Whiplash is the rapid motion of the neck during a crash that can result in a number of injuries. Many of these injuries are impossible to see on x-rays or MRI. Even though there may be minimal damage to your car or bicycle, you can still sustain whiplash. In fact, even at low speeds, occupants can experience severe whiplash.
Common presentation is neck pain and stiffness; headaches, upper/lower back and/or arm pain, associated stress and anxiety, jaw tightness or pain. Most soft tissue injuries take 6 to 8 weeks to settle down. It is important to implement early treatment and encourage return to normal function as soon as possible. Research has shown that the prognosis of whiplash depends on many factors, including the availability of early physiotherapy intervention.
This is where the neck suddenly becomes stiff and painful when turning the head to the side (usually one side more than the other) and looking up can cause a severe “catching” pain. The muscles on one or both sides of the neck may also go into spasm and pain may be felt from the base of the skull right down to the shoulder blade and outwards to the top of the shoulder.
The most common history is, waking with a bit of neck stiffness in the morning, but then when you turn your head in the shower or reverse out of the driveway you can experience a sudden onset of sharp pain and locking in the neck, you are unable to move your neck without experiencing sharp pain. This is usually due to a “locked” facet joint. It is thought that inflamed tissues get pinched in the joint and the neck “locks” into spasm to prevent further movement.
Cervicogenic headache is pain on one side without side shift (within that episode & typically between). Symptoms usually begin in neck or occiput (double sided), with possible shoulder/arm pain. This is different to a migraine which begins in front and behind the eye.
Headaches can be episodic or continuous and can be associated with, nausea (not very often), dizziness, photophobia (like a hangover – no bright light/loud noise) and ‘blurred vision’ (haziness/head feels a bit fuzzy or light). This is caused by poor neck movements/postures, with pain easily reproduced with external pressure to upper cervical or occiput or restricted neck movements.
The upper 3 (C1-3) cervical levels are most commonly involved cervicogenic headaches.
This occurs when the subacromial space becomes too small to allow easy passage of soft tissue structures during movements. This space can be narrowed due to anatomical or postural changes. The soft tissues can become swollen (acute phase) and thickened (chronic phase) resulting in further pain and disability.
Common presentation is sharp shoulder pain with overhead activities and when reaching. You may have difficulty sleeping on that shoulder and the shoulder may ache in the evening. Pain usually presents at the deltoid insertion (outside), but may also travel closer to the front of the shoulder. If the pain extends into the upper trapezius muscle, then the cervical spine (neck) is usually involved.
A forward shoulder position increases the tendency for impingement to occur and can be caused through prolonged poor sitting postures, sporting activities with repetitive overhead movements (swimming, tennis), and stiffening of the thoracic spine.
BPPV is a disorder of the inner ear, which is characterised by episodes of vertigo that are position dependent. ‘Benign’ refers to the fact that this condition is not due to any serious pathology and that the prognosis for recovery is good. ‘Paroxysmal’ refers to the swift onset of the vertigo, and ‘positional vertigo’ refers to the spinning/dizzy sensations which you may experience in certain positions.
The cause of BPPV is related to the presence of abnormal debris within the semicircular canals. The debris is usually small crystals which have dislodged from another part of the inner ear. This debris causes abnormal stimulation of the sensory hair cells in the semicircular canal and leads to the sensations of dizziness and vertigo experienced in BPPV.
The common presentation is intermittent episodes of vertigo. Vertigo is an abnormal feeling that you or your surroundings are in motion. The vertigo is brought on by changes in your head position (e.g. rolling over in bed, looking upwards or bending forwards), and lasts less than one minute.
Other symptoms can include light-headedness, dizziness, nausea, and feeling off balance.
Spondylolisthesis is a condition where one vertebrae slips forward on the one below, usually this occurs at L5S1. Predisposing factors include the presence of bilateral pars defects, chronic disc disease, associated facet joint degeneration and excessive anterior pelvic tilt. This leads to increased shear at the L5S1 spinal level.
Common presentation is low back, buttock pain, pain moving from the low back down the leg (1 or 2 legs), numbness/ weakness in 1 or 2 legs, problems with walking and reproduction of symptoms with bending or twisting.
Sacroiliac joint (SIJ) dysfunction is often associated with pregnancy or post partum mums, and can also be related to overuse injuries (repeated bending activities) or sporting incidents. The SIJ does not have a very large range of movement, but is an integral central component of the skeleton with full weight bearing. It is essential that biomechanically, the joint is moving in a coordinated fashion bilaterally.
