Whiplash

Whiplash

What is Whiplash?

Whiplash is a term often used to describe a neck injury that is caused by a sudden vigorous movement of the head in any direction. This sudden, uncontrolled movement of the head results in a ‘whipping’ action through the neck that can cause damage to the muscles, ligaments, connective tissue and small joints of the cervical spine.

A good analogy of the head to neck proportion would be to consider an olive on a cocktail stick! Now visualise the strain potential through the neck (cocktail stick) if the head (olive) were to be rapidly moved in any direction without control.

What causes Whiplash?

Most commonly, whiplash occurs after road traffic accidents (RTAs) but it can also occur from injuries as a result of sporting activities, accidental falls or an assault to name a few.

The weight of the body, through the law of inertia, resists the sudden impact associated with RTAs and remains essentially motionless. But the weight of the head (on average 14lbs or 6kgs!) above the highly mobile neck, shifts forward, with severe strain placed on the delicate connective tissue of the neck and upper spine (see picture attached).

Imagine holding a bowling ball in both hands close to your trunk. Now consider the strain on the trunk and connective tissue as the bowling ball is taken slowly away from the trunk through outstretched arms. The same would apply for the weight of the head moving forwards over the clavicles and sternum, BUT, without the pre-warning and required preparation in the connective tissue.

Symptoms of Whiplash?

Symptoms can include any of the following:

•    Neck pain and stiffness (and in some cases swelling)
•    Tenderness to touch the neck and shoulders
•    A reduction/loss of neck movement
•    Headaches
•    Lower/mid back pain
•    Pain/numbness/pins & needles in the arms and hands
•    Muscle spasms
•    Tiredness
•    Dizziness, blurred vision, difficulty swallowing, nausea, vertigo (sensation that you are spinning), tinnitus (ringing in the ears)

The anatomy of the cervical spine and shoulder girdle is extensive and the space permitting the connective tissue to exist is limited. Following whiplash and any associated inflammation, the space for muscle, ligament and nerves to function can be reduced. Bare this in mind and pay particular attention to symptoms of vertigo, tinnitus, blurred vision and dizziness. This could be an indication that the upper cervical spine is irritated and the cranial nerves affected.

Whiplash symptoms can take between 6 – 24hrs post injury to onset, and are often delayed as a result of the associated shock from the accident and/or delayed inflammation to the tissue.

As practitioners potentially working with clients who have sustained a whiplash injury, (especially if the injury occurred en route to their Pilates session!), it is important to be aware of the delay in onset as they may report no symptoms or pain initially. Excessive strain on the head, neck and shoulders during a Pilates session could further damage the connective tissue and delay recovery.

Pilates and Whiplash

Pilates is definitely of benefit for the client suffering from whiplash. However, it would be fair to assume that you are unlikely to receive a referral for someone with acute whiplash. Chances are one of your clients will attend a session and notify you of a whiplash type injury that they have sustained, hoping that you can offer some further advice on recovery!

What follows are suggestions of how to aid the whiplash sufferer with Pilates and are by no means the best options for ALL clients. Whiplash is a generic term and as such not every client will present with the same symptoms.

In the acute phase of whiplash (first 6 weeks):

•    Observe and encourage a healthy alignment of the cervical spine
•    Use postures that offer more support of the head and neck (i.e. semi-supine / relaxation position) instead of those that would strain the neck (prone)
•    Encourage the use of the hands to cradle the head for any abdominal work if at all tolerable, otherwise, avoid curls in the short-term
•    Monitor for symptoms of dizziness, light headedness, tinnitus – if occurring, take the client out of the posture and stop the session.
•    Offer advice on using heat to release the soft tissue tension, pain relieving medication and gentle active exercises for the neck & head
•    Consider supported head rolls, chin tucks, shoulder drops – any exercises that help to release the tension of the head, neck & upper body
•    Advise on maintaining the support of the head and neck whilst sleeping
•    ENCOURAGE a healthy posture throughout the spine throughout the day!

In the sub-acute phase of whiplash (> 6 weeks):

•    Gradually increase the loading into the neck with variation in postures but maintain healthy cervical alignment as usual
•    Consider side lying work and potentially prone work using arms for support (i.e. a small swan prep / small back extension) as pain allows
•    Trial abdominal work but again offer support for the weight of the head
•    Consider finishing the session with plenty of neck and shoulder release work

Gradually, as pain and time allows (which will vary between clients), their symptoms will reduce and the loading through the neck can be increased.

The key to a quicker recovery is good posture and active neck exercises as soon as possible.