Whiplash Injuries: Chapter 2 - Symptoms, Diagnosis, WAD Criterion
- Dr. Brian Abelson
- May 22, 2023
- 8 min read
Updated: Aug 15, 2024
Welcome to Chapter 2 of our whiplash guide, where we dive into the complexities of this often misunderstood injury. In this chapter, we’ll explore the wide range of whiplash symptoms and provide practical insights into conducting a thorough physical examination.
We’ll also introduce the WAD classification system, a key tool used by healthcare professionals to gauge the severity of whiplash-associated disorders. Our goal is to equip you with a clear understanding of the symptoms and diagnostic methods for whiplash, helping you better grasp the impact of this injury on the body.
Article Index
Identifying Symptoms of Whiplash Injury
Whiplash symptoms can affect various parts of the body and may not appear immediately, sometimes surfacing weeks after the incident. Commonly reported symptoms include:
Neck pain: The most prevalent complaint.
Headaches: Affecting 50%-75% of individuals, often starting at the base of the skull.
Jaw pain: Temporomandibular Dysfunction (TMJ) is a frequent consequence of car accidents.
Facial pain: Can be direct or referred from other areas.
Shoulder pain: Often mistaken for a rotator cuff injury.
Pain between shoulder blades: Known as inter-scapular pain.
Arm pain: May involve muscles, tendons, ligaments, or result from nerve compression.
Additional Whiplash Symptoms
Paresthesia: Abnormal sensations in the neck, shoulders, upper back, and arms, affecting 33%-100% of patients.
Balance issues: Often related to the upper cervical spine.
Sleep disturbances: Experienced by 39%-89% of patients.
Dizziness: Commonly associated with the upper cervical region, occurring in up to 70% of those with chronic symptoms.
Fatigue: Can be severe in some cases.
Lower back pain: A frequent symptom in whiplash cases.
Concentration and memory issues: Potentially linked to a concussion sustained during the accident.
Psychological changes: Including depression and anxiety.
Tinnitus: Perception of ringing or buzzing in the ears.
Visual disturbances: Such as sensitivity to light.
Weakness: Reported in 80%-90% of patients, typically affecting the neck or upper extremities.
Physical Examination
Conducting a thorough physical examination after an automobile accident is not just recommended—it's essential. Delaying this assessment could significantly affect the injury's recovery process and impact any potential legal claims. A comprehensive evaluation should cover orthopedic, neurological, vascular, and concussion assessments, each playing a critical role in accurately diagnosing the injury and planning the recovery path.
To enhance your understanding, we’ve included video demonstrations for each assessment category, highlighting their importance in post-accident evaluations. These evaluations are crucial—they serve as the foundation for effective medical intervention following a car accident.
Orthopaedic Assessment
Cervical Examination
This video offers an in-depth guide to examining Whiplash Associated Disorder (WAD) injuries, focusing on the cervical region. It covers the entire process, including inspection and observation, palpation techniques, assessing active and passive ranges of motion, and performing an orthopedic examination. These steps are crucial for accurately diagnosing and managing WAD injuries.
Neurological Assessment
Cranial Nerve Examination
The Cranial Nerve examination is a key tool in assessing sensory and motor dysfunction related to Whiplash Associated Disorder (WAD) injuries. This examination is routinely performed on all new patients to identify any neurological impairments resulting from the injury.
Upper Limb Neuro Exam
The upper limb neurological examination is an essential component of assessing Whiplash Associated Disorder (WAD) injuries. It evaluates the motor and sensory neurons supplying the upper limbs, helping to detect any nervous system impairments. This assessment serves both as a screening and investigative tool to identify potential nerve damage related to WAD injuries.
Vascular Assessment
Peripheral Vascular Examination
A peripheral vascular examination is vital in the context of Whiplash Associated Disorder (WAD) injuries to identify any signs of vascular-related complications that could arise from the trauma. Detecting and addressing these issues early can help prevent serious cardiovascular and cerebrovascular complications. This video outlines the routine procedures we incorporate into our clinical practice to ensure comprehensive care for WAD patients.