Common presentation is pain around the SIJ that may refer into the buttock and even down the posterior thigh, with groin pain also being possible. Standing, walking and running or rolling over in bed, often aggravates pain.
Research suggests that up to 80% of acute low back pain is a result of injury to the lumbar discs and physiotherapy treatment has been shown to be effective in the management of lumbar disc injuries.
Lifting, bending, putting on shoes – often there is a minor incident with minimal discomfort at the time that can lead to injury. The following morning the patient “can’t get out of bed”. Occasionally there is a major disc injury with immediate onset of pain and disability. If there are obvious neurological signs (loss of power or reflexes), specialist review is recommended as soon as possible.
You may present with central, bilateral or unilateral pain, but only about 20% will have leg pain. You can experience back stiffness in the morning, difficulty getting in/out of the car and difficulty with standing from sitting, and may have a slight list (stand crooked) or a loss of lordosis (flat back). Coughing and sneezing will often reproduce symptoms. Symptoms can be eased when lying, walking and changing positions.
Lumbar facet joint pain can present as an acute joint sprain, (most common in the sporting population, particularly golf and tennis) but is more often a chronic problem associated with degenerative changes. A chronic lumbar disc injury places more stress on the facet joints at that level, leading to increased wear and tear. Osteo-arthritis of the facet joints is the most likely cause of the problem if there has been gradual onset with low back stiffness in the mornings.
Common presentation is local low back aching, where the pain can refer into the buttocks, hips or knee. It is diffuse in nature and difficult to localize but can be sharp with movement. Pain is exacerbated with bending back, walking, prolonged standing and bending forward. Sitting in a supportive chair and doing gentle back movements and exercise can ease pain.
Plantar Fasciitis is a painful condition affecting the sole of the foot, with pain usually localised around the front of the calcaneum and radiating along the middle of the sole of the foot towards the toes. There is usually tenderness on the insertion of the plantar fascia onto the calcaneum. Usually this is related to a sudden increase in walking or a change in shoe support, or even direct impact onto the sole of the foot, such as stepping onto a rock.
Often, on X-ray, there will be a boney spur protruding from the calcaneum related to the insertion of the plantar fascia. The most common pattern of plantar fasciitis is of gradual onset related to faulty foot or poor lower limb biomechanics. Factors that may predispose you to this condition include over pronation of the foot or weakness of the hip abductors leading to internal rotation of the hips during full weight bearing movements (ie. walking).
Pain Presentation – Pain from the hip joint is commonly experienced in the groin region, but can also refer to the lateral hip region, the medial knee, under the crease of the buttock and the lateral leg. The pain can occur spontaneously with no obvious cause, but on examination there is often quite restricted hip joint mobility and muscle weakness, which can suggest a gradual asymptomatic onset.
The bursa cushions and lubricates the areas between bone and tendon. The trochanteric bursa separates the greater trochanter of the hip and the muscles, tendons of the buttock. It can be caused by poor gluteal control, tight ITB or activities that place excessive pressure on the bursa (movements across the body)
Common presentation is lateral hip pain that can spread to the knee, localized swelling tenderness with palpation of the greater trochanter and problems with running, walking and sitting.
Acute anterior hip pain may be related to iliopsoas bursitis or tendinitis, and is often caused by an unusually difficult or prolonged walking session (bush walking or going on a walking holiday).
“Clicky” anterior hip pain is usually a long, weak iliopsoas muscle/tendon unit and is often seen in flexible females, such as dancers or gymnasts.
The most common loss of ranges of movement of early stage osteoarthritis of the hip is extension and rotation. Often the patient will present with a mild hip flexion deformity resulting in an anteriorly rotated pelvis. This anteriorly rotated pelvic position leads to increased shear forces at the L5S1 segment of the lumbar spine, and can lead to associated degenerative changes at the L5S1 facet joints and the L5 disc.
It is an injury of the tendon of gluteus medius, a major hip stabiliser. It can be thought of as like a tennis elbow problem affecting the gluteus medius tendon. Tendinopathy is a failed healing response in the tendon and can be caused by dropout of some of the tendon fibres, and irritation of the remaining fibres. Common presentation is pain over the outside of the hip, especially with walking but also lying in bed on the affected side. Decreased ability to walk for long periods, or climb stairs or hills. Tenderness – over the greater trochanter is also likely.