WORKING WITH WHIPLASH

AMT FORUM POST- WHIPLASH
© Colin Rossie 2007. Not to be printed or used without permission of the copyright holder.

Whiplash/ acceleration- deceleration injury has in turn acute, sub acute and chronic stages. Then there is WAD (Whiplash Associated Disorder), a long-term effect of severe, poorly or untreated whiplash.

In the acute phase (first few days post injury), if a client comes to see you then send them to their doctor to take care of them, do x-rays, ultasounds, scans etc.

In sub acute cases (3-14 days), only proceed if they have been seen by their doctor and have permission to receive manual treatment (i.e any swelling has abated and there have been radiological tests done.) At this stage, appropriate techniques for neck work may include: Strain/ counter strain or orthobionomy type work, lymphatic drainage, gentle PROM and possibly (as pain and swelling starts to subside) the gentle, Barnes style MFR. On other, non-cervical and non-cranial structures more robust work can be done, such as trigger point, MET and direct myofascial techniques. This can help relieve satellite and distal pain resulting from the injury.

In chronic whiplash, in addition to the above techniques mentioned for the neck, MET, trigger points and direct myofascial techniques can be added. Cranio- sacral techniques can be used at this stage as well. Special attention should be paid to the sub occipitals, especially Rectus Capitus Posterior major and minor. Often, Rectus Capitus Posterior minor is especially indicated: it partly attaches to the dura mater and this attachment is often partially torn in whiplash injuries. The nuchal ligament can also be torn.

Cross fibre frictions and deep tissue work for any local adhesions that result from the injury can be commenced after the 6-week phase.

Don't forget to start appropriate strengthening as part of rehabilitation. Also consider movement education, such as Feldenkrais or Rolf Movement, to retrain and enhance proprioception and co-ordination. There is always the possibility of autonomic involvement in whiplash, so these can also help with this.

Commonly affected structures to consider other than the sub occipitals include the longus colli, semispinalis, spinalis cap & cervicus, SCM, scalenes, infrahyoids, omohyoid, platysma, pec minor & subclavius myofascia and tendons. Also consider the major fascial sheaths in the neck (especially the pre vertebral), which also receive a lot of damage in whiplash. Facet joints are also often affected.

Remember that many neck muscles have insertions in the thoracic region, so working distally from the focus of the pain is also highly effective. Immediately I'm thinking of head & neck muscles with attachments on the scapulae, ribs and thoracic spine, but given the fascial and neural connections one should also consider the sacrum and on into connections in the lower limb. Interestingly, many clients with whiplash mention effects in the sacrum and pain radiating into the legs & feet! (Hardly surprising if one considers the RCP minor attachment to the dura mater being damaged in whiplash and the effect of this into the cauda equina and beyond.)

Any pre existing osseous conditions can be exacerbated by whiplash and become a source of further irritation. Gentle mobilisation of the cervical vertebrae should be included in any long-term treatment plan (assuming you are qualified to do these). In the acute and subacute phases don't do any mobilisations or craniosacral techniques such as CV4 or a cranial base release. These are great in the chronic phase but not in the acute or subacute phases.

Colin Rossie
Dip. Health Sc. (Massage Therapy)
Certified Rolfer™
Rolf Movement Practitioner