Whiplash Associated Disorders (WAD)
Whiplash Associated Disorders (WADs) is a term used to describe the symptoms resulting from whiplash. WAD can either be acute (0-12 weeks post-accident) or chronic (12 weeks post-accident); the severity of which is graded on the Quebec Task Force Classification from 0 to 4.
- Grade 0 – No neck pain or discomfort. No physical signs of injury.
- Grade 1 – Neck pain, stiffness or tenderness only. No physical sign(s) of injury.
- Grade 2 – Neck pain, stiffness or tenderness and some physical signs of injury, such as reduced range of movement and point tenderness
- Grade 3 – Neck pain, stiffness or tenderness and neurological signs of injury, such as weakness or changes to reflexes.
- Grade 4 – Neck pain and fracture or dislocation.
WADs are neck injuries usually occurring due to a motor vehicle accident (MVA) but can be the result of any impact that causes the head to jerk back-and-forward, e.g. contact sports such as football.
- Neck pain and stiffness
- Decreased range of motion
- Shoulder pain
According to clinical guidelines from the National Health and Medical Research Council:
- 44% of patients have recovered 1 month post injury
- 65% of patients have recovered 12 months post injury
- 75% of patients have recovered 5 years post-injury
- Approximately 25% of patients with whiplash progress to chronic symptoms
Factors associated with poorer outcomes (slower or less complete recovery):
Psychological factors such as:
- passive coping style
- depressed mood
- fear of movement
Current evidence indicates that the most beneficial treatment is exercise and remaining active. Exercise prescription typically includes range of motion and strengthening; specifically targeting neck and scapular muscles (WAD guidelines 2014).
It is important to advise patients to act as usual and avoid voluntary restricting neck movements. There is no current evidence supporting benefits from immobilisation techniques (including the use of neck bracing and collars in most cases) as these may delay recovery. If a collar is prescribed for WAD, it should not be used for greater than 48hours. (NHMRC 2008)
Other treatments may be used in conjunction with exercise when there is ongoing evidence of benefit. These include:
- Simple analgesics-short term use
- Heat and ice
- TENS, electrical stimulation, ultrasound
Treatment is similar to that of acute whiplash, promoting an active component of rehabilitation. Cognitive behavioural approaches and passive joint mobilisation have been proven effective and should be combined with an active component of rehabilitation. Continued use is based on the presence of ongoing evidence of benefit.
At Holistic Physio Fitness we specialise in treating whiplash injuries. To make an appointment or for more advice over the phone please call us on (02) 9999 6666.
al, C. e. (2009). Course and Prognosis Factors for Neck Pain in Whiplash- Associated Disorders (WAD). Journal of Manipulative and Physiological Therapeutics, 32 (2); S97-S107.
Motor Accidents Authority (2014). Technical Report- Guidelines for the management of acute whiplash associated-disorderes for health professionals.
National Health and Research Council (2008). Clinical guidelines for best practice management of acute and chronic whiplash-associated disorders.
Scholten-Peetersa. (2003). Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies. Pain, 303-322.