Some common conditions

Whiplash Injuries

A whiplash is a soft tissue injury often arising from minor trauma. It most commonly affects the neck though can also affect the thoracic and lumbar spine. Although it can cause considerable pain and discomfort it is rarely serious and most people make a full recovery in 6 – 12 weeks.

Whiplash can be caused by a road traffic accident (RTA) or sustained whilst participating in a variety of sports. It is commonly caused when the neck is jolted suddenly from behind and then recoils in a forward direction. This is the typical onset in a car accident where there is a rear end shunt. It may also happen in the opposite direction if you are unlucky enough to run into the vehicle in front.

With our roads getting busier ever day more and more of us are involved in road traffic accidents. It is estimated that 1 in 150 will suffer from whiplash at some time in our lives. If you follow a few simple guidelines in the early stages following a whiplash type injury you can really take control of your symptoms and help yourself to a speedy recovery.

A whiplash is rarely serious, however, there a few occasions when you should be checked over by your GP or nearest Accident and Emergency Unit. If you are experiencing any of the following symptoms or have been in a major accident we would advise you make an appointment to see your GP before seeking the help of a Chartered Physiotherapist. These include:- have severe neck pain, loss of consciousness, have a severe headache, disturbed vision, drowsiness, confusion, nausea, vomiting, balance problems or pain with numbness or pins and needles in your arms.

It is normal to feel under some stress and anxiety following a whiplash injury but remember that being in pain does not mean that you have a major problem. It is important to stay as active as possible and carry on with every day normal life. Try and stay at work and carry on with hobbies. Let your employer know that you have had an accident and they will be more understanding and may be able to offer a lighter work load for a few weeks.

To help you carry on normally it is important to control the pain adequately. This can be done with the help of some over the counter pain killers. We do not recommend the use of anti-inflammatories in these early weeks as they have been shown to slow the healing process even though they do help control pain. Pain can be felt almost immediately after a whiplash injury, however, it is quite common for it to come on more slowly over the first 48 hours. This is as the inflammation builds up. This is nothing to worry about and is part of the normal cascading inflammatory process that is in fact essential to normal healing.

If your pain is not controlled we would recommend seeing your GP who would be able to prescribe a stronger combination of drugs as appropriate.

Please remember that by controlling your pain effectively it will help you remain active and stop your joints from stiffening up. Hot or cold packs are also very useful in helping to control your pain and we would recommend trying either to see which helps you the most.

If your pain is not settling and you neck remains stiff after a week following the above advice we would recommend having an assessment with a Chartered Physiotherapist who is specialised and experienced in treating whiplash disorder. They will carry out a thorough examination of your injury and give you education and advice specific to your problem.

Physiotherapists will also use a variety of other treatments to help control your pain and to get you moving again. Massage may be used to reduce tension and pain around your neck muscles. Electrotherapy or acupuncture may be used to help reduce your pain. Joint mobilisation and manipulation have been shown to be particularly helpful when used soon after the whiplash injury to restore normal movement.

Please remember that if you have been involved in an accident and have sustained a whiplash injury you can speed up your recovery by following a few simple rules.

It is usual to experience some pain and discomfort after your injury but this does not normally mean you have sustained a serious injury.

Get your pain under control with some over the counter analgesia. Use hot packs or wheat bags as well.

Take care of your neck posture and keep your neck moving by gently turning it to one side a few times then to the other.

If your pain is not lessening and your movements remain restricted after 7-10 days consider having a thorough assessment by one of our team and let us help speed up your recovery.

Causes of Neck and Back Pain

Osteoarthritis / Spondylosis / Wear and tear

The above terms all mean the same thing. Arthritis is part of the normal aging process and everyone will get some degree of arthritis as they get older. However, the extent to which people are affected will vary from person to person.

As spinal joints get worn the disc separating each vertebrae become thinner. Extra bone may grow called osteophytes. Your joints, muscles and ligaments get stiffer. Muscles often get weaker and joints can become inflamed.

Physiotherapy concentrates on restoring movement and strength, by using a combination of exercises, mobilisation and manipulation. Electrotherapy can be used to reduce inflammation. All this helps to reduce pain and restore function.

Disc Problems

Your “intervertebral discs” sit between the vertebrae (bones in your back). This is a common cause of pain as bending your back or having poor posture of the back/ neck, puts more pressure on the back wall of the disc which can lead to a prolapsed disc or “slipped disc” (i.e. the disc can leak out into the surrounding tissue). This can be very painful and often limits your movement to one side i.e. you may be able to take your back/ neck to the left but not the right. The prolapsed disc can also press on a nerve which can give you pain/ pins and needles or numbness/ weakness in your arm/leg.

Physiotherapy can help to reduce the disc protrusion by using, manipulation, traction and exercises.

Spondylolysthesis

A condition where one vertebrae slips forward on the other. This can be a very small slip, which can leave you pain free with no symptoms. Or it can be a larger slip, which could put pressure on the spinal canal and nerves, causing pain and possible pins and needles/ numbness. The most accurate way to diagnose this is by having an X-ray. However, some therapists can feel a “dip” in your spine when you are standing which could indicate a possible spondylolysthesis.

