New Concept of Whiplash Injuries Rehabilitation

Authors

  • Piotr Godek Sutherland Medical Center, Warszawa
  • Michał Guzek Rotmistrza Witolda Pileckiego
  • Jakub Przychodzeń Rotmistrza Witolda Pileckiego

DOI:

https://doi.org/10.30564/jhp.v3i1.2668

Abstract

Whiplash injuries are a global health problem and a significant financial burden for both health care systems, and for insurance providers. The diverse symptomatology after whiplash injury both in the somatic, emotional and behavioral sphere prompted separation of the Whiplash Associated Disorders (WAD) as a separate category of diseases. The exact mechanism of whiplash injury is still under debate and theories explaining pathogenesis of WAD are very diverse ranging from purely biomechanical to neurophysiological, emphasizing central sensitization but the core disability seems to be strictly connected to somatosensory dysfunction. As a result, the optimal algorithm of rehabilitation has not been established and data published in the current literature on effectiveness of such algorithms are inconsistent. Based on the prsesnted here of Head Neutral Reference Point (HNRP), the objective of central desensitization is to restore valid somatosensory output from Cranio - cervical Junction (CCJ). This new concept of rehabilitation after whiplash presented here is based on clinical observations and is supported by initial results.

Keywords:

Whiplash injuries; Rehabilitation; Somatosensory disorder; Craniocervical injury; Pain management

References

[1] Spitzer W. O., Skvtn M. L., Salmi L. R., et al. Scientific monograph of the Quebec task force on whiplash-associated disorders: redefining “whiplash „and its management. Spine. 1995; 20:2–235. DOI:https://doi.org/10.1097/00007632-199805010-00015

[2] Blincoe L, Miller T, Zaloshnja E, Lawrence B. The Economic and Societal Impact of Motor Vehicle Crashes, 2010. (Revised) (Report No. DOT HS 812 013). Washington, DC: National Highway Traffic Safety Administration; 2015.

[3] Yadla S, Ratliff JK, Harrop JS. Whiplash: diagnosis, treatment, and associated injuries. Curr Rev Musculoskelet Med. 2008 Mar;1(1):65-8. doi: 10.1007/s12178-007-9008-x. PMID: 19468901; PMCID: PMC2684148.

[4] van der Velde G, Yu H, Paulden M, Côté P, Varatharajan S, Shearer HM, Wong JJ, Randhawa K, Southerst D, Mior S, Sutton D, Jacobs C, Taylor-Vaisey A. Which interventions are cost-effective for the management of whiplash-associated and neck pain-associated disorders? A systematic review of the health economic literature by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Spine J. 2016 Dec;16(12):1582-1597. DOI:https://doi.org/10.1016/j.spinee.2015.08.025. Epub 2015 Nov 26. PMID: 26631759.

[5] Stemper BD, Yoganandan N, Pintar FA, Maiman DJ. Mechanism of injury. In: Sterling M, Kenardy J editors. Whiplash evidence base for clinical practice. Elsevier, 2011, pp. 16-28.

[6] Tisherman R et al. Biomechanical contribution of the alar ligaments to upper cervical stability. J Biomech. 2019 (11) 23:109508.

[7] Bogduk N. On cervical zygapophysial joint pain after whiplash. Spine (Phila Pa 1976). 2011 Dec 1;36(25 Suppl): S194-9. Barnsley L, Lord S, Bogduk N. Whiplash injury: clinical review. Pain 58(3) 1994:283-307.

[8] Verhagen AP, Scholten-Peeters GG, van Wijngaarden S, de Bie RA, Bierma-Zeinstra SM. Conservative treatments for whiplash. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD003338. DOI:https://doi.org/10.1002/14651858.CD003338.pub3. PMID: 17443525.

[9] Yoganandan N, Pintar FA, Zhang J, Baisden JL. Physical properties of the human head: mass, center of gravity and moment of inertia. J Biomech. 2009 Jun 19;42(9):1177-92. DOI:https://doi.org/10.1016/j.jbiomech.2009.03.029. Epub 2009 May 9. PMID: 19428013.

