Q: My brother experienced a car accident last month and the doctors have used a term whiplash injury while describing his condition. Kindly guide what is the meaning of the term in detail and how physical therapist can help the patients.

A: Whiplash injuries are commonly sustained in motor vehicle accidents due to sudden acceleration and deceleration movement of the cervical (neck) spine. There is proper diagnosis based on clinical picture of the patient in order to rule out any fracture, disc herniation, artery rupture, spinal cord injury, ligament injury or subluxations. A physical therapist takes detailed history with examination to proceed. There are three stages of the injury, 1: Flexion (bending) of the cervical spine, 2: S shape cervical spine, 3: Extension (backward bending) of the cervical spine which can lead to compression. The condition has been graded as 1: The patient has neck pain, stiffness or tenderness with no positive findings on physical examination, 2: Decreased range of the neck and tenderness, 3: Neurological sign and symptoms like sensory disturbances and muscle weakness etc. The condition is not only confined to motor vehicle accidents, it can also occur in sport injuries and falls. It is common in women as compared to men. The condition depends on various factors including impact, gender, age etc. The prognosis is variable for every case, there is complete recovery in most of the cases, in about 25% cases experience some disability. A multidisciplinary program is initiated for the patients, a physical therapist encourages return to activity and utilizes relaxation techniques, mobilizations / manual techniques, strengthening and postural education to ensure maximum rehabilitation.

Q: My daughter is 10 years old and the doctors have diagnosed her with scoliosis. Please describe the condition.

A: Scoliosis is the deviation of the spine to the side (lateral deviation). It is commonly diagnosed in childhood or adolescence. In order to measure scoliosis. Although the lateral deviation is highlighted in scoliosis, the element of rotation also adds to it. The signs of scoliosis include lateral or sideways deviation of the spine, the sideways posture, shoulders are not aligned and one of them is higher than the other, muscles are aching, pulmonary issues (the concern in progressing scoliosis). In a number of cases patients have back pain, though the diagnosis needs to be thoroughly confirmed. There are three types of scoliosis, 1: Idiopathic: In most of the cases (about 80%) if no cause is identified the condition is said to be idiopathic.It can also occur in adults specially old adults due to degenerative changes of the spine, it is common in adolescents and is further divided into Infantile scoliosis (the child is 0-3 years old), Juvenile scoliosis (child is 4-10 years old, if the condition is not properly and timely treated, it can lead to cardiopulmonary issues. If the curve is more than 30 degrees it can progress and even require surgical procedures, Adolescent scoliosis (11-18 years of age) 2: Congenital scoliosis means that the condition is by birth, It may be due to any faulty or slow development of the spine at a location during pregnancy. 3: Neuromuscular scoliosis: The condition can develop as a complication of any neuromuscular condition like cerebral palsy, spina bifida or muscular dystrophy. For the diagnosis of scoliosis, a physical examination, an x-ray, MRI or a CT scan. Cobb’s angle is used to measure the angle of scoliosis which will further define the severity and progression. An Adam’s forward bend test and a scoliometre is also used. An examination is required to check whether the scoliosis is structural (no plasticity is found generally and the pathology lies in the spine) or non-structural (caused by any other factor or structure than the spine itself e.g. leg length shortening on one side). The treatment is divided into conservative and medical or surgical. The patients who just have mild lateral deviations do not need any kind of treatment, in children however regular checkups are recommended because of their growing age. The conservative management includes braces and physical therapy, if a child has mild scoliosis and wears a brace, it will keep the condition from progressing but will not work to reverse the deviation. Severe conditions require surgical procedures like spinal fusion of some vertebrae, hence they lose movement and get fixed. In some cases when scoliosis is continuously progressing, a rod is placed in the spine. A physical therapist can help in muscular strengthening, coordination, equilibrium, respiratory education, ergonomics etc and plan an exercise program for the patient.