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Decoding Whiplash: Chapter 2 - Symptoms, Diagnosis, WAD Criterion

Updated: Dec 5, 2023


Welcome to chapter 2 of our comprehensive guide on whiplash, a common yet often misunderstood injury. Our focus in this chapter revolves around the complexity and variety of whiplash symptoms. We will also dive into the practicalities of a physical examination, offering insights into how professionals assess the impact of such an injury.


Moreover, we introduce the WAD classification system, a pivotal tool healthcare practitioners use to categorize the severity of whiplash-associated disorders. By traversing this educational expedition, we aim to equip you with a robust understanding of the myriad symptoms and diagnosis methods related to whiplash, enabling you to comprehend better the effects of this injury on the human body.


Article Index

 

Identifying Symptoms of Whiplash Injury


Symptoms of a whiplash injury can impact various body regions and may not appear immediately, possibly emerging weeks after the incident. The most commonly reported symptoms following a whiplash event include:

  • Neck pain: The most common complaint.

  • Headaches: Experienced by 50%-75% of individuals, usually originating at the skull's base.

  • Jaw pain: Temporomandibular Dysfunction (TMJ) is a frequent issue after car accidents.

  • Facial pain: This could be direct or referred facial pain.

  • Shoulder pain: Often mistaken as a rotator cuff injury.

  • Pain between shoulder blades: Also known as inter-scapular pain.

  • Arm pain: Can involve muscles, tendons, and ligaments or result from nerve compression.


Additional Whiplash Symptoms


  • Paresthesia: Abnormal sensations in the neck, shoulders, upper back, and arms, experienced by 33%-100% of patients.

  • Balance issues: Often linked to the upper cervical area. • Sleep disturbances: Reported by 39%-89% of patients.

  • Dizziness: Often tied to the upper cervical area, prevalent in up to 70% of patients with chronic symptoms.

  • Fatigue: Can be severe in some cases.

  • Lower back pain: A frequent complaint in whiplash cases.

  • Concentration and memory issues: Possibly resulting from a concussion sustained during the accident. • Psychological changes: Such as depression and anxiety.

  • Tinnitus: Perception of noises (e.g., ringing or buzzing) in the ears. • Visual disturbances: Such as light sensitivity.

  • Weakness: Reported in 80%-90% of patients post-whiplash, typically in the neck or upper extremities.


 

Physical Examination


Implementing a detailed physical examination after an automobile accident is not just recommended but vital. Postponing such an assessment could have profound consequences, impacting not only the trajectory of the injury recovery but also influencing any legal claims, if necessary. This comprehensive evaluation should involve various domains, including orthopedic, neurological, vascular, and concussion assessments. Each element is pivotal in accurately diagnosing and mapping out a recovery path.


We have provided video demonstrations for each category to understand these assessments, illustrating their significance in post-accident examinations. The importance of these evaluations cannot be overstated—they form the backbone of effective medical intervention following an automotive mishap."



Orthopaedic Assessment


Cervical Examination

This video provides a detailed walkthrough of the examination process, including inspection and observation, palpation techniques, assessment of active and passive ranges of motion, and an orthopaedic examination focusing on the cervical region.



Neurological Assessment


Cranial Nerve Examination

The Cranial Nerve examination is one of the ways that we assess sensory and motor dysfunction. We commonly perform this examination on all new patients.



Upper Limb Neuro Exam

The upper limb neurological examination is part of the overall neurological examination process and is used to assess the motor and sensory neurons which supply the upper limbs. This assessment helps to detect any impairment of the nervous system. It is used both as a screening and an investigative tool.



Vascular Assessment


Key Elements of Peripheral Vascular

Examination A peripheral vascular examination is crucial in identifying indications of vascular-related disorders. Recognizing and treating Peripheral Vascular Disease (PVD) can help prevent cardiovascular and cerebrovascular health complications. This video highlights routine procedures we incorporate into our everyday clinical practice.


 

Concussion Assessment


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


The importance of diagnostic imaging in evaluating soft-tissue damage severity and excluding potential fractures subsequent to whiplash trauma cannot be understated. Depending on the particulars of the case, an array of imaging modalities may be employed, including radiographs (X-rays), Computed Tomography (CT), ultrasound imaging, and Magnetic Resonance Imaging (MRI).