[10] Stanton TR, Leake HB, Chalmers KJ, Moseley GL. Evidence of Impaired Proprioception in Chronic, Idiopathic Neck Pain: Systematic Review and Meta-Analysis. Phys Ther. 2016 Jun;96(6):876-87. DOI:https://doi.org/10.2522/ptj.20150241. Epub 2015 Oct 15. PMID: 26472296; PMCID: PMC4897597.

[11] Kristjansson E, Treleaven J. Sensorimotor function and dizziness in neck pain: implications for assessment and management. J Orthop Sports Phys Ther. 2009 May;39(5):364-77. doi: 10.2519/jospt.2009.2834. PMID: 19411769.

[12] Nakamura M, Jang IS. Characterization of dural afferent neurons innervating cranial blood vessels within the dura in rats. Brain Res. 2018 Oct 1;1696:91-102. DOI:https://doi.org/10.1016/j.brainres.2018.06.007. Epub 2018 Jun 15. PMID: 29886250.

[13] Malmström EM, Karlberg M, Fransson PA, Lindbladh J, Magnusson M. Cervical proprioception is sufficient for head orientation after bilateral vestibular loss. Eur J Appl Physiol. 2009 Sep;107(1):73-81. DOI:https://doi.org/10.1007/s00421-009-1097-3. Epub 2009 Jun 9. PMID: 19506897.

[14] Barnsley L, Lord S, Bogduk N. Whiplash injury. Pain. 1994 Sep;58(3):283-307. DOI:https://doi.org/10.1016/0304-3959(94)90123-6. PMID: 7838578.

[15] Côté P, Cassidy JD, Carroll L, Frank JW, Bombardier C. A systematic review of the prognosis of acute whiplash and a new conceptual framework to synthesize the literature. Spine (Phila Pa 1976). 2001(10)1;26(19): E445-58.

[16] Scholten-Peeters GG et.al. Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies. Pain. 2003 (7);104(1-2):303-22.

[17] Yoganandan N, Brian D, Stemper BD, Rao RD. Patient Mechanisms of Injury in Whiplash-Associated Disorders, Seminars in Spine Surgery Volume 25, Issue 1, (3) 2013, pp. 67-74.

[18] Ricciardi L, Stifano V, D'Arrigo S, Polli FM, Olivi A, Sturiale CL. The role of non-rigid cervical collar in pain relief and functional restoration after whiplash injury: a systematic review and a pooled analysis of randomized controlled trials. Eur Spine J. 2019 Aug;28(8):1821-1828. DOI:https://doi.org/10.1007/s00586-019-06035-9. Epub 2019 Jun 18. PMID: 31214856.

[19] Vállez García D, Doorduin J, Willemsen AT, Dierckx RA, Otte A. Altered Regional Cerebral Blood Flow in Chronic Whiplash Associated Disorders. EBioMedicine. 2016 Aug; 10:249-57. DOI:https://doi.org/10.1016/j.ebiom.2016.07.008. Epub 2016 Jul 14. PMID: 27444853; PMCID: PMC5006659.

[20] Freitag P, Greenlee MW, Wachter K, Ettlin TM, Radue EW. fMRI response during visual motion stimulation in patients with late whiplash syndrome. Neurorehabil Neural Repair. 2001;15(1):31-7. DOI:https://doi.org/10.1177/154596830101500105. PMID: 11527277.

[21] Häggman-Henrikson B, Lampa E, Nordh E. Altered thermal sensitivity in facial skin in chronic whiplash-associated disorders. Int J Oral Sci. 2013 Sep;5(3):150-4. DOI:https://doi.org/10.1038/ijos.2013.42. Epub 2013 Jul 19. PMID: 23867844; PMCID: PMC3967328.

