Whiplash Associated Disorder (WAD) and Ultrasound-guided Prolotherapy
Most people who have suffered from whiplash associated disorder (WAD) improve over time although some require multi-modal rehabilitation. However, there is a sub-section of those involved in motor vehicle collisions, or who have sustained a body blow from a sport or a fall, who have ligaments in their spine that were sheared and remain lax.
These individuals have refractory (ongoing) pain and tightness in the upper back and neck that improves to a degree with conservative rehabilitation treatment and/or medication, but always returns in the same pattern. Usually, they have tight and tender sub-occipital muscles, trapezius, semi-spinalis capitis, scalenes, levator scapula, and rhomboid muscles. They often demonstrate a rounded-shoulder head-forward position and sometimes altered scapular muscle control.
This population typically benefits from medical dry-needling, trigger point injections, massage, manual therapy, taping, bracing and medication - but only temporarily. However, when prolotherapy is added to the treatment regime and creates increased stability in the previously injured joints and ligaments, much improved outcomes are normally experienced in terms of reduced pain and improved activity levels.
Research has shown that the C5-6 segment in the cervical spine is typically a hinge point and is often damaged in WAD-type injuries. However, mounting evidence now suggests that the upper thoracic spine may also be more of a contributor to neck, shoulder and upper back pain and dysfunction than was once thought.
As result, we have successfully explored the use of ultrasound-guided prolotherapy to the costotransverse joints and capsular ligaments of the upper thoracic spine (T1 to T6 typically) to address ongoing pain. Anecdotally, we have found that treatment to these areas reduces sub-occipital tone (upper neck muscle tightness), and improves scapular control as these muscles are no longer trying to stabilize the costotransverse joints.
Typically, one requires 4-9 treatments sessions at a 2-4 week intervals. We recommend that you see your preferred rehabilitation professional between treatments, and for at least 6 weeks following the completion of the treatments to relieve post-treatment discomfort, and to progress one’s rehabilitation in an effort to maximize the new-found stability in the neck and thoracic spine.