Whiplash Associated Disorder (WAD)
By Matt Fitzsimmons- Physiotherapist
What is it?
Whiplash associated disorder (WAD) is a term given to a variety of symptoms often reported following an acceleration/deceleration injury to the neck or spine, most commonly via a motor vehicle accident.
Symptoms often reported, depending on the severity of the injury, may include neck pain, stiffness, headaches, and sometimes arm pain with or without numbness and/or tingling.
These symptoms are associated with disability, inability to work, decreased quality of life, and psychological distress. Therefore, both physical and psychological interventions are necessary for successful management of this condition.
How Long Will It Take to Get Better?
Most individuals will recover from WAD within 2-3 months following the injury. However, a significant portion of individuals who sustain a whiplash injury will continue to report ongoing pain and disability one year after the injury.
Which Factors Lead to Longer Recovery?
Surprisingly, most factors for delayed recovery are psychological variables such as:
• Post-traumatic stress symptoms
• Depressed mood and/or anxiety
• Pain catastrophizing
• Negative expectations of recovery
Other variables include higher initial pain intensity and higher initial levels of disability. Interestingly, variables such as speed of accident, position in the vehicle during impact, findings on imaging, age, gender, or compensation-related factor do not predict how someone will recover from WAD.
Timeframes are also important in your recovery. Because most recovery occurs within the first 2-3 months, it is important to seek help as early as possible from your physiotherapist to potentially prevent the development of a chronic condition.
Medical Management
Routine imaging, such as X-Rays, are not recommended unless your physician or therapist suspect a fracture or dislocation of the spine. Your physician may prescribe pain medications, if appropriate, but will most likely refer you to a physiotherapist for treatment.
Physiotherapy Management
What to Expect at your First Appointment
The first appointment is an initial assessment. This will include a physical examination of the spine which may include assessing your available range of motion, joint movement, strength, nerve function, and any structural tests that may help in diagnosing a specific tissue injury.
In addition to a physical examination, your physiotherapist may give you questionnaires to fill out to aid the assessment and better help determine your current level of pain, psychological status, and disability.
Under ICBC’s new regulations, patients with an approved motor vehicle accident claim are now automatically approved for 25 treatment sessions with a physiotherapist.
Advise & Education
In addition to explaining what whiplash is, the prognosis, and outlining a treatment plan for you, your therapist can help advise you on the best approach to returning to your usual activities, work, and/or exercise. They can also help you understand pain mechanisms as well as discuss pain management techniques.
Exercise & Activity
Exercise is one of the cornerstones of your rehabilitation treatment plan and research consistently demonstrates that exercise and movement, guided by a physiotherapist, are safe and superior to rest or immobilization with a neck collar for whiplash. These exercises will be individualized to your needs but may include range of motion exercises, muscle strength and endurance training, and postural or motor control exercises.
Manual Therapy
Manual therapy are techniques applied to the tissues by a physiotherapist that may include stretching, joint mobilizations, or even sometimes joint manipulation. Your therapist may employ certain manual therapy techniques in conjunction with exercise and advise.
Interdisciplinary Approach
As mentioned above, some individuals may present with high psychological distress from their motor vehicle accident that will affect their recovery. If identified, a referral to a psychologist in conjunction with your physical therapy program, as well as medical management from your physician, is suggested to optimize your recovery.
Overall, physiotherapists are the health care providers who likely see the greatest number of patients with WAD, and by virtue of the health system set-up, spend the most time with these patients. Physiotherapists are well situated to coordinate and provide treatment in line with evidence-based management for whiplash associated disorder.
References
Sterling, M. (2014). Physiotherapy management of whiplash-associated disorders (WAD). Journal of physiotherapy, 60(1), 5-12.