Whiplash Injury in Sports This document discusses whiplash injuries, which occur when the neck is forcefully whipped backward or forward. It defines whiplash and provides details on the anatomy of the neck. Common causes are motor vehicle accidents and contact sports. Signs and symptoms range from neck pain and stiffness to neurological issues. Treatment includes rest, physical therapy such as exercises and modalities, and surgery for more severe injuries. Risk factors include previous neck injuries and degenerative spine conditions. Most patients improve within weeks but some issues can become chronic.

1. Whiplash Injury in Sports
Dr. Nidhi Shukla

2.  Introduction
 Definition
 Anatomy
 Mechanism of injury
 Causes
 Sign & symptoms
 Investigation
 Treatment
 Risk factors
 Progress

3.  Cervical sprain and strain are injuries that
commonly occur with whiplash injuries.
 Whiplash occurs when the neck is forcefully
whipped backward or forward.
 The muscles, ligament, tendons, disc, and nerves of
the neck are susceptible to injury.

4.  Whiplash injury is an acceleration-deceleration
mechanism of energy transfer to the neck which
may results from rear-end or side impact.
 The energy transfer may result in bony or soft tissue
injuries(whiplash injuries), which in turn may lead
to a wide variety of clinical manifestations(whiplash
association disorders).

5. ANATOMY
 The human spine is made up of 33 spinal
bones, called vertebrae. Vertebrae are
stacked on top of one another to form the
spinal column. The cervical spine is
formed by the first seven vertebrae
referred to as C1 to C7.(C1) connects to
the bottom edge of the skull.
 A bony ring attaches to the back of the
vertebral body. the rings form a hollow
tube. This bony tube surrounds the spinal
cord as it passes through the spine.

6.  Two spinal nerves exit the sides of each
spinal segment, . As the nerves leave the
spinal cord, they pass through a small bony
tunnel on each side of the vertebra, called a
neural foramen.
 Each spinal segment includes two vertebrae
separated by an intervertebral disc, The disc
is a specialized connective tissue structure
that separates the two vertebral bodies of the
spinal segment.

7.  An intervertebral disc is made up of two
parts. The center, called the nucleus,. The
nucleus is held in place by the annulus, a
series of strong ligament rings surrounding
it.
 There are two facet joints between each
pair of vertebrae one on each side of the
spine. The surfaces of the facet joints are
covered by articular cartilage.
 The alignment of the facet joints of the
cervical spine allows freedom of movement
as you bend and turn your neck.

8. Mechanism of Injury

9. CAUSES
A. RTA commonly-
front/back/side.
B. Accidental/intentional
blow to head.
C. Child abuse- shaking,
hitting.

10. Contact sports-
 Football
 Boxing
 Karate
 Martial arts

11. High impact sports-
 Soccer
 Rugby
 Ice hockey
 Basketball
 Skiing
 gymnastics

12. Classed by severity of signs and symptoms
 WAD 0 No complaints or physical signs
 WAD 1 Neck complaints but no physical signs
 WAD 2 Neck complaints and musculoskeletal signs
 WAD 3 Neck complaints and neurological signs
 WAD 4 Neck complaints and fracture / dislocation

13. SIGNS -
SYMPTOMS
 Neck pain and swelling
 Stiffness
 Headache
 Fatique
 Dizziness
 Tenderness or pain in
shoulder, upper back and arm.
 Tingling or numbness in the
arm.
 Loss of ROM in the neck.

14. LATE SYMPTOMS-
 Blurred vision
 Ringing in the ear
 Sleep disturbances
 Irritability
 Difficulty in concentration
 Memory problem
 Depression

15. Imaging test-
 Cervical x-ray
 Cervical spine CT scan
 Cervical spine MRI scanning
 EMG/NCV

16. HISTORY-
 Demographic information
 Injury onset of symptoms
 Current complaints
 Relative medical information
 Activities of daily living
 Vocational information

17. PHYSICAL EXAMINATION-
 Observation
 ROM tests
 Palpation
 Special test

18. FORMINAL CLOSURE
TESTS
Mid and lower
cervical foraminal
closure test.
Upper cervical
foraminal test.

19. CERVICAL
COMPRESSION/DIS
TRACTION TEST

20. UPPER LIMB
TENSION TEST
ULTT1- median nerve dominant tension
test that uses shoulder abduction.
ULTT2A- median nerve dominant
tension test that uses shoulder girdle
depression and external rotation of the
shoulder.
ULTT2B- radial nerve dominant tension
test that uses shoulder girdle depression
and internal rotation of the shoulder.
ULTT3- ulnar nerve dominant
tension test that uses shoulder
abduction and elbow flexion.

21.  Protect from further injury
 Reduce pain
 Increase mobility
 Prevent chronicity
 Return to normal activities
 Increase strength and function

22. In acute stage(0-2 week)-
 Rest-first 24 hours after injury
 Ice pack or ice massage-10-15 hours for first 3 days
 Soft cervical collars

23. Acute condition(0-12
week)-
Electrotherapies modality-
TENS
Ultrasound
Laser
SWD

24. The Chin Nod Exercise

27. Neck Retraction

28. Side bending

31. Dry needling

33. In chronic stage (more than 12 week)-
 manipulation
 mobilization

35. MOBILIZATION

36.  Grade 1- no medication
 Grade 2/3- NSAID
Muscle relaxant- diazepam/ baclofen
 Grade 4- surgical treatment to reduce dislocation or
stabilize the cervical spine.

37.  Underlying degenerative disease of the spine
 High risk sports
 Poor strength and flexibility of the neck
 Previous neck injury
 Being unaware of the impending impact

38.  Some patients starts improving with in a few weeks.
 50-60% eventually make a full recovery.
 2-5% continue to complain of symptoms

39.  Orthopaedic Physical Therapy by Robert A.
Donatelli/ Michael J. Wooden
 Apley’s System of Orthopaedics And Fractures by
louis solomon, david warwic, selvadurai nayagam
 Clinical Sports Medicine By Peter Brukner and
Karim Khan
 www.intl.elsevierhealth.com/journals/jbmt

40. THANK YOU