Hypermobility and whiplash

[physiofi]

Hi all,

I was just wondering what people's experiences were (with regards to treatment of patients / personal experience or both - mine is both!) regarding whiplash associated disorders and hypermobility. 9 months ago I had a whiplash injury, was rear-ended at about 50mph while my neck was rotated to the right. Developed stiffness and pain in both sides of my neck, but predominantly left side over the next few days. This took a good 3-4 months to settle completely and I thought I was alright, although aware it could take longer to fully resolve. About 2 months ago, I slipped while walking and fell landing on my knee but noticed my neck became a lot more sore after this (also coinciding with quite a lot of stress in work). I had one of my colleagues look at my neck and he said he thought it was because my neck was quite hypermobile that it would take longer to heal. The left side of my neck feels tight despite regular stretching (traps, lev scap, scalenes etc) and will occasionally spasm and be very painful if I'm stressed or not on top of my exercises (ROM / retractions).

I've also had headaches since the accident (have had no formal treatment or x-ray etc as didn't feel it warranted it at the time) which vary from mild and behind my eyes/head to raging and lasting about 4-5 hours, worsening with stress/tiredness. These have settled down considerably...I find if I have a session of trigger pointing after using heat and gentle stretching that most of my neck pain settles considerably and is no longer as severe as it was, although it tended to relapse from 0 pain to very painful so quickly that I am a bit wary when saying it's resolved...even though I feel at the moment it is getting there.

My question is, do people with hypermobile joints take longer to recover from injuries e.g. whiplash? I haven't found much information or discussions on it so was wondering what other physios' experiences were. Should I keep going with trigger pointing and stretching over a longer period to resolve things? Or is there anything I can try to speed it up?

Any input would be much appreciated

Thanks,
Fi.

P.S. I should add that I'm not completely hypermobile....I seem to be borderline-hypermobile, quite flexible but not quite clicking and lax in all joints. 7/9 Beighton score.

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[bikelet]

Hi Physiofi,

Through my experience with patients I think they may be some link between hypermobility and whiplash associated disability. Below is just my thoughts on this, feel free to disagree or discuss.
Whiplash can be messy to recover from and seems more strongly affect those who are more mobile in the neck.

Why?
-Possibly because if there is more movement to control at each joint, the muscles have a harder time maintaining postural control and are thus more susceptible to trigger points and muscle fatigue.
-Related to this point- joint pain can occur when muscle control is suboptimal and there is joint subluxation or excess end of range loading.
-Another thought is that the whiplash itself may have increased your cervical mobility through the accident itself, through stretched or torn ligaments. If ligaments and muscles are damaged from the accident, this is decrease your sense of proprioception through altered joint and muscle receptors and make it easier to take joints past their natural comfortable limit resulting in abnormal loading(think of a sprained ankle).

So with these points in mind, probably the most important thing to improve is your postural control. Improved postural control will decrease abnormal muscle and joint loading and pain signals going into the brain and hopefully break the pain cycle.
Pay close attention to head, neck and shoulder posture as well as making sure that the whole body posture is good. Pay very close attention to your posture throughout the day and see if you can find any links to tasks and your pain-there are usually more than you would think.
Do proprioception exercises for your neck eg writing letters with your nose, doing deep neck flexors exercises. Trigger points and muscle releases are good- especially infraspinatus and subscapularis however don't forget to strengthen appropriate muscles as well or the trigger points are likely to return.

Hope this helps

[physiofi]

Hi bikelet,

thanks for your reply. I definitely agree - I hadn't even noticed I was 'hypermobile' or so flexible until one of my colleagues had pointed it out, as I'd never had any problems prior to this whiplash injury. I have been adding in deep neck flexor exercises to my daily routine and find these really help at easing my neck pain. I definitely feel I'm on the road to recovery now and things are settling considerably...

As you said, identifying the triggers that will set it off is important and I know if my posture isn't good then I will feel it more. As I write this, I've neglected my posture the past few hours and can already feel the difference! Will definitely try the proprioceptive stuff. When writing the letters with my nose, should I be writing them with a small, controlled movement, or a larger sweeping motion?

[bikelet]

Hi Fi,

I'm glad to hear that you are having some improvements in your symptoms. You can do both small and large circles with your nose- so big and finer controlled movements. Also pay attention to your scapular position throughout the day, maybe do some scap setting ex