Edited by Doctor Andrea Bondanini
These are the classic "whiplashes" that do not cause important anatomical lesions, but are still responsible for very painful syndromes.
The etiopathogenetic mechanism is given by hyperextension or hyperflexion trauma of the cervical spine (typically from road tamponade). Clinically there is stiffness and pain; muscle trigger points may be highlighted, or neurological signs such as sensitivity disorders and / or absence of osteotendinous reflexes. Vegetative disorders are also often present, such as atypical dizziness, nausea, occipital, frontal or supraorbital headache, blurred vision, etc.
The Canadian Task Force has classified according to a clinical criterion, cervical whiplash in various degrees:
1st degree: stiffness and pain;
2nd degree: musculoskeletal signs, presence of trigger points;
3rd degree: presence of neurological signs (absence of osteo-tendon reflexes);
4th degree: presence of fracture-dislocation at the level of the cervical spine.
The treatment it will be characterized, in general, by an early immobilization with collar, to reduce painful phenomena, associated with pharmacological treatment (in particular NSAIDs and muscle relaxants) systemically or, if possible, locally with mesotherapy. Re-education must be started early and is aimed at a rapid weaning from the guardian to avoid above all those phenomena of dependence which are very frequent in these forms.
Acute phase (0-15 days): antalgic work with physical therapy (antalgic electrotherapy, ultrasound therapy), breathing exercises, exercises for cautious mobilization of the cervical spine of the active-assisted and active type is indicated. The goals will be pain reduction, contracture reduction, and weaning from the brace.
Sub-acute phase (15-30 days): you can move on to proprioceptive exercises, relaxation exercises; massage therapy (acupressure or Cyriax); a possible selective treatment of trigger points (infiltrations, stretch and spray) may be useful; the goals will be to reduce pain and contracture, recover movement and rebalance posture. The proprioceptive re-education must be started as soon as possible, in fact it plays a beneficial role on a psychological level and allows an early recovery of mobility and stability of the cervical spine.
Last phase (over 30 days): includes exercises for the recovery of the complete joint range, both passive and active, proprioceptive exercises to reintegrate the neck into one's body scheme, global postural re-education exercises, exercises and ergonomic concepts to prevent episodes of exacerbation of neck pain (especially related to incorrect postures in the workplace).
In some selected cases, Vertebral Manipulations prove to be decisive, requiring specific knowledge and manual skills for the physician who performs them.
Early, but short, management allows to limit the frequency of post-traumatic cervical syndromes with the classic symptomatic procession (dizziness, tinnitus, headaches, visual disturbances) and the chronicization of neck pain, whose treatment is always long, difficult and , at times, not conclusive.In all the traumatic forms of the cervical spine, both severe and mild, the advice on hygiene and postural education that must always be given to patients become a fundamental preventive moment.
