When you get it in the neck

head injury

19 March 2016

Ever heard of ‘railway spine’? In the 19th century, when trains were much lighter and slower  than they are now and crashes were relatively frequent, a particular type of neck pain was first described. Typically suffered by those facing away from the impact when a crash occurred, sufferers often showed no obvious evidence of injury, and rail road operators dismissed the claims as fake.

The name ‘railway spine’ has long since been consigned to irrelevance, but the condition remains both as an injury and as a source of controversy in medical and insurance circles: Whiplash.

Whiplash injuries are typically the result of a sudden, unexpected extension of the neck, such as occurs in car accidents, although other potential causes include assaults and falls, even bungee jumping. The most common presentation in terms of car accidents is when a driver or passenger in a car has been rear-ended, resulting in a sudden backwards then forwards whip-like motion of the head.

It is estimated that in Ireland, 80 percent of injury-based insurance claims following road accidents are for whiplash injuries, and insurance companies are quick to blame recent price hikes on the cost of paying out such claims. Whilst this isn’t the forum for a rant against insurance companies, it should be mentioned that a former Chair of the Injuries Board noted last year that there was a €1 billion difference in the amount paid in to insurers and the amount paid out in claims.

The Quebec Task Force, established in 1995 to classify and recommend treatment for Whiplash Associated Disorders, grades injuries from 0 to 4, based on severity of symptoms and associated physical signs. Patients who present for physiotherapy fit into grade 1, where there is some pain, stiffness or tenderness to touch but no physical signs; grade 2, where there is restricted range of movement and local tenderness in the neck; and grade 3, where there are also neurological signs present. A big problem, and part of the reason it is easy for insurance companies to demonise those making claims, is that there are no defined radiological signs of whiplash injuries. In other words, X-rays and MRIs can’t confirm or exclude whiplash as a diagnosis. Whiplash injuries are notoriously difficult to treat, partly because there is no definite structural injury. In the early stages, the best thing is to keep moving as much as is possible, and to seek assessment from your GP for pain relief and your chartered physiotherapist, who will be able to provide treatment, advice and education in terms of how best to manage your symptoms day to day. Treatment options include massage, mobilisation, acupuncture and a specific, guided exercise programme to improve range of movement and neck strength.

Another significant problem associated with whiplash injuries, adding to the battle between insurers, medics and patients, is that an accurate prognosis or recovery time is almost impossible to predict.

The accepted wisdom at present is that one-third of patients will recover within six months and one-third within 18-24 months, with the remaining one-third having ongoing problems beyond two years, but it is difficult to know from the outset who is likely to fit into each group. What is known is that anyone with associated psychological problems is unlikely to recover until such issues are addressed. Even relatively minor accidents can result in an element of post-traumatic stress, and it is important to inform your doctor or physiotherapist if you have flashbacks or are afraid to get back in a car after an accident so that the appropriate help can be sought.

If you are unfortunate enough to be involved in a car- or indeed train- accident and develop neck pain afterwards, you should attend your GP initially for pain relief and referral for an X-ray if necessary, then seek an appointment with a chartered physiotherapist for assessment and treatment, and remember to keep moving as much as you can tolerate

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