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  • Q&A with Australian Health Practitioners

    Does anybody know about the condition I have - Chronic Whiplash Syndrome?

    After a motor vehicle accident I was diagnosed by a Neurologist as having Chronic Whiplash Syndrome (there were 86 signs and symptoms in his Neurology book).
    The symptoms are similar to “Shaken Baby Syndrome” and I have Autonomic Nervous System damage.
    Even medical staff seem to have very little knowledge of this condition.
    The symptoms persist after 20 years although they have lessened in severity.
    Some symptoms are: headaches; dizzy spells; poor balance and coordination; visual disturbances; Panic Attacks; fatigue; Depression; pins and needles down arms; severe neck pain.
    I was told to avoid stress as it worsens my symptoms.
    I also have C5/C6 damage from the MVA.
    When I mention Chronic Whiplash Syndrome to people they do not think beyond just having a stiff or sore neck for a while and I feel I am judged because of this non-understanding.
    Is there anybody who has come across this condition of Chronic Whiplash Syndrome before?
    I
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    Helen Potter

    Physiotherapist

    As a Specialist Musculoskeletal Physiotherapist, with extensive experience and highly advanced qualifications, as well as excellent communication skills, I can help you to: Become informed ... View Profile

    “Whiplash” describes a forward/backward stress on the neck usually associated with low speed motor vehicle accidents. Problems such as neck pain, headache and dizziness persisting after a whiplash type injury are called ”Whiplash Associated Disorders”.
     
    The good news for anyone suffering from a whiplash type injury is that over eighty percent of people suffering this type of trauma are better within six weeks. Many others are back to relatively normal after three months. While the acute injured tissues heal in this period, sometimes symptoms persist in a small number of people.
     
    The current concept, which may be a bit tricky to understand initially, is that the brain PERCEIVES that the tissues are still injured. Your brain also causes your body to develop “maladaptive postures and movement patterns” to try to avoid pain. These can change. Your past life experiences, previous pain problems and your emotional response to persisting pain all influence how you feel. Your brain can learn how to perceive pain differently.

    Recent high quality Australian physiotherapy research has identified some of the factors involved in this persistence of symptoms. While your brain has caused maladaptive postures and movement patterns and is misinterpreting the importance of pain as a sign of injury you can get better.

    We know that:

    • Every person has a unique story and individual response to what has happened
    • Multiple factors influence how you perceive pain. These include your age, gender previous neck trauma and your family, work and social circumstances
    • The brain has a big part to play in the persistence of symptoms
    • It is never too late to undo brain patterns that have been set

    On testing we may find:
    •  Residual faults in your posture and movement patterns that are increasing the load on your tissues and adding to your pain.
    • problems with your ability to know where your head is in space (feeling dizzy) and problems with your brain/tissue circuits (hypersensitivity to touch and movement )
     
    If you complain of feeling dizzy then we test your balance and eye follow responses. If you have pain and restriction of neck motion, we will find tight or overactive muscles, weak or inactive muscles. There is often also evidence of oversensitivity to tests of pressure.
     
    The brain is plastic so we can help you to “rewire” your brain memory and thought processes to allow you to manage the pain better. If you are willing to challenge some of your old beliefs, and be part of a dynamic educational approach, you will enjoy life more.
     
    Helen Potter Specialist Musculoskeletal Physiotherapist, In Touch Physiotherapy, Subiaco WA
     
     
     
     

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    Alli grew up in Hobart, Tasmania before completing a 5 year Osteopathic degree at RMIT. After graduating Alli moved to Greece to play in the ... View Profile

    Hi, 

    I agree with Helen.  I would also like to mention that in a whiplash injury the membranes surrounding the brain and spinal cord are also injured.  Symptoms may persist into a chronic whiplash injury due to strains and stresses on these membranes.

    The brain is surrounded by membranes that continue down the spinal column surrounding and supporting the spinal cord with a three layered membrane known as the “meningies” this membrane has attachments in different segments in the upper neck (C2) and the lower back in the sacral/ coccyx area.

    When a whiplash injury occurs there can be evidence of strain patterns not only in the neck, but also in the coccyx region as well.  It is really important that the coccyx and lower back is taken into consideration with whiplash injuries as they play a crucial part in the strain pattern of these membrane attachments and can anchor strain patterns in the neck if they are not addressed.

    Are you experiencing any lower back pain?  
    What symptoms specifically are you experiencing?
    When was the accident?
    What treatment have you sought?

