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Epidemiology
Whiplash is the term commonly used to describe hyperflexion and hyperextension. Whiplash is one of the most common nonfatal car accident injuries. Over 1 million whiplash injuries occur each year due to car accidents alone. This is an estimate because not all cases of whiplash are reported. There is an estimate 3.8 cases per 1000 people per year that experience whiplash symptoms. “Freeman and co-investigators estimated that 6.2% of the US population have late whiplash syndrome”. The majority of cases with whiplash occur in patients in their late fourth decade. Unless a cervical strain has occurred with additional brain or spinal cord trauma mortality is rare Whiplash injury can occur at speeds of fifteen miles per hour or less; it is the sudden jolt, as one car hits another, that causes ones head to be abruptly thrown back and sideways. The more sudden the motion, the more bones, discs, muscles and tendons in ones neck and upper back will be damaged. Spinal cord injuries are responsible for about 6,000 deaths in the U.S. each year and 5,000 whiplash injuries per year result in quadriplegia.

Most cases of whiplash occur among Caucasians 66.1%, as compared to 27.1% for African Americans, 8.1% for Hispanics, and 2% for Asians, as seen in figure A. After 12 months, only 1 in 5 patients remain symptomatic, only 11.5% of individuals were able to return to work a year after the injury, and only 35.4% were able to get back to work at a similar level of performance after 20 years. Estimated indirect costs to industry are $66,626 per year, depending on the level and severity. Lastly, the total cost per year was $40.5 billion in 2008, a 317% increase over 1998 .

Treatment
Treatment for whiplash is dependent on the grade category. It can be categorized as grade 0 being no pain to grade 4 being very severe pain. A physical examination can help identify what type of treatment is most suitable. For the most part we will be looking at treatment for grade 1 and 2. . Whiplash Associated Disorders. Pain Practice, 10 (2), 131-136. states that there are two treatment options: conservative management and interventional management. Conservative management includes active and passive treatments. Interventional management is medical treatments and interventions this includes: steroid treatments and botulinum toxin injections.

Active treatments are light repetitive exercises that work the area to maintain normality. Basic information is used to teach the patient about their injury. These exercises are done at home or under the care of a health professional. . Physiotherapy and Management in early whiplash associated disorders (WAD). Advances in Physiotherapy, 8, 98-105 suggested using three types of exercises to improve mobility: looking over each shoulder, moving the arms up and down anteriorly, and taking a deep breath while lifting the shoulders upwards and exhaling while relaxing the shoulders. Active treatments and are usually preferred.

Passive treatments are physiotherapy techniques such as: acupuncture, massage therapy, and stimulation. These techniques all involve physical agents. used physiotherapy techniques such as acupuncture, stimulation, and heat treatments in their study and the results showed that patients showed significantly less pain. Botulinum toxin type-A is used to treat involuntary muscle contraction and spasms. Botulinum toxin type-A is only temporary and repeated injections need to take place in order to feel the effects

For chronic whiplash patients rehabilitation is recommended. Patients who entered a rehabilitation program said they were able to control their pain, they continued to use strategies that were taught to them, and were able to go back to their daily activities

Everyone reacts to treatment differently. It is important to follow up with a doctor and follow all necessary instructions.

Rehabilitation
The potential injury to the cervical spine from hyper-flexion or hyperextension may be debilitating, and pain was reported to be the biggest stressor event experienced in daily living, so it is important to begin rehabilitation immediately to prevent future pain (Bring, Soderlund, Wasteson, Asenlof, 2012). In most clinical cases, soft collars are recommended until the pain ceases (Schnabel, Ferrari, Vassiliou, & Kaluza, 2003). Schnabel and colleagues (2003) also stated that the soft collar is not a suitable medium for rehabilitation, and the best way of recovery is to include an active rehabilitation program that includes physical therapy exercises and postural modifications. Another study found patients who participated in active therapy shortly after injury increased mobilization of the neck with significantly less pain within four weeks when compared to patients using a soft collar (Logan, Holt, 2002). When beginning a rehabilitation regimen, it s important to begin with slow movements which include cervical rotation until pain threshold three to five times per day, flexion and extension of the shoulder joint by moving the arms up and down two to three times, and combining shoulder raises while inhaling and releasing the shoulder raise while exhaling (Soderlund, Olerud, Lindberg, 2000). Soderlund and colleagues (2000) also recommend that these exercises should be done every day until pain starts to dissipate. Early mobilization is important for preventing chronic pain, but pain experienced from these exercises might cause psychological symptoms that could have negative impact on recovery (Sterner, Gerdle, 2004). To avoid any negative effects, patients should take caution when performing neck exercises.

Prevention
The best way to deal with whiplash injury is to prevent it completely. In car crashes, the head restraint is an important component in preventing whiplash injuries. The most effective head restraint must allow a backset motion of less than 60 mm to prevent the hyperextension of the neck during impact (Stemper, Yoganandan, Pintar, 2006). In the case of athletes who might experience hyperextension of the neck during competition, regular strength building exercises for neck muscles prevent injuries from occurring. Although there is different strength training modalities available, the Multi Cervical-Unit was found to be the most reliable in building isometric strength of the neck (Burnett, Naumann, Price, Sanders, 2005).

Anatomy
Whiplash can occur in many different situations, the most common way is in a vehicle collision. Or for those who are thrill seekers in can occur during bungee jumping. Whiplash can be described as a sudden strain to the muscles, bones and nerves in the neck. The neck is made up of seven bones and they make up the cervical vertebrae (Floyd, Thompson) The first two cervical vertebrae are distinctive because they are not shaped like the rest. The first cervical vertebra is the atlas and the axis follows. The atlas and axis are responsible for movement from side to side (cervical rotation to the right and left); also moving forward and back ward (cervical flexion and extension)( Floyd, Thompson) Excessive extension and flexion can disrupt the vertebrae.

There are four phases that occur during “whiplash”: Initial position (before the collision), retraction, extension and rebound. In the initial position there is no force on the neck it is stable due to inertia Anterior longitudinal ligament injuries in whiplash may lead to cervical instability. Medical Engineering And Physics, 28(6), 515-524. They explain that during the retraction phase that is when the actual “whiplash” occurs, since there is an unusual loading of soft tissues. The next phase is the extension, the whole neck and head switches to extension, and it is stopped or limited by the head restraint. The rebound phase transpires as result of the phases that are mentioned.

During the refraction phase the spine forms an S-Shaped curve, and this caused by the flexion in the upper planes and hyperextension at the lower planes and this exceed their physiological limits this phase the injuries occur to the lower cervical vertebrae. At the extension phase all cervical vertebrae and the head are fully extended, but do not surpass their physiological limits. Most of the injuries happen in C-5 and C-6