Concussion Assessment
Assessing for concussions is crucial in the context of Whiplash Associated Disorder (WAD) injuries, as the forces involved in a whiplash event can also impact the brain. Proper concussion assessment is essential to identify potential neurological impairments that may not be immediately apparent but could significantly affect recovery. By conducting these tests, such as the Vestibular Ocular Motor Screening (VOMS), HINTS Exam, and Dix-Hallpike Maneuver, healthcare professionals can detect subtle signs of a concussion, ensuring comprehensive care and guiding appropriate treatment strategies for those affected by WAD.
VOMS
VOMS, or Vestibular Ocular Motor Screening, is a method specifically formulated to identify indicators of a concussion, whether from sports, impact tests, or general concussions. It investigates the coordination of balance, vision, and movement systems. VOMS examines five distinct domains of vestibular (balance) and ocular (vision) motor impairment.
HINTS Exam
The HINTS Exam serves as a diagnostic tool to distinguish benign peripheral disorders from central nervous system conditions, such as strokes. HINTS is an acronym for Head Impulse-Nystagmus-Test of Skew. The 'Head Impulse' component involves testing the function of the vestibulo-ocular reflex. A normal result on this test (HIT) strongly suggests that the cause of Acute Vestibular Syndrome is situated within the central nervous system.
Dix HallPike Maneuver - Vertigo
BPPV (Benign Paroxysmal Positional Vertigo) is among the leading causes of vertigo, characterized by a sudden feeling of spinning or the internal sensation of the head spinning. While BPPV vertigo can cause significant discomfort, it seldom poses a serious threat unless it heightens the risk of falls. This video will walk you through the Dix Hallpike maneuver, a fundamental step in diagnosing vertigo (BPPV).
Diagnostic Imaging
Diagnostic imaging is essential for assessing soft-tissue damage and ruling out fractures after a whiplash injury. Various imaging techniques may be used depending on the case:
Radiographs (X-rays): Often the first choice for quickly detecting fractures or dislocations, though limited in assessing soft tissue injuries.
Computed Tomography (CT): Offers detailed, multiplanar views of bones and some soft tissues, useful when fractures are suspected but not confirmed by X-rays. However, CT involves higher radiation exposure.
Ultrasound Imaging: A safe, non-invasive method for visualizing soft tissues and real-time body movements without radiation exposure.
Magnetic Resonance Imaging (MRI): Provides superior soft tissue visualization, ideal for detecting damage to muscles, ligaments, and discs, though it’s more costly and time-consuming.
While imaging is crucial, it’s important to note that for Grade 1 and Grade 2 Whiplash Associated Disorders (WAD), CT scans and MRIs are generally not recommended. Any signs of fracture or dislocation warrant immediate referral to an emergency department for further evaluation.
Grading of Whiplash Associated Disorders (WAD)
The grading of Whiplash Associated Disorders (WAD) is based on criteria established by the Quebec Task Force, widely accepted in the insurance industry. This system plays a crucial role in determining the extent of coverage for individuals suffering from whiplash injuries and guides healthcare providers in diagnosing and treating these injuries.
The Quebec Task Force's grading system categorizes the severity of whiplash injuries, from no symptoms to significant physical trauma. This classification not only helps quantify the injury for insurance purposes but also informs the clinical approach, allowing for personalized treatment plans.
The WAD grading system includes:
Grade 0: No symptoms or physical signs of neck injury. The individual experiences no discomfort, stiffness, or unease, and physical examination shows no evidence of injury.
Grade 1: The person reports neck discomfort, stiffness, or sensitivity but exhibits no physical signs of trauma during examination.
Grade 2: In addition to neck pain, there are musculoskeletal signs such as reduced range of motion and point tenderness, where pain is felt upon touch or pressure.
Grade 3: Neck pain is accompanied by neurological signs, including reduced deep tendon reflexes, muscle weakness, and sensory deficits like numbness or tingling.