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    Joel Laing

    Physiotherapist

    I am a McKenzie Method specialised physiotherapist, with a Diploma in Mechanical Diagnosis & Therapy. Using the McKenzie Method I predominantly treat low back and ... View Profile

    I also agree with Helen.

    The key is that Whiplash Syndrome is really a generic label to describe a method for injuring your neck, and like any syndrome is just a collection of symptoms and not a useful and meaningful diagnosis.

    I frequently see patients like you and they have a disc problem from the accident that is not accurately diagnosed. When this disc bulges and compresses the nerve behind this causes the tingling/aching/weakness in the arms. 

    I would seek a specific Assessment as your problem may be rapidly amenable to the correct treatment even though it is chronic in nature.

    As Allison mentioned your lower back could also be affected and contributing to the neck (the link is hard to understand but lower back problems can frequently affect the neck, and as a McKenzie Physiotherapist I know this as treating the lower back will frequently clear up the seemingly separate neck problem).

    I am biased (like all of us health professionals) in my particular field, as I feel a McKenzie practitioner could very likely help you, or at worst see you no more than 3-4 times to determine if you will respond (eg. you will not have to test it for 3-4 weeks to know if it will sort your particular issue out). 

    www.mckenziemdt.org.au is the mckenzie website that can help you locate a suitable practitioner near where you live. The McKenzie method is safe, evidence based and in 30 countries in the world. The website is an international one, and has a therapist locator link that is both country and state specific.

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    Helen Potter

    Physiotherapist

    As a Specialist Musculoskeletal Physiotherapist, with extensive experience and highly advanced qualifications, as well as excellent communication skills, I can help you to: Become informed ... View Profile

    Thank you Allison and Joel for adding to my information on whiplash.

    There are many different approaches to treating the symptoms of whiplash and it is difficult for a lay person to sort out who to trust and believe.

    The first essential step is to find out why you are feeling the pain and symptoms you are and then choose a logical rational approach from a qualified and registered health professional. You are hopefully looking for someone who will discuss your needs and goals and help you choose the most appropriate treatment for you despite any bias they may have toward a specific approach.

    There are very dedicated health professionals available who can help you on your journey to good health. As Joel noted you should know within three sessions if you have found the right person and approach for your particular problems, needs and goals. Don't just put up with pain. Become informed by relieble information, Seek help,  and take part in your own recovery. Good luck. Helen

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    Neil Synnott

    Exercise Physiologist, Physiotherapist

    I am qualified as a PHYSIOTHERAPIST and ACCREDITED EXERCISE PHYSIOLOGIST.I primarily use the McKENZIE METHOD for assessment and management of musculoskeletal pain disorders. The McKENZIE ... View Profile

    Chronic whiplash
    Chronic whiplash has many factors which medical professionals need to be aware of - specific restrictions and dysfunctions within the cervical, thoracic (and lumbar) spine, motor control of cervical and thoracic spine as well as how well the individual processes peripheral and central pain sensations (how the brain interprets/ perceives pain). We all have unique experiences that influence how we interpret and respond to pain sensations… this can be a whole topic in itself!!
     
    The mechanism of ‘whiplash’ is undoubtedly important in the development of acute and chronic whiplash symptoms – high-velocity hyperflexion then hyperextension, hyper-lateral flexion to one side then the other or combination of all movements of the cervical/ thoracic/ lumbar spine.
     
    The person with chronic whiplash often reports neck pain, dizziness, concentration difficulties, headaches and fatigue (amongst other symptoms).  
     
    The following is meant to be a guide only. As we are all unique individuals, assessment and management with appropriately trained and skilled health care professionals is advised. Below is a guide as to suggested management approaches for different stages of whiplash.
     
    Acute (initial 2-3 weeks) whiplash symptoms can be contributed to by:

    • Local joint and muscle restrictions in the cervical, thoracic (and lumbar spine)
    • Sensitisation of the nervous system (peripheral more so than central –some evidence suggests central sensitisation can start as early as 7 days after the accident!)
     
    Ideal management strategies
    • Assessment with a general practitioner for appropriate medications (as needed) and referral to a reputable physiotherapist/ osteopath
    • Provision of a SPECIFIC TO YOU home exercise program by a physiotherapist which promotes increased cervical/ thoracic movement and decreased pain – improvement should be seen within 3-4 sessions!
    • Local manual therapy to the cervical, thoracic spine and muscles that promotes increased cervical and thoracic movement – techniques must not increase pain! This should be a minor aspect of management.
     
