Topic 8 Cervical Sprain.pdf

Topic 8 Physiotherapy in AccelerationDeceleration injuries of the Cervical Spine. 1 300.000 cases /year in U.E 2 1 INTRODUCTION • Whiplash Injury: H. Crowe (1928), posterior impact • Whiplash Syndrom: A. Davis (JAMA 1945). • Whiplash Associated Disorders (WAD): Quebec Task Force (1995). 3 3...

Topic 8 Physiotherapy in AccelerationDeceleration injuries of the Cervical Spine. 1 300.000 cases /year in U.E 2 1 INTRODUCTION • Whiplash Injury: H. Crowe (1928), posterior impact • Whiplash Syndrom: A. Davis (JAMA 1945). • Whiplash Associated Disorders (WAD): Quebec Task Force (1995). 3 3 Definition: Whiplash is an acute injury which causes a strain to the bones, muscles, nerves, tendons, and vertebral discs of the neck region It is caused by a sudden, unexpected impact which jerks the head back and then forward causing the neck to snap out of alignment. crushed 4 2 PATHOMECHANICS OF WHISPLASH . 5 5 EXTENSION : • STRESS in anterior structures : • CAVL and flavum lig. tears • Strain in scalene and ECM • Avulsions of anterior margin disk. • Fracture of spinous processes • Intervertebral foramen alterations . 6 6 3 FLEXION: • STRESS in POSTERIOR structures : • Cervical muscles strain I • ligaments sprain :Interspinous and flavum • Fracture of axis dens (5%) • Avulsions of annulus 7 7 They usually occur between 6 and 12 hours after the trauma. ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Radiated cervical pain to UL Joint and muscle stiffness. Headache. Visual disturbances. Dizziness, instability. Weakness, paresthesia in MMII. Tinnitus. Swallowing and breathing alterations. 8 8 4 Quebec Task Classification • Grade I: Neck pain (NP), and stiffness (ROM) • Grade II: NP AND muskuloskeletal signs (muscle spasm) • Grade III: NP AND neural signs • Grade IV: fracture or dislocation 9 Whisplash : treatment Grades I, II , III : Conservative treatment: Inmobilization, analgesic and muscle relaxation Grade IV: same protocle as Fractures 10 10 5 . Whisplash : treatment Days : 1- 4 . INMOBILIZATION PHASE / Maximal P. P OBJECTIVE THERAPEUTIC STRATEGY DECREASE PAIN Electro analgesic currents : TENS( 1-4 Hzs) 150- Grade I , II, III 200 ms), Collar 24 hrs DECREASE MUSCULAR SPASM ATTENTION TO UPPER TRAPEZIUS and THORACIC muscles : masage, thermotherapy Grade III PAINLESS R.O.M. Grade I –Only authorised rotations with collar –-Avoid Flexión, extensión, lateral bending 11 11 12 6 WISPLASH TREATMENT Mobilization period > 4 days. Moderate to Minimal P. Phase OBJECTIVE REMOVE INMOBILIZATION All grades NECK CONTROL All grades THERAPEUTIC STRATEGY –Retire 1 -2 hs /day as tolerance –Pain control if necessary –Cervical manual therapy –Propioception : Cervical joint position sense 13 13 Neck stabillity is a active tranining. Avoid passive techniques 14 7 15 8