Grade 4: The most severe grade, where neck pain is accompanied by evidence of a fracture or dislocation, indicating significant structural damage that requires immediate medical attention.
This classification is essential for insurance assessments and for guiding treatment. Understanding the WAD grade allows healthcare providers to create a tailored treatment plan that effectively addresses the patient's specific symptoms and injuries.
Chapter 2: Conclusion
In Chapter 2, we explored the complexities of Whiplash Associated Disorders (WAD), focusing on the diverse symptoms, essential diagnostic processes, and the critical role of grading in managing these injuries. Understanding the wide range of potential symptoms—from neck pain and headaches to neurological deficits and balance issues—is key to ensuring comprehensive care. The WAD classification system, established by the Quebec Task Force, is instrumental in guiding both clinical management and insurance considerations. This system helps healthcare providers tailor treatment plans that address each patient's specific needs, ensuring that the severity of the injury is properly recognized and managed.
Building on this foundation, Chapter 3 will cover the treatment options and exercise programs crucial for recovering from WAD. We will provide practical guidance on therapeutic interventions, from manual therapy and pain management to targeted exercises that help restore strength, flexibility, and function. A personalized approach to treatment, informed by the WAD grading system, can significantly improve recovery outcomes and support long-term healing. Stay tuned for detailed strategies that will empower you to take control of your recovery journey.
Note: References at to be found in Chapter 3
Disclaimer:
The content on the MSR website, including articles and embedded videos, serves educational and informational purposes only. It is not a substitute for professional medical advice; only certified MSR practitioners should practice these techniques. By accessing this content, you assume full responsibility for your use of the information, acknowledging that the authors and contributors are not liable for any damages or claims that may arise.
This website does not establish a physician-patient relationship. If you have a medical concern, consult an appropriately licensed healthcare provider. Users under the age of 18 are not permitted to use the site. The MSR website may also feature links to third-party sites; however, we bear no responsibility for the content or practices of these external websites.
By using the MSR website, you agree to indemnify and hold the authors and contributors harmless from any claims, including legal fees, arising from your use of the site or violating these terms. This disclaimer constitutes part of the understanding between you and the website's authors regarding the use of the MSR website. For more information, read the full disclaimer and policies in this website.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson is dedicated to using evidence-based practices to improve musculoskeletal health. At Kinetic Health in Calgary, Alberta, he combines the latest research with a compassionate, patient-focused approach. As the creator of the Motion Specific Release (MSR) Treatment Systems, he aims to educate and share techniques to benefit the broader healthcare community. His work continually emphasizes patient-centred care and advancing treatment methods.
Join Us at Motion Specific Release
Enroll in our courses to master innovative soft-tissue and osseous techniques that seamlessly fit into your current clinical practice, providing your patients with substantial relief from pain and a renewed sense of functionality. Our curriculum masterfully integrates rigorous medical science with creative therapeutic paradigms, comprehensively understanding musculoskeletal diagnosis and treatment protocols.
Join MSR Pro and start tapping into the power of Motion Specific Release. Have access to:
Protocols: Over 250 clinical procedures with detailed video productions.
Examination Procedures: Over 70 orthopedic and neurological assessment videos and downloadable PDF examination forms for use in your clinical practice are coming soon.
Exercises: You can prescribe hundreds of Functional Exercises Videos to your patients through our downloadable prescription pads.
Article Library: Our Article Index Library with over 45+ of the most common MSK conditions we all see in clinical practice. This is a great opportunity to educate your patients on our processes. Each article covers basic condition information, diagnostic procedures, treatment methodologies, timelines, and exercise recommendations. All of this is in an easy-to-prescribe PDF format you can directly send to your patients.
Discounts: MSR Pro yearly memberships entitle you to a significant discount on our online and live courses.
Integrating MSR into your practice can significantly enhance your clinical practice. The benefits we mentioned are only a few reasons for joining our MSR team.
Comments