    Subacute (initial 4-12 weeks) whiplash symptoms can be contributed to by:
    • Persistent local joint and muscle restrictions in the cervical, thoracic and lumbar spine. During the acute stage, if provided with (and performed regularly) the correct SPECIFIC TO YOU exercise program, restrictions should be minimal!
    • Sensitisation of the nervous system (more so central sensitisation)
    • Reduced coping with pain strategies (especially if symptoms are not improving)
     
    Ideal management strategies
    • Continued general practitioner and physiotherapist consultation
    • Provision of a SPECIFIC TO YOU home exercise program by a physiotherapist which promotes cervical/ thoracic movement control (for stability and endurance) and cardiovascular exercise
    • Referral to a psychologist specialised in pain management for assistance with development of coping strategies (if needed)
     
    Chronic (> 12 weeks) whiplash symptoms can be contributed to by:
    • Sensitisation of the nervous system (central sensitisation)
    • Reduced coping strategies (especially if symptoms are not improving)
     
    Ideal management strategies
    • Continued general practitioner and physiotherapist consultation
    • Provision of a SPECIFIC TO YOU home exercise program by a physiotherapist which promotes cervical/ thoracic movement control (for stability and endurance) and cardiovascular exercise
    • Referral to a psychologist specialised in pain management for assistance with development of coping strategies (if needed)
     
    For the person who has chronic whiplash symptoms, remaining positive and proactive with the SPECIFIC TO YOU management strategies for you is vitally important! Involvement in regular exercise as tolerated is very important… So please keep as active as you can with the help of your health care team!

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    Joel Laing

    Physiotherapist

    I am a McKenzie Method specialised physiotherapist, with a Diploma in Mechanical Diagnosis & Therapy. Using the McKenzie Method I predominantly treat low back and ... View Profile

    I think Helen's last comment is most important.
    See a specialised health professional and if you are not getting anywhere within 3-4 sessions you are not likely being led down the best solution to your problem.
    The thing that dissapoints me most about fellow health professionals (and certainly this is not all of them!!) is that many are happy to continue to treat people for months at a time without seeing anything better than a short lived change in the treatment room.
    I am amazed when I see people who end up being fixed after 3 sessions with me or my staff that have seen another health professional for months and sometimes years without results.
    It is important for practitioners to recognize when they are not making significant change or feel that a particular patient is outside their particular skill-set. These patients are often so happy just to be referred towards a resolution, even if the particular practioner themselves is unable to significantly help them .

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    mollyemma

    Healthshare Member

    Hello

    I have the same problem.  Would you mind giving me the contact detials of your neurologist.  I would like to see him.

    Thanks

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    Noeline Rayner

    Healthshare Member

    Hello Mollyemma

    I cannot give you the contact details of my Neurologist as he retired about 10 years ago.
    I can tell you that he was a very well qualified and respected Neurologist and I was so relieved to finally have a diagnosis after years of being told that either I was exaggerating or that they did not know why I still had all these symptoms so long after the MVA.
    While it is not good for you to have these problems also, it is reassuring to me to finally hear that somebody has very similar symptoms.
    If you look under the heading of Autonomic Dysfunction you will recognise a lot of what you are experiencing, as this is the newer diagnosis that I have and also it is now more recognised by the medical profession.
    Research that I have done suggests that there was damage of the brain cells controlling the Autonomic Nervous System without it being classed as an actual brain injury.
    I wish you well with your journey to some help and recovery.
    Rhapsody

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    Apostlegirl

    Healthshare Member

    I also have been diagnosed with this. I have found that the best short term results have been from a physio and from a chiropractor. The inflammation does set me back a little, but generally, I will feel really good (like a normal person) for a day or two, but then as it gets inflamed again or I move it too quickly (my head that is) I will end up back where I started. The physio seems to have less impact but lasts longer. I don't take drugs for anything, but am starting to reconsider that as it has been almost three years and I am struggling to run my own business and be a single mum to two very active boys. I know exactly what you mean by people thinking it is just a sore neck. I also have short term memory loss as a result, which people often make jokes about me being forgetful… It isn't that I am forgetful at all… I just don't know what happened thirty minutes ago, it is like it did not happen. I feel sorry for anyone who has this as you look and talk normally, so people think you ate lazy when you are so dizzy you need to lay down in the middle of the day.

