Factors Linked to Chronic Whiplash Associated Disorders
Whiplash associated disorders (WAD) is a term that describes the cluster of symptoms that can arise from an injury caused by the sudden acceleration and deceleration of the head and neck, most often seen in a motor vehicle collision. Whiplash injuries are classified in four levels: WAD I (no/minimal complaints/injury); WAD II (soft-tissue injury—muscle/tendon and/or ligament injury); WAD III (nerve injury); WAD IV (fracture). The current research suggests that between 20-50% of WAD patients will continue to experience some degree of life-interfering pain and disability a year following their initial injury. Several studies have sought to uncover why some patients develop chronic WAD (or cWAD) while others have a full recovery.
Among the risk factors associated with cWAD, a higher initial pain intensity and higher initial disability scores—which are indicative of more severe injury—are two of the most important. Thus, a patient with WAD II is at greater risk for chronic symptoms than the WAD I patient. Likewise, patients with WAD III have a higher risk for chronic pain and disability than those with WAD II. With respect to physical characteristics, individuals with a more slender and less muscular neck have an elevated risk for more serious injury, as do those with weaker neck muscles, arthritis in the cervical spine, and a history of neck pain.
Additionally, there are two more prominent risk factors for cWAD, but they are related to the response to injury. These factors are pain catastrophizing (describing pain in more negative and exaggerated terms) and poor expectation of recovery. These can be attributed to the patient having a poor understanding of their condition. When this occurs, the patient is more likely to let their pain get the best of them and restrict their activities. This can lead to deconditioning of the neck muscles (or the body in general), which can slow the recovery process.
For the best chance of a full recovery, doctors of chiropractic provide manual therapies like spinal and extremity joint manipulation (high-velocity thrust), mobilization (low-velocity non-thrust), manual traction, massage, assisted-stretch, neuro-motor retraining manual methods, and a host of soft-tissue therapies. The chiropractor may also employ modalities like electric stim, ultrasound, pulsed electro-magnetic field, class IIIb or IV laser, and more. Patients are also encouraged to remain active to help them feel more in control of their recovery and can keep the muscles in the neck from becoming deconditioned.
While the multimodal approach utilized by doctors of chiropractic is recommended by treatment guidelines as preferred front-line treatment, the chiropractor may co-manage the patient with allied healthcare providers such as a medical physician, physical therapist, acupuncturist, or psychologist to address aspects that fall outside their traditional scope of care.