  • Radiographs: Radiographs, typically the initial imaging modality employed due to their rapidity and efficacy in detecting skeletal fractures or dislocations, have limited utility in visualizing soft tissue injuries.

  • Computed Tomography (CT): CT scans, providing a more detailed, multiplanar representation than radiographs, can better visualize osseous structures and, to some extent, soft tissues. They are particularly beneficial when fractures are suspected but are not definitively visualized on radiographs. However, they do necessitate higher ionizing radiation exposure to the patient.

  • Ultrasound Imaging: Ultrasound imaging provides a safe, non-ionizing, non-invasive modality to assess soft tissue injuries. Utilizing high-frequency sound waves, it can visualize the real-time movement of the body's internal structures and hemodynamics within vessels.

  • Magnetic Resonance Imaging (MRI): MRI scans, offering superior visualization of soft tissues, are crucial in identifying damage to musculature, ligaments, and intervertebral discs. However, they entail higher costs and longer imaging duration compared to other modalities.


While the indispensability of diagnostic imaging is acknowledged, it's important to understand that for Grade 1 and Grade 2 Whiplash Associated Disorders (WAD), CT scans and MRIs are usually not indicated.


Remember, any clinical or imaging signs of fracture or dislocation necessitate an immediate referral to an emergency medical department for further assessment and management.


 


Grading of Whiplash Associated Disorders (WAD)


The categorization of Whiplash Associated Disorders (WAD) follows a specific set of criteria established by the Quebec Task Force. This system, which has gained widespread acceptance and usage in the insurance industry, plays a significant role in determining the degree of coverage provided to an individual suffering from a whiplash injury.


The Quebec Task Force's grading system delineates the nature and severity of whiplash injuries, thus facilitating the diagnostic process and helping health professionals navigate the complexities of whiplash injuries. Each grade represents a distinct level of injury severity, ranging from no apparent symptoms to profound, demonstrable physical signs of trauma. This classification system has a two-fold significance. Firstly, it assists in quantifying the degree of injury, which is integral to insurance companies when assessing coverage eligibility and compensation. Secondly, it informs the course of clinical management, guiding healthcare providers in tailoring appropriate therapeutic interventions.


The grading system for WAD is as follows:

  • Grade 0: This grade signifies an absence of symptoms or physical signs pertaining to the neck. Essentially, the individual neither experiences nor reports any discomfort, stiffness, or form of unease in the neck, and there are no detectable physical signs of injury upon examination.

  • Grade 1: Here, the individual experiences and reports neck discomfort, stiffness, or sensitivity but without any physical signs of trauma. While the individual may verbalize discomfort or pain, the physical examination does not uncover any concrete indications of injury or trauma.

  • Grade 2: This grade denotes the presence of musculoskeletal signs in addition to complaints of neck pain. These signs may encompass a reduced range of motion in the neck - a common aftermath of whiplash injury - and point tenderness, a localized, acute pain that surfaces upon touch or applying pressure.

  • Grade 3: At this level, the individual experiences neck discomfort and exhibits neurological signs. These signs may include diminished or absent deep tendon reflexes, muscle weakness, and a variety of sensory deficits, such as numbness or tingling in certain areas.

  • Grade 4: This is the most severe grade of WAD, characterized by complaints of neck pain accompanied by evidence of a fracture or dislocation. This grade implies that the whiplash injury has resulted in considerable structural damage in the neck, necessitating immediate and potentially intensive medical intervention.


The classification system detailed above is instrumental for insurance considerations and shaping the therapeutic approach and prognosis. Understanding the WAD grade enables healthcare providers to design a personalized treatment plan that effectively addresses the patient's specific symptoms and injuries.


 

Conclusion


This chapter delves into the intricate nature of whiplash injuries, shedding light on the diverse symptoms and the importance of a comprehensive physical examination for accurate diagnosis. The Whiplash Associated Disorders (WAD) classification by the Quebec Task Force aids in understanding the severity of these injuries, impacting both insurance assessments and clinical management. The provided videos elucidate assessment techniques, while the segment on diagnostic imaging highlights the role of various modalities in identifying injuries, guiding subsequent treatment plans. The grading of WAD helps in tailoring personalized treatment regimens, underscoring the importance of a well-rounded approach to managing whiplash injuries, aiming to improve the quality of life of affected individuals.





Note: References at to be found in Chapter 3

 

DR. BRIAN ABELSON DC. - The Author


Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.

 


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