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The What And Why Of Whiplash

Mr David will forever be reminded of the car accident he suffered a week before his wedding two years ago. His wedding photographs show him wearing the soft collar doctors had prescribed to help him recover from whiplash, after his car collided with a van. The 27-year-old Cisco officer says: "I felt okay immediately after the accident, but when I got home I felt dizzy and numb." His parents took him to hospital.

Dr Ronald, a consultant at the hospital's department of orthopaedic surgery, says such a reaction is typical in whiplash injuries - the victim may not feel the pain immediately. Typically, after an accident, the motorist first thinks about his car. "The adrenaline starts to flow, because of anger or anxiety... They don't feel the pain at that moment because there is a preoccupation with a lot of other things: 'How am I going to get my car fixed?

Will insurance cover this accident?' and so on." Hours later or the next day, the victim is expected to show signs of whiplash injury. A clinical examination follows, and X-rays are taken to make sure there is no bone injury. But whiplash itself does not show up in X-rays because it is a soft-tissue injury.

The soft tissue that gets damaged is usually in the neck, from a sudden "whipping" of the head as a result of a car collision. It can also be caused by violent impact in a contact sport. "Unfortunately, the result of this whiplash mechanism can give rise to a lot of problems," says Dr Ronald. "And it's not just neck or spine pain. It can be a lot of things -numbness in the hands, blurred vision headaches, memory loss, difficulty in concentrating because of the numbness or pain."

Dr Paul, consultant orthopaedic surgeon, says: "The definition of whiplash is essentially injury to the neck as a result of a forcible movement in any direction." For example, Dr Paul has a friend who was sitting in a plane when a piece of luggage fell out and hit him on the neck. He had whiplash as a result. The term is still most commonly associated with road traffic accidents, and Dr Paul says these are probably the most common type of injury his department sees.

Whiplash can involve sections of the spinal cord, which will result in numbness or weakness in the upper and lower limbs. In more severe forms, there could be spinal cord injury and the worst-case scenario would be complete paralysis. Mr David had to wear a soft collar and go for physiotherapy twice a week. He stayed active throughout, which he thinks helped him heal. It took him a year to recover fully.

Dr Ronald says the soft collar does not cause much restriction in neck movement 20 per cent at most. And it is a useful reminder that you have an injury and you should not move about much. But you should not give up all activity, he adds. He says: "There are studies to show that immobilisation may be detrimental to you and the patient should start moving the neck."

The inflammation from the injury should be allowed to settle down before the patient starts on physiotherapy. One could apply ice in the first 48 hours and try muscle relaxants or analgesic painkillers, says Dr Ronald, and take a couple of days off work. It can take one and a half months to 1 and a half years to recover from whiplash. Recovery varies from person to person, say orthopaedic surgeons.

It depends on factors such as the level of activity and the amount of time the patient has for physiotherapy or acupuncture. "If a patient doesn't do one or the other, he may take longer to recover," says Dr Ronald. "And not all symptoms maybe resolved, so patients with whiplash may experience persistence of their symptoms, which become chronic," says Dr Paul.

When symptoms persist longer than six months, they are said to be chronic. They could bug you for the rest of your life problems such as persistent neck pain, neck pain with headaches, or pain and numbness in the limbs. Dr Paul believes that patients who are more active and who have stronger neck muscles will have fewer whiplash problems.

He encourages them to go on an exercise programme as long as it does not hurt too much. Swimming is excellent for all spinal injuries. Those who cannot swim, can try running instead but slowly and on a gentle slope. If it hurts, they must regulate their exercise. There are no real preventive measures you can take against whiplash, according to Dr Ronald and Dr Paul.

Seat belts do provide some protection, but as the belt does not cover the neck completely, there will still be whiplash if the car is involved in a collision. The only way to minimise the risk of whiplash is to drive carefully and even then, you cannot control how other people drive. Mr David says: "After having a head-on collision, I'm now wary about driving, even though I do it every day."


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