnel. The body can recover, the nervous system can “re-wire” (more about this idea in later BLOGS on chronic pain) so it is not impossible for the symptoms of whiplash to go away. I have had many people tell me 1-2 year after the injury they have returned to normal.

However, and I know it seems a great big fat lie but you can live and live well even with pain. I hope this BlOG gives you some pointers, some hope. You shouldn’t have to do it alone there are some inspirational PAIN SPECIALIST PHYSIO’s . Whether I am a specialist or not I don’t know but I spend a lot of my day to practice working with people like you.

YOUR LIFE

Good luck, I hope you have enjoyed & been helped

PAIN…Faulty !

Pain is supposed to be useful. It warns us of injury, illness – to avoid putting our foot back on the floor when we have stepped on a tack…..BUT sometimes even this useful system goes wrong – that is what this blog is looking at.

 Lets start with a definition: As defined by the leading world authority on the subject –  The International Association for the Study of Pain (IASP).

Pain
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

There is lots of detail to understand in that definition. Note the use of the word emotional – pain is miserable, depressing, agonising and so much more than this. The sensory bit is things like dull, sharp, stabbing, aching. Also note the use of words ACTUAL – meaning you are damaged and the word POTENTIAL – there isn’t any damage but the threat is sufficient to produce a response !

The image above is trying to show that acute pain (new pain or damage pain – “useful pain !! there’s a thought for you) is relatively simple: damage produces a simple “ON & OFF” switch of pain that is proportional or correct for the level of damage. Switches off when the problem is sorted.

The Chronic Pain device is filled with complicated dials and no obvious “OFF” switch.

Chronic pain can be due to a long term medical problem and therefore appropriate (many of the “arthritis” conditions are examples, there are about 200 different types of arthritis !!) BUT more often chronic pain is FAULTY, pointless, useless, greater than the level of any remaining damage, existing when NO damage exists anymore, going up & down for no obvious reason.

YES: It is still miserable, agonising, depressing, and affects your life & REAL.

NO; it is not imagined or made up….. BUT….

YOU ARE NOT DAMAGED OR BEING DAMAGED DESPITE WHAT IT FEELS LIKE !!

… how do we know?? – well we don’t absolutely  BUT  “what’s left?”

Of course you need to be sure that there is no cause, disease or that something has been overlooked. Then what? …..

…..well, this is whole new world, a change of what you believe,  your body seems to telling to you there is something wrong BUT there isn’t. The “spark” that seems to ignite your pain is often small, “a draft”, “I sat wrong” or so many other triggers which get blamed for causing a flare up. Stress is a significant factor in amplifying, influencing pain. Stress chemicals are evil and do affect how we experience pain and cope with pain.

But if you want to move on and” get your life back” changing  your thinking  is what you must do. And yes it is absolutely possible millions of people do … they get to enjoy life, living “despite pain” !! …. So on with the concept of how do you get started.

Have a look at this simple 10 min video link about “acute” pain and in particular “chronic” pain:

https://www.youtube.com/watch?t=14&v=KfYC6zfrV80

THE CONCEPTS:

You are on staircase to a better life EVEN with your pain – REALLY ! well yes probably:  plan for the worst. YOU  have to get on with life – to live – You can & YOU will….

1. PLAN – small steps. Plan your activity whether it is housework, a walk or whatever. Think  like an ATHLETE but you are you’re own coach: what are you going to do? how much? & for  how long. NOT UNTIL IT HURTS LIKE HELL – WRONG

2. PACE – make your activity achievable, small victories are best.

3. GRADED EXPOSURE – gradually increase your exposure to activity, chores and exercises (walking, gentle keep fit, tai chi, yoga, Pilates  – are reasonable early suggestions) plan the exposure NO leaps into the unknown

4. PLAN – review the success of your 1st step – plan the next step: slightly more slightly less or repeat the same.

There will be some UP’s and some DOWN’s – you will not get it right all the time. Increases in PAIN are to be expected and will most often be FOR NO REASON – so don’t over analysis.

So go on get out an old fashion note pad. Set a couple goals – to leave the house, to do something in the garden, to meet up with a couple of friends, do a walk.

SMALL, ACHIEVABLE – PLAN it DO IT. Success or failure DO IT AGAIN make some SMALL changes – DO IT

Do not get controlled by the good day / bad day swing door – do Too much on the Good days and do nothing on the bad !!  Sometimes called the under activity / over activity trap.

FIND A LEVEL THAT YOU CAN DO REGARDLESS

Do what you planned, Stick to the plan NOT more Not less. Build in rest – this might be a lie down but could easily be a lighter activity. But PLAN it – DO IT.

: IF YOU NEED SUPPORT –  LOTS OF PHYSIO’s WORK IN THIS AREA, THERE ARE CHRONIC PAIN SERVICES – ASK YOUR GP. EVEN IF YOU FEEL YOU HAVE BEEN LET DOWN BY HEATHCARE TO-DATE…… GOOD LUCK, YOU CAN DO IT: