Whiplash Associated Disorder (WAD)

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1 Information for patients Whiplash Associated Disorder (WAD) Physiotherapy Department Tel: DPS ref: (RP) Issue 3: December 2014 Review date: November 2017 The Ipswich Hospital NHS Trust, All rights reserved. Not to be reproduced in whole, or in part, without the permission of the copyright owner.

2 What is whiplash associated disorder (WAD)? Whiplash is an injury which involves a sudden accelerationdeceleration movement of the neck. This can occur as the result of a rear end or side impact motor vehicle collision, fall or sporting injury. It involves trauma to multiple tissues within the neck region. It can result in neck, head, shoulder and arm discomfort or stiffness. Some people also report headaches after the injury. How long will it take me to recovery? Recovery time can vary depending on the symptoms you have after the initial injury. However following a WAD you are very likely to recover. Between 82% and 94% of people will make a full recovery following a whiplash within two years. What will help me to recover well? Continuing with work, hobbies and everyday activities. Positive attitudes and beliefs are helpful in regaining activity. Good pain control with regular medication. Physiotherapy. An exercise programme for pain reduction. This can be started within four days of injury. Changing position frequently. Maintaining a good posture. Sleeping positions Getting your neck in a good position to sleep is very important as you will spend quite long periods without moving your neck. If you have a painful or stiff neck when you wake in the morning, keeping your neck in a fairly neutral position may be most comfortable for you. Fill the space between your head and shoulder with a pillow or support. Try to keep your neck straight when you sleep on your side. Try not to have too many pillows under your head if you sleep on your back. If your chin rests on your chest try reducing your pillow height. There is no right pillow. Try several until you find one that works for you. Avoid sleeping on your front. When you travel, take your own pillow. You can adjust the height of your pillow slightly by having a folded towel under your pillow. Pillow options to try 1 Roll up a small towel or tea towel lengthways. Slide this inside your pillowcase so that when you lie on the pillow the roll rests in the space between your head and shoulder where your neck is slimmest. 2 Place two pillows in an upside-down V shape. Lie on your side with your head on the two layers of pillow and your shoulder resting in the gap, directly onto the mattress. 3 Tie or twist your pillow in the middle to make a butterfly shape. Rest your head on the middle of the pillow where it is narrowest. 4 For arm pain you may find having a pillow to support underneath your shoulder and arm helpful. Is a collar helpful? Current evidence shows that using a collar can delay your recovery and cause long-term pain. If your head feels heavy you can manage your symptoms by sitting with your head supported on the back of a chair or cushion. Alternatively you could rest lying down. However you should limit this time to minutes and combine this with some gentle exercises (see later in this booklet). Page 2 Page 3

3 Why is good posture important? Good posture enables the weight of your head to be supported by the structures within the spine which are designed for that purpose. Poor posture causes other structures to compensate. This can cause muscle tension, stiffness and pain. When lifting or bending forwards, gently tuck your chin in before beginning the movement. Correct posture when sitting Your shoulders should be relaxed. Gently lift your breastbone to bring your shoulder blades together. Your head should be supported by your spine. Your chin should be gently tucked in to lengthen the back of your neck. This should be fairly easy to maintain and not cause you to strain. What medication could help me? Regular pain relief is important to maximise comfort and allow you to continue with your normal everyday activities. Regular use of paracetamol in the first instance, particularly during the initial stage after injury when natural recovery is expected, will help to manage your pain. Progression to regular use of anti-inflammatories (NSAIDs) when paracetamol alone is inadequate and where there are no contraindications. If you have had an anti-inflammatory recommended this should start to ease your pain and help with your movement. If your pain is not well managed it may be necessary to use stronger pain relief. Your GP or pharmacist will be able to advise you about the appropriate medication for you. Should I use ice or heat? Ice should be used for the first 48 hours. This will help to reduce inflammation and swelling, therefore reducing pain and promoting healing. A bag of frozen peas or crushed ice cubes wrapped in a damp tea towel works well. You can also use a wheat bag which has been left in the freezer for a few hours. Rest with your head supported and leave the ice pack on for minutes. Heat can be used after 48 hours and is effective for relaxing muscle spasms. You can use a hot water bottle wrapped in a towel or a wheat bag warmed in the microwave. (Do not place a towel around the wheat bag once heated. Place layers of towel onto your neck and place the wheat bag on top). You should feel no more than gentle warmth. Leave the heat pack on for minutes. Please note any prolonged use of ice or heat can cause a burn so avoid using for longer than stated. You should not use ice or heat if you have a compromised circulatory system. What good advice should I follow to help me carry on with my normal activities? Avoid sudden movements. Neck muscles will tense due to the startle reflex which may cause discomfort. Avoid carrying heavy bags divide small amounts of shopping into more bags to spread the load. When watching television or using a computer try to sit facing the screen so your head is not turned for prolonged periods. Change your position frequently. When you read or write, prop material up in front of you so it slopes towards you to maintain your neck in a neutral position. What exercises should I do to aid my recovery? Exercising little and often will help to reduce pain and help your recovery. Exercising within four days is recommended following a WAD. Flexibility and strengthening exercises are important in aiding recovery. Page 4 Page 5

4 Group exercises have been shown to improve function. At Ipswich Hospital we run a neck exercise class which your physiotherapist may recommend for your recovery. Repeat times for each exercise, times through the day. Exercises These exercises should be done little and often throughout the day. They may cause you to feel a stretch but should not increase your pain for prolonged periods. When you are comfortably able to sit up to do your exercises, start by correcting your posture. Over the next few days following your injury, you may find exercises more comfortable lying down with your head supported on your pillow. You may also find these very useful if your neck is stiff when you wake in the morning. Repeat exercises 1, 2 and 3 (below) until the stiffness eases. 1 Turn your head gently from side to side. 1 4 Take your chin down towards your chest. 5 Tip your head up towards the ceiling. (Do not do this if it makes you feel dizzy.) 6 Turn your head to look over your left 7 Turn your head to look over your right 8 Tip your left ear down to your left 6 / Keep your head relaxed on the pillow. Place your tongue on the roof of your mouth. Gently nod your chin down (about 1 2 cm) so you make the back of your neck slightly longer. Hold for 10 seconds. Repeat 10 times. 3 Gently lower your shoulders down towards the bed as far as is comfortable. Hold for 10 seconds. Repeat 10 times Tip your right ear down to your right 10 Gently shrug your shoulders up and down. 11 Sit on a chair in an upright position and turn to the left and right with your arms folded at waist height. 11 Page 6 Page 7

5 Produced by: The Ipswich Hospital NHS Trust Heath Road, Ipswich, Suffolk IP4 5PD Hospital switchboard:

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