1. Whiplash Associated Disorder

2. Normal Anatomy Vast amount of soft tissue within the cervical spine Facet joints surrounded by a capsule Large amount of muscles in the surrounding area

3. Pathology Variety of symptoms following an acceleration/deceleration injury to the neck Facet joints (articular surface and capsules) become inflamed and scar tissue develops. Protective spasm in the cervical muscles. Nerve roots may be compressed by swollen soft tissue (e.g Brachial plexus). Vertebral and Carotid Arteries and vertebral discs may become damaged due to compression. Fatty deposits in cervical extensors due to immobility

4. Mechanism of Injury Road traffic accident Fall Sporting injury Music concert

5. Classification Quebec Task Force (QTF) 0 – No complaint about neck pain. No physical signs I – Neck complaint of pain, stiffness or tenderness only. No physical signs II – Neck complaint. Musculoskeletal signs including Decreased ROM Point tenderness III – Neck complaint. Neurological signs including: Decreased or absent deep tendon reflexes Muscle weakness Sensory deficits IV – neck complaint and fracture or dislocation

6. Prognosis 50% will have ongoing symptoms for 1 year 25% will experience post traumatic stress disorder Factors showing prognostic indicators for poor recovery Initial pain levels >5.5/10 Initial disability levels: NDI > 29% Symptoms of post traumatic stress Negative expectations of recovery High pain catastrophizing Cold hyperalgesia

7. Subjective Examination Neck pain with referral Stiffness first thing in the morning Report restricted range of movement Cervicogenic Dizziness Headaches Paraesthesia Pain catastrophizing Post Traumatic Stress

8. Objective Examination Reduced and painful ipsilateral rotation Global restriction in range of movement Poor quality of movement Reduced joint play/ segmental mobility testing Muscle spasm Reduced proprioception Poor cervical extensor and scapular muscle strength

9. Further Investigation MRI

10. Management Very poor quality research Education and advice paramount Exercise interventions, manual therapy and other modalities show inconsistent results Future interventions will look at “Active Behavioural Physiotherapy Interventions”

11. Conservative Reassurance, pain education, return to normality ASAP Pain Relief NSAID’s, Ice or Heat, Massage Restore ROM – Cervical AND Thoracic Cervical Rotation, Extension, Thoracic Extension and Rotation Soft Tissue, Joint Mobilisations Restore Normal Muscle Activation Deep cervical flexors, Deep cervical Extensors, Scapular upward rotators and posterior tilt Restore Normal Dynamic Stability and Proprioception

12. Plan B - Management Only considered for neurological compromise Facet Injections rare due to high risk Fusion rarely completed