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Risk Factors for Chronic Whiplash

Risk Factors for Chronic Whiplash
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Whiplash describes a mechanism of injury that occurs following the sudden acceleration and deceleration of the head and neck that stretches its various soft tissues beyond their physiological limits leading to sprains, strains, tears, etc. The resulting cluster of symptoms is collectively known as whiplash associated disorders (WAD). Past research suggests that up to half of WAD patients will continue to experience chronic symptoms for up to a year or more following the initial injury event, which can place a heavy burden on the individual and their family. In recent years, much research has been conducted on uncovering why some patients experience a resolution of their symptoms and why some progress to chronic WAD.

A 2015 study monitored 599 patients who sought treatment for WAD symptoms three weeks post-injury. After one year, 30% of this group had transitioned to chronic WAD. Researchers were then able to look back at initial intake data to identify any factors that may be more common among those with chronic WAD versus those who recovered. They noted five such risk factors: high baseline disability (physical or functional impairments that interfere with the ability to carry out activities of daily living); longer predicted recovery time (an assessment of the severity of the patient’s injury taking into account the patient’s overall health and how it can affect recovery); psychological distress (symptoms such as depression and anxiety); passive coping (relying on wishful thinking or avoidance instead of actively participating in managing the condition) and a greater number of initial symptoms. The authors concluded that the presence of one risk factor resulted in 3.5 times greater risk for chronic WAD and the presence of four or more risk factors raised the risk 16 times.

A systematic review of fourteen studies conducted in 2016 found that patients with chronic WAD exhibited greater cross-sectional area in the neck muscles, which was explained by greater fat infiltration into the muscle tissue. Fat infiltration can occur when muscles become deconditioned following poor health and inactivity, leading to weaker muscles, altered biomechanics, increased pain sensitivity, reduced range of motion, and other factors that lead to ongoing neck pain and disability. If you look at the risk factors for chronic WAD, you can see how they can contribute to the neck muscles becoming less active due to the body’s reaction to injury and/or the patient’s resulting activities (or lack thereof).

In addition to in-office treatment like manual therapies and modalities to help restore normal motion to the injured joints and soft tissues, doctors of chiropractic assure patients that they can recovery and recommend WAD patients to stay as active as possible (within pain tolerances), get regular exercise, perform exercises that specifically target the neck muscles, eat an anti-inflammatory diet, and get sufficient quality sleep to aid in recovery. As with other musculoskeletal disorders, the odds for a satisfactory WAD outcome are best early in the course of the disease so seek care sooner rather than later.


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