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Whiplash
A cervical whiplash can be clinically complex. If an internal derangement plays a role, it should be reduced as soon as possible in order to avoid future instability.
(Part I, p267 ; Part II, p63-73)
Whiplash trauma
The word "whiplash" of course is not a diagnosis ; it only indicates what kind of injury has occurred : e.g. the car was run into from behind, the patient's head has moved first into hyper-
extension, then hyperflexion. Several lesions could occur, e.g. a ligamentous rupture, a fracture, spinal cord compression or (in many cases) a central disc protrusion.
The series of events is well known : after the accident, the patient is stunned for a moment, there is a medical imaging examination which probably proves negative. The next day, the neck is very painful and very limited, it is fixed in flexion ; a cough hurts. The pain and the limitation remain rather severe for several weeks, and improve gradually within the next few months.
The Cyriax approach is as follows : if the medical imaging proves negative and the clinical examination shows the pattern of a large central disc protrusion with a cough hurting (the same combination of gross articular signs and a dural symptom as in an acute lumbago), then we think of an internal derangement being responsible for the symptoms. Unreduced, this would cause the formation of osteophytes within six months with, as a result, irreversible loss of some degree of rotation and/or extension.
This evolution should be avoided by early reduction of the bulged disc.
(Another advantage of early reduction is the lesser possibility of ligamentous overstretching, which would make this level rather unstable.)
It is highly important to realize that the protrusion lies on the midline, i.e. that only the strategy for central disc protrusion is used : only manipulation techniques under strong traction may be used, and no rotations at all !
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