Any time that I get injured, I try to look at the bright side and view it as an opportunity to learn. If nothing else, it helps me to have more empathy for patients who present with the same injury.
Recently I was on vacation and had the opportunity to ride a flowrider. If you’re not familiar with what a flowrider is, it’s a perpetual wave of water that you can surf. My daughter kindly informed me that my falls were more spectacular and louder than most people on the wave. Not surprisingly then, I had one rather intense fall in which my upper back hit the bottom first, and then the back of my head followed. Thankfully, I did not have a concussion, but I did sustain mild whiplash.
To explain the mechanism of the fall, imagine doing a sit-up and appreciating the strain in the muscles on the front of your neck. Now imagine falling straight backwards from a standing position and resisting the speed of the fall with those same muscles. Although I had immediate pain, most of the pain was experienced the following day. What was interesting is that I had absolutely no pain on the sides or the back of my neck. All the pain was in the front of my neck and in my throat. I had no difficulty with turning my head or looking down, but the pain inhibited the muscles from activating. Due to this, I had a very hard time lifting my head off a pillow and looking up. I also had difficulty swallowing.
Whiplash Associated Disorder (WAD)
Any acute sprain-strain injury affecting the neck can be referred to as a whiplash injury. The technical term is whiplash associated disorder, or “WAD” for short.
There are four different types of whiplash associated disorder. WAD 1 is a whiplash injury that is painful but does not limit movement. WAD 2 is painful, and movement is limited. WAD 3 involves nerve pain that travels down the arm, usually requiring an objective neurological finding to confirm the diagnosis.
WAD 4 is rather rare as it is characterized by a fracture. In my case, I experienced a mild WAD 2 as my neck was painful, and I couldn’t move properly in all directions.
Management of Whiplash
The management of whiplash injuries can be rather complex and often involves a multidisciplinary approach. At the same time, my case resolved rather quickly with very little intervention. I kept active. I tried to somewhat ignore the discomfort while I carried on with my vacation.
I obviously understood the various aspects of whiplash injury that I tell my patients; pain doesn’t necessarily equate to tissue damage, and new moments of pain when moving are unlikely to be causing any harm or damage to my neck. I had a few treatments of active release (ART), and I did occasional gentle stretching. After about one week, I would say that I’m 90% better. Swallowing is mostly back to normal, and I can look up with no pain.
Perhaps what I learned most from this is that whiplash injury can be a little scary, even for someone who treats it on a regular basis. I have never experienced a change in swallowing with any sprains or strains I’ve experienced in the past. I can understand how that symptom might frighten someone. I can also appreciate how if someone received the wrong information and guidance on managing this condition, they might rest and protect it too much, creating frailty in the area and an exacerbation of symptoms.
Recovery would obviously then take longer, which may then impact someone’s mental health, spiralling into a chronic case of neck pain that can then become tricky to overcome.
It has been well established in the literature that whiplash injuries can be very complex and complicated to resolve. At the same time, I can speak from experience that consulting with a knowledgeable practitioner who can guide you through the recovery process can be of great benefit and facilitate a rather speedy recovery. It isn’t always that bad! In terms of prevention, avoiding the flowrider is one option. Perhaps a better option is to strengthen the muscles of the neck. Not only will this make your neck more resilient and capable of withstanding trauma, but a stronger neck has also been shown to help reduce the possibility of concussion. You can’t go wrong with getting strong!
Collins CL, Fletcher EN, Fields SK et al. Neck strength: a protective factor reducing risk for concussion in high school sports. J Primary Prevention. 2014 (online).