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    sachia888

    Healthshare Member

    Dear Rhapsody (& Molleyemma and Apollogirl),

    I'm not a medical expert - I'm at the other end of the spectrum suffering a chronic health condition similar to your own. I formerly worked as a chemist, an adult educator and I'm a trained counsellor.  I am now a carer and volunteer in the disability sector but like yourself am trying to rebuild my health and re-enter ‘a’ world of choice in life rather than being ‘done to’ and told and diagnosed and judged. Your story is not unique or odd Rhapsody - it's an echo of thousands.  I completely relate to what you're saying and I write here to VALIDATE what you're going through as a typical and normal reaction to an extremely challenging and life changing experience.  I write this for you and myself and anyone else reading who might benefit. It may challenge medical experts who might read it from a qualified professional perspective however I ask that they would consider questioning their own capacity for empathy and ‘entering the world of the patient’ rather than judging. 

    I've been told I have chronic whiplash along with many other diagnoses dependent upon the current presentation of (often cyclic) symptoms and the training and experience (both type and degree) of the practitioner I'm visiting at that particular time. Often, in the absence of hard clinical evidence which is rather easily interpreted, what people like us get is a best fit diagnosis - which for us, often in intolerable pain and suffering, is little better than an educated guess.  Often my long winded list of symptoms have been judged and interpreted as a good old fashioned whinge rather than “these are my symptoms, do you know what's wrong and can you fix it?”.  After years of this and a loss of trust and faith in medical “expertise”, (not to mention tens of thousands of dollars) one gives up as they ‘feel’ discarded into the hypochondria heap and basically told to “get over it”. Fortunately there are many good medical practitioners around particularly those who understand integrated medicine and holistic health (strengthen what can be strengthened and minimise all bodily and psychological stressors for optimal outcome whilst pursuing curative treatments).

    Being told to change your attitude Rhapsody, I find offensive. You don't have to look far in the medical literature to find everything from nasal hair to menstruation being blamed on hysteria. Having a chronic health condition is not something one can ‘move on’ from, ‘get over’ or ‘deal with’ any more than one may move on from, get over or deal with depression or a broken leg. Your ‘attitude’ was probably no different to ‘the experts’ attitudes before your injury and what you need is ‘supportive’ friends and practitioners (usually the more supportive doctors are those who have a family member or friend who has suffered a similar condition). Your healthy friends will eventually judge you (given time) and become impatient, think you're malingering as many medical experts will. The best place to find the right kind of validating support is with a community (either local or net) of people who also have your medical condition. It is also from their experience at eventually finding treatments that work and practitioners that use them rather than random medical experts that will help most. Doctors would do well to obtain and pass on such resources as relevant support groups in their locales. You could ask your neurologist, do a web search for your area, contact your local Community Health Centre, ADHC office (Nurse), a local Counsellor, Regional Social Research and Development organisations.

    Also  www.elevate.com.au//Health-Services/Cold -Laser-Therapy may help if you have an unresolved soft tissue injury. I'm saving as it's expensive and I don't live in Sydney but you pay as you go and it's Medicare rebateable (I believe it's available in Adelaide also). It's a cold laser treatment developed by NASA and delivered by qualified medical doctors and has zero side effects.You can enquire and have an initial phone consult with a doctor there.

    Practical measures and treatments that work are ultimately what's going to be effective rather than well-meant advice which you've probably been given by every person you know and every stranger you've met as well as well-meaning doctors.  What you don't need is what you also usually get plenty of - judgement from those same people with all the answers and zero experience of what you are going through.  Think about asking them “How many people have you cured from this condition?”.   Even worse, you lose your income, your privacy, your independence and social participation. You are constantly forced to repeat your list of symptoms in the hope that maybe one person knows what's wrong, that one person can help. Instead you're told you're the problem. Your attitude is the problem or a big part of it. You are blamed for your condition.

    Don't accept it!  I challenge any super-human to keep their chin up, smile, be happy and cheerful when they have flu-like inflammation, a knife in their back, a fire under their neck, migraine and little more to look forward to besides much more of the same as well as invalidation. 

    Another truth is, your diagnosis is as good as your ‘observable’ physical signs and symptoms, your communication abilities, the communication ability of your doctors, the diagnostic capabilities of the clinical tests additionally employed and the ability of your doctor to integrate and interpret these based on his/her individual training, knowledge and experience.  From the human perspective, being ill brings with it vulnerability - we become reliant upon ‘experts’ to solve our medical dilemma. Very few of these experts have suffered from the conditions they treat. They are thus text book rather than experiential experts, some with much experience, some with strong opinions, some with prejudices relying more upon belief systems than good science.

