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What is Whiplash?
Submitted by
Surrey Orthopaedic & Sports Physiotherapy Clinic
An accredited member of the Active Physiotherapy Rehabilitation Group
The human skeleton is comprised of hard and soft tissue. Hard tissue is bone and cartilage and soft tissue makes up the remainder of the skeleton, including muscles, ligaments, tendons, joint capsules and fascia. Soft tissue can become injured as a result of a direct trauma, when over-stretched, or made to endure too much weight. Whiplash occurs when muscles and other soft tissue structures of the neck and spine are stretched beyond their normal length and tearing occurs.
What Happens When Soft Tissue Becomes Injured?
When soft tissue is damaged, regardless of the mechanism of injury, several things happen.
Tiny tears occur in the tissue. These tears are so tiny that they do not cause any visible disruption in the tissue but cause pain and inflammation.
Inflammation is characterized by swelling, redness and pain. You may not be able to detect any swelling or redness if the damaged tissue lies deep beneath the skin.
Other symptoms that may be present when soft tissue is injured are muscle spasm, muscle weakness and limited movement.
How Does the Body Respond to a Whiplash Injury?
The human body has the capability to heal damaged soft tissue and does so by laying down new tissue to mend the damaged tissue. This tissue is called "scar tissue". Scar tissue is rigid when produced, and therefore, it is essential to stretch and "mould" it into flexible tissue as it develops. Eventually, the inflammation settles down and ceases to exist. The average healing time for soft tissue ranges from 6 to 8 weeks. Occasionally, residual problems remain following a soft tissue injury; however these problems are never a result of the tissue not healing. Rather, it is a result of the tissue not healing correctly (i.e. with limited flexibility).
What Should I Do If I Have a Soft Tissue Injury?
You should see your family physician immediately. He/she will most likely examine your injury, and if there is a possibility of a broken bone, an X-ray will be ordered. If, on the other hand, your doctor is certain that you have a soft tissue injury, an X-ray will not be ordered, since X-rays do not show soft tissue.
Rehabilitation may be required if your symptoms persist beyond two weeks. A good rehabilitation program should address your pain, improve your movement, increase your strength and general condition. In addition, it should help you to return to your normal activities as quickly as possible.
During the early stages of a soft tissue injury, ice can be applied to control swelling, reduce pain and ease muscle spasm. Ice should be applied for 15 to 20 minutes at a time, up to three times a day. Other modalities such as heat, ultra sound, electrotherapy, massage and manual therapy can also help ease the symptoms, and speed the healing process during the early stages of soft tissue injury. Keep in mind that these types of "passive" treatments are helpful during the early stages but they should be replaced with more active forms of treatment as the symptoms lessen.
Movement is very important right from the onset of injury. The injured part should not bear excessive weight during the acute stages - pain should be your guide when deciding if something is too heavy. However, movement without resistance is extremely important right from the beginning. Stiffness and limited range of motion are normal occurrences with soft tissue injury. Nevertheless, the tissue needs to be moved in order for it to function properly when it eventually heals. Movement will sometimes cause some discomfort. Keep in mind that discomfort is permissible, pain is not.
Exercises should progress from gentle movement exercises to a full exercise program, as tolerated. This program should take at least one hour to complete. The secret to any good exercise program is that it is designed specifically for you based on your injury, job, interests and hobbies. It should include strengthening exercises, stretching exercises and cardio-vascular exercises. You should be instructed on how to safely increase the weight and number of repetitions as you improve.
A proper progressive exercise program will ensure that the damaged tissue heals properly and will prevent chronic problems from occurring. Exercise has the following effects:
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Prevents the formation of rigid scar tissue
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Increases circulation, which speeds the healing process
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Prevents the muscles from becoming weak and atrophied
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Increases your general physical condition, making it possible to eventually return to safe physical activity
It is important to remember that all tissue eventually heals, so do not be discouraged by slow progress. Everyone heals at slightly different rates, dependent on the type of injury. Try to set small achievable goals for yourself every week - practical goals that are meaningful in your life. For example, the first week following your injury, your goal may be to become independent in dressing. The following week, your goal may be to lift up your child, and so on. If you set overly ambitious goals for yourself, you will be disappointed when you fail to achieve them. Before you know it, you will reach your ultimate goal of returning to a normal active life.
When Can I Return to Normal Activities?
This will vary for each individual, as everyone heals at different rates and people have different levels of physical requirements for their jobs. Individuals who are required to perform light duties will be able to return to their job quicker than those whose jobs require heavy lifting. Very often your employer can provide you with a lighter job until you have recovered fully. A physiotherapist or occupational therapist can test you to make sure it is safe to return to work, and in many cases, will arrange for you to try doing normal activities before discontinuing your treatment. You may still be experiencing some discomfort when you return to work. However, at that point you should have the knowledge to deal with your discomfort. You can expect to feel a little better each day. And before you know it, you will be back in the swing of things and enjoying life to its fullest.
Take Charge!
The most important thing to remember is to take charge of your own recovery. Tell your doctor you want to get started on rehabilitation right away. Once in treatment, take responsibility for your own progression. If you are not getting "good treatment" say something or go elsewhere. You have a choice!
It is also important to maintain a positive attitude while you are recovering. Take the quiet times to be reflective. Take the opportunity to start eating properly, and start dealing with the stress in your life.
And, finally, try returning to work as quickly as possible. Forget the past and get on with things.
Start enjoying life again!
--Brenda Rusnak is a Registered Physiotherapist with 18 years of practical experience. She is owner of two Physiotherapy clinics in Toronto and is CEO of ACTIVE Health Management, Inc. She has also written for numerous publications including Canadian Underwriter Magazine; Canadian Insurance Magazine; and Insurance West.
http://www.activehealth.ca/AHM.asp |