Rheumatoid Arthritis or RA

In this rare condition you body mistakes its normal tissue for foreign tissue. Therefore, your own immune system attacks your healthy tissue causing pain and inflammation in your joints.

More than one joint is affected in RA, so if you only have neck/ back pain you are unlikely to have RA. Normally the small joints in your hands and feet are involved. It is more common in women than men, and is normally diagnosed when the patient is young i.e. in their 20's or 30's.

Whiplash

“Whiplash” is caused when your head is quickly whipped forwards and backwards e.g. when in a car crash/ on a fairground ride etc.

This overstretches your muscles and joints causing inflammation and pain. It may also affect your disc, which can lead to more severe problems.

However, most whiplash injuries will get better over time provided they are kept moving and postural advice is followed. Sometimes treatment is needed to speed up the recovery process.

Osteoporosis

This condition tends to effect post-menopausal women, although it can affect men. New bone is formed all the time and old bone is reabsorbed by our bodies. Osteoporosis occurs when old bone is absorbed quicker than new bone is made. This makes your bones more brittle and more likely to fracture (break). It is diagnosed using a bone scan of the heel, although some advanced cases can be seen on X-ray. It is a painless condition; therefore osteoporosis itself cannot cause pain.

Poor Posture

Posture is talked about frequently. It can be a cause of pain in itself (e.g. stretching of muscles or putting pressure on a disc, by sitting in poor posture) or it can prevent other conditions from healing fully (e.g. whiplash injuries often do not get better because the muscles are repeatedly stretched by poor postures).

Pregnancy

During pregnancy more pressure is put on the back as the pelvis is pulled forwards. This can cause pain in the back and the pelvis, which normally resolves after giving birth. This can also happen if you are overweight.

Muscle Spasm

Your muscles can go into “spasm” when in pain for any of the above reasons. The muscle tightens in order to try to protect the joint, which is painful. However, this contraction in itself is painful. It can often be relieved by heat/ stretches/ relaxation.

Stages of Healing

Lots of people who have had pain for a long time think that the pain means there is still something wrong, and that the problem hasn't healed yet. They may think that because their back still hurts that it still means it is fragile.

Pain is often a sign that you are ill (e.g. appendicitis), or that an area of your body is injured (e.g. broken arm). However, sometimes people have pain even though an injury or illness has fully healed up.

An understanding of the healing process can help us to work out the best way to treat healing or healed tissue. It can also help us to see some of the reasons why we may feel stiffness even years after injury/operations.

Unlike a machine the human body can heal itself. With few exceptions every kind of tissue heals in the same way e.g. bone heals by making new bone, ligaments/muscles/skin heal with gristle (scar tissue).

Healing begins immediately after as injury has taken place, and there are several different stages of healing.

1) Bleeding - - this stage lasts about 10 minutes. Blood vessels are damaged whenever tissue is damaged. Bleeding soon stops as the blood clots. The blood can spread out under the skin (i.e. forms a bruise).

2) Inflammation and Swelling - this stage lasts up to 10 days. Within 10 mins of injury inflammation begins. The blood supply to the area is increased and chemicals are released, causing the area to go red and feel hot. At the same time a fluid called serum (which comes from the blood) builds up. Serum is a thick, sticky, yellow fluid which contains protein. This protein will eventually form scar tissue.

The body tends to produce so much serum that it causes swelling e.g. sprained ankle. As serum is sticky, it binds the tissues in the injured area so that they cannot move easily and feel stiff.

Consequently, during this stage of healing it is important to gently move the area to minimise stiffness and swelling, and to help the serum to be absorbed once it has done its job. Movement can be started very gently, with frequent rest periods, and gradually built up.

3) Repair - begins 2-3 days after injury and continues for 3 months. The protein in the serum joins together to form scar tissue, which repairs the gaps left by the injury. From 3 weeks after the injury the scar tissue begins to contract and tighten. It is therefore important to stretch the healing tissue to increase its elasticity and strength.

Unfortunately, healthy tissue can become glued to the serum making the area stiff and tight so it is important to keep moving.

4) Remodelling - 3 months onwards. The scar tissue changes, for example a scar on the skin turns from purple to white. Movement of the area helps the process of remodelling and helps to stretch and strengthen the scar tissue.

5) Contraction - starts at 2 months and is ongoing The scar tissue tightens and shortens. It continues to occur as the years go by.

However, it is never too late to stretch the scar tissue and make it more flexible and supple.

In summary: Most tissues heal by making scar tissue, and this process is complete by 3 months. There is usually some sensitivity left within the tissues. However, healed but scarred tissue can become less sensitive once it is stronger and more elastic.

Different tissues in the body heal at different rates. It depends on the site and size of the injury, the blood and nerve supply to the tissue and the age of the person.

So, if your body has healed up properly, there is no need to think it is damaged or fragile. Gentle exercises and getting back to everyday activities (but pacing it) is good for you.

Chartered Society of Physiotherapy Manipulation Association of Chartered Physiotherapists Physio First Association of Chartered Physiotherapists in Orthopaedic Medicine Society of Orthopaedic Medicine Acupuncture Association of Chartered Physiotherapists