    Chris Uhlmann (Sky news presenter) also found judgementalism - and the  additional superior or condescending attitudes people believe they have a right to impose upon you when you are no longer in ‘their league’ (healthy and successful - highly valued social attributes as opposed to illness and disability which are generally unconsciously devalued in our society) - a difficult factor to deal with when he was struck down with a chronic fatigue illness following a hepatic insult. He's written a book about it but look around for similar books also, they're helpful for validating your illness ‘experience’ whereas society, in general, is unable to. Finally, you'll know who your friends really are when you are well again. I am much improved and continuing to do so with the help of some excellent local practitioners. Good luck and good on you for continuing in your struggle to find answers. You've genuinely erned my respect. I hope to hear that you have fared well and regained your health.

    Kind regards,

    Sachia888

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    Dr Ryan Hislop

    Chiropractor

    Dr Ryan Hislop, Chiropractor is situated in Mudgee with the team from Chiropractic Health and Wellness Centre. He has a special interest in sports chiropractic ... View Profile

    Dear Sachia888,

    I am interested to hear of your experience of cold laser therapy.

    All the best with your recovery. We hear these kinds of stories all too often.

    Warm regards,
    Ryan

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    Shinaynaye

    Healthshare Member

    I hadn't heard of the term chronic whiplash syndrome before.  I was in a MVA in 1999.  I have  never resolved the constant headaches, pain, dizziness, eye pain, jaw pain etc.  what works for me is an adjustment and trigger point injections from my DO. But the relief is only temporary.  I have had “radio-frequencies” for the neck pain, an ear profusion for the Ménière's disease , which did help for years.  I did all the rehab I was told to do, got a splint for my TMJ…what I'm trying to say is don't let anybody tell you that your pain is not real.   They can put any name on it they want, but we know how we suffer and it's not in our heads. There has to be a way we can manage this pain and live feeling better.  I am going to a psysiatrist later this month hoping to get Botox injected into the spazing muscles… I hope it can give me some long term relief.  Lets keep in touch.  I hope you feel better soon!!!

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    Apostlegirl

    Healthshare Member

    I have actually recently had great results treating my chronic whiplash syndrome… I am working closely with a physiotherapist who completed his thesis in cws at the university of qld, where amazing study is being done to help overcome this disorder…. I would suggest that you find a physio who is well trained in this exact condition and the best thing for me has been the brain building excercises on lumosity.com it has helped heaps with my concentrarion and memory and i would suggest it strongly to anyne suffering cws. Also, reaffirming that it is real and that i have actually got a serious health condition is so important, because you do feel like you are going crazy!

  • Malcolm Nay

    Healthshare Member

    Hi, could you tell me who your physio was/is (I am in Brisbane).

  • Josephine Perry

    Bowen Therapist

    Josephine is a fully qualified Bowen Therapist, with full insurance cover and Association membership. Rebates provided by most health funds, according to levels of cover.Practice ... View Profile

    Bowen Therapy is a very effective way of treating whiplash.  Realignment of muscles and ligaments surrounding the spine is one part of the treatment.  There is also a very specific procedure for whiplash, which I found to have worked extremely well in addressing the most severe symptoms, including migraine.

  • Helen Potter

    Physiotherapist

    As a Specialist Musculoskeletal Physiotherapist, with extensive experience and highly advanced qualifications, as well as excellent communication skills, I can help you to: Become informed ... View Profile

    Hi all, Thank you for your input.

    Every professional who has replied to the original post has stressed that what a person is suffering is real.  The therapists have all been empathetic to your problem and not judgemental. 

    Overall we have all emphasised the need for people with chronic pain to have quality assessment from an experienced and understanding therapist. You need a diagnosis - not just Whiplash) and a specific individual plan for recovery that you can tackle together with your therapist. Despite the chronicity of your pain and in spite of any underlying damage to structures, you can get better. You will

    You need a diagnosis - (not just Whiplash) and a specific individual plan for recovery that you can tackle together with your therapist. Despite the chronicity of your pain and in spite of any underlying damage to structures, you can get better. You will

    Despite the chronicity of your pain, and in spite of any underlying damage to structures, you can get better. You will benefit from finding a highly qualified experienced therapist who will help you physical and emotionally to improve. Accurate information will reduce your fears.

    Kind Regards

    Helen Potter

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