Integrated Model of Management for Whiplash Associated Disorders

Overview

• Course Context: Revisits content from 3401 AHS - Musculoskeletal Physiotherapy 2.
• Key Topics:
  • Pathophysiology of whiplash
  • Clinical presentations
  • Prognostic indicators
  • Stratified management plan
  • Stress inoculation training

Whiplash Basics

• Definition: Injury to the neck with acceleration-deceleration force, transferring energy to the cervical spine.
• Common Causes: Car accidents, sports like football, motor racing, skiing, cycling, etc.
• Symptoms:
  • Neck pain, headaches, radiating back/arm pain
  • Neurological symptoms (dizziness, visual/auditory disturbances)
  • Psychological effects (post-traumatic stress, anxiety, depression)

Classification (Quebec Task Force, 1995)

• Grade System: Grades 1 to 4
  • Grade 1: No physical signs
  • Grade 4: Fracture/dislocation, requires imaging
  • Grades 2-3: Varying musculoskeletal and neurological symptoms
• Prognostic Challenges: Grades 1-3 have unpredictable outcomes

Imaging Guidelines

• Canadian Cervical Spine Rule: Determines need for imaging
  • Primarily for alert patients
  • Factors: Age over 65, dangerous mechanism, neurological signs

Neurological Screening

• Key Aspects:
  • Sensory motor deficits
  • Reflexes
  • Antalgic postures

Pathophysiology and Contributing Factors

• Complex Interactions: Muscle tone, proprioception, psychological factors
• Assessment Considerations:
  • Muscle reactivity, hypertonicity
  • Postural control
  • Environmental and personal psychological factors

Pain and Psychological Responses

• Walton and Elliot Model: Interaction of injury, psychological distress, and pre-existing conditions
• Pathways:
  • Resilient individuals: Transient pain and recovery
  • Vulnerable individuals: Chronic pain cycle, stress response

Case Study: Hetty

• Profile: 32-year-old woman, 5 weeks post-car accident
• Assessment:
  • Signs of local tissue damage and mechanical pain
  • Classified as Grade 2 using Quebec system
  • High neck disability index (NDI) and impact of events scale (IES)

Prognostic Tools

• WhipPredict: Uses NDI and hyperarousal score for risk stratification
• Orebro Short Form: Generic, suitable for multiple pain areas

Communicating Prognosis

• Risk Stratification: Low, medium, high risk based on age, NDI, hyperarousal
• Patient Communication: Using tools like My Whiplash Navigator for guidance

Management Guidelines

• Broad Recommendations:
  • Low-Risk: Minimal hands-on, reassurance, activity encouragement
  • Medium/High-Risk: Dizziness exercises, CBT, multidisciplinary care if chronic
• Specific Treatments: Stress inoculation training
• Not Recommended:
  • Cervical spine manipulation
  • Opioids, electrotherapy, trigger point needling
  • Corticosteroid injections, botulism toxin, surgical interventions unless indicated

Conclusion

• Next Steps: Explore stress inoculation as a treatment approach

Note: Refer to draft Australian clinical guidelines for comprehensive, evidence-based treatment strategies.