When Whiplash Causes Chronic PainEver have a moment when you experience a bit of dizziness? Fortunately it passes quickly and you return to normal once again. But for up to 40 per cent of people involved in car accidents, neck trauma in the form of whiplash causes persistent symptoms. Dizziness is one of three most common symptoms after whiplash trauma. Pain and postural unsteadiness are the other two common problems reported.
In this article, a physical therapist from "down under" (Australia) presents the current information available on dizziness and postural problems as these two symptoms relate to chronic whiplash. In particular, the role these two symptoms play in moving from an acute to a chronic problem is investigated.
Physical therapists often treat patients with chronic symptoms of dizziness and vestibular dysfunction (unsteadiness). Understanding the transition from acute to chronic whiplash may help therapists find better ways to treat these problems, and possibly prevent the long-term symptoms that accompany chronic whiplash.
Postural control is the ability to stay upright and move through space easily and efficiently. Head and neck alignment, vision, and balance are all components of postural control. You may not realize it but something as simple as walking across a room while carrying an object requires the complete coordination of multiple systems.
Anything (e.g., whiplash injury) that affects postural control may contribute to the development of chronic symptoms (dizziness, blurred vision, unsteadiness or loss of balance). That makes sense but what is it about a whiplash (neck) injury that can explain postural disturbances?
Sensors called receptors in the head and neck communicate with the musculoskeletal system. Together these mechanisms signal the nervous system, vestibular system, and the visual systems. The postural control that allows you to walk, see where you are going, carry objects with you, and maintain upright posture are all tied in together.
There are also reflexes between the eyes, neck, and vestibular (inner ear) system that can be altered because of damage to the cervical spine. Any change in the sensory input from the neck muscles, tendons, and joints to the postural control system can result in the common symptoms of chronic whiplash. And until the effects on the postural control system are addressed, an unending cycle occurs and the symptoms remain.
This is where physical therapy comes in. If the therapist can alter the signals to and from the cervical spine (neck), it may be possible to do more than just manage symptoms but actually put an end to them. Restoring normal sensory function in the neck and resetting the postural control system may be possible. Research so far has focused on the role of exercise, acupuncture, and manual therapy to improve postural control.
The results have been encouraging. Pain is reduced, dizziness limited, the perception of neck disability is less, and visual gaze and eye-head coordination improved. It is thought that this treatment approach improves sensitivity of the deep muscle spindle and thus improves postural control. A muscle spindle is a small cluster of specialized muscle fibers within a muscle. Also called stretch receptors, they detect stretch (changes in the length) in the muscle.
Other treatment strategies aimed at restoring normal postural control after whiplash currently under investigation include acupuncture, acupressure, vestibular rehabilitation, coordination exercises, and spinal manipulation.
Results have been variable. Some of these treatment tools improve balance and dizziness but do not alter pain. Others seem better at reducing pain but without changing coordination. Various studies combining different programs together are still underway.
In conclusion, it appears that there are multiple reasons why some people experience chronic symptoms associated with a whiplash injury. Among those reasons is the role of damage to the cervical spine as it communicates with other systems (nervous system, vestibular system, musculoskeletal system).
The effect of damage to specific receptors in the neck on postural control shows up at first as dizziness and/or unsteadiness. The role of dizziness, unsteadiness, and postural control in developing chronic whiplash syndrome is pointed out in this article.
These symptoms are not just the end result of chronic whiplash but actually part of the reason why chronic whiplash develops in the first place. The presence of dizziness early on after whiplash injury may be an indicator of (poor) prognosis. And that brings us back to the importance of finding ways to intervene early after neck injuries resulting in whiplash in order to prevent the transition from acute to chronic status.
Julia Treleaven, PT, PhD. Dizziness, Unsteadiness, Visual Disturbances, and Postural Control. In Spine. December 1, 2011. Vol. 36. No. 25S. Pp. S211-S217.
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