[22] Myrtveit SM, Skogen JC, Sivertsen B, Steingrímsdóttir ÓA, Stubhaug A, Nielsen CS. Pain and pain tolerance in whiplash-associated disorders: A population-based study. Eur J Pain. 2016 Jul;20(6):949-58. DOI:https://doi.org/10.1002/ejp.819. Epub 2015 Nov 16. PMID: 26568528; PMCID: PMC5063105.

[23] Biendara J, Otte A. Whiplash Syndrome- a disorder of the brain? Hell J Nucl Med. 2017 May-Aug;20(2):110-112. DOI:https://doi.org/10.1967/s002449910550. Epub 2017 Jul 12. PMID: 28697186.

[24] Otte A. Pathophysiological interrelated deactivation/activation processes in the exhausted brain after whiplash injury. Hell J Nucl Med. 2019 May-Aug;22(2):92-95. DOI:https://doi.org/10.1967/s002449911000. Epub 2019 Jul 7. PMID: 31273349.

[25] Elliott JM, O'Leary S, Sterling M, Hendrikz J, Pedler A, Jull G. Magnetic resonance imaging findings of fatty infiltrate in the cervical flexors in chronic whiplash. Spine (Phila Pa 1976). 2010 Apr 20;35(9):948-54. DOI:https://doi.org/10.1097/BRS.0b013e3181bb0e55. PMID: 20118837.

[26] Elliott J, Pedler A, Kenardy J, Galloway G, Jull G, Sterling M. The temporal development of fatty infiltrates in the neck muscles following whiplash injury: an association with pain and posttraumatic stress. PLoS One. 2011;6(6): e21194. DOI:https://doi.org/10.1371/journal.pone.0021194. Epub 2011 Jun 16. PMID: 21698170; PMCID: PMC3116885.

[27] Elliott JM, Courtney DM, Rademaker A, Pinto D, Sterling MM, Parrish TB. The Rapid and Progressive Degeneration of the Cervical Multifidus in Whiplash: An MRI Study of Fatty Infiltration. Spine (Phila Pa 1976). 2015 Jun 15;40(12): E694-700. DOI:https://doi.org/10.1097/BRS.0000000000000891. PMID: 25785961; PMCID: PMC4466088.

[28] Pedler A, McMahon K, Galloway G, Durbridge G, Sterling M. Intramuscular fat is present in cervical multifidus but not soleus in patients with chronic whiplash associated disorders. PLoS One. 2018 May 24;13(5): e0197438. DOI:https://doi.org/10.1371/journal.pone.0197438. PMID: 29795590; PMCID: PMC5967697.

[29] Jull G, Kristjansson E, Dall'Alba P. Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients. Man Ther. 2004 May;9(2):89-94. DOI:https://doi.org/10.1016/S1356-689X(03)00086-9. PMID: 15040968.

[30] Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine (Phila Pa 1976). 2004 Oct 1;29(19):2108-14. DOI:https://doi.org/10.1097/01.brs.0000141170.89317.0e. PMID: 15454700.

[31] Bunketorp L, Lindh M, Carlsson J, Stener-Victorin E. The effectiveness of a supervised physical training model tailored to the individual needs of patients with whiplash-associated disorders--a randomized controlled trial. Clin Rehabil. 2006 Mar;20(3):201-17. DOI:https://doi.org/10.1191/0269215506cr934oa. PMID: 16634339.

[32] O'leary S, Jull G, Van Wyk L, Pedler A, Elliott J. Morphological changes in the cervical muscles of women with chronic whiplash can be modified with exercise-A pilot study. Muscle Nerve. 2015 Nov;52(5):772-9. DOI:https://doi.org/10.1002/mus.24612. Epub 2015 Sep 3. PMID: 25702919; PMCID: PMC4545448.

[33] Jull GA, Falla D, Vicenzino B, Hodges PW. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Man Ther. 2009 Dec;14(6):696-701. DOI:https://doi.org/10.1016/j.math.2009.05.004. Epub 2009 Jul 25. PMID: 19632880.

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Vol. 3 , Iss. 1 (June 2021)

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Copyright © 2021 Piotr Godek, Michał Guzek, Jakub Przychodzeń

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