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Medical Journal of the Mexican Social Security


ISSN: 0443-5117
Mexican Social Security Institute Mexico

Ramírez González, Susana; Chaparro Ruiz, Ezequiel Salvador; de la Rosa Alvarado,
María del Rocío; Diaz Vega, Manuel; Guzman Gonzalez, Juan Manuel; Alcantara Jimenez, Jose
Alfredo Jimenez Alcantara; Lopez Roldan, Veronica Myriam; Rosas
Medina, Julio
rehabilitation clinic for patients with cervical sprain, guide on the first level
of attention
Medical Journal of the Mexican Social Security Institute, vol. 43, no. 1 2005, pp. 61-68
Mexican Social Security Institute
Federal District, Mexico

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7 SUMMARY SUMMARY July Rosas Medina 1 The whiplash injury is a ligamentous stretching the Whiplash is a sprain of the ligament strain of the muscles of the cervical spine for acceleration mechanism paraspinal With muscles due to acceleration or 1 Emergency Hospital and disadvantages acceleration energy transmitted to the acceleration of energy transmitted back to the neck.guince Communication with: muscles of the cervical spine by a mechanism of their activities of daily life and work through Juan Manuel acceleration and deceleration of energy transmitted to rehabilitation treatment pro. in 2000 Ron REGISTERS at the Mexican rehabilitation Institute of Social Security more than 15 thousand cases of work accidents CLA. affecting work and a multitude of discomforts That Affect job-related and Dominguez " activities and daily life of the patient presents.First version: June 8. 2004 Accepted: August 17.: 5726 1767 E-mail: Clinical data presented are neck pain. 6 Myriam Verónica López Roldán. 1 Ezequiel Ruiz Salvador Chaparro. 4. rehabilitation Rev Med IMSS 2005. 1-5 of care. CLI. With This information. Jose neck.6-10 Its incidence was cal. neck stiffness. addressed to the family doctor. On this organized an expert team in order to Develop guidelines XXI century basis a clinical guide rehabilitation of patients with using methodology of evidence-based medicine and with a 3 Unit of Physical Medicine and cervical esguin. In 2000. limited jmguzman@avantel. Tel the neck. muscle spasm or "contracture". timely referral to another ni.fied in the heading of Users guide Key words dislocations. 4 sprain. if necessary. was more than 15 due to job-related activities.ce. 43 (1): 61-68 61 . 12 Whiplash family physician. snapping sensation. rehabilitation. lacerations and sprains neck. 2 Medicine Unit incidence of cervical sprain that occurred in 2000 in the rity System more than 15 000 Treated cases of whiplash Family Room neck mobility (stiffness). 5 José Alfredo Jimenez Alcantara. who focus on early treatment prescribed by generally the rehabilitation Region determined Bera promptly implement the practitioner in order for the patient to Obtain quick relief Center recommendations of the guide was developed.vel care.cula Specific objectives in more than one million cases annually in the United States. eleven sequelae. physical therapist. muscle symptoms are neck pain. Women are affected in 70% and the age Reduce disability time. at work 5 Care Coordination 6 Orthopedic Hospital Lomas Verdes and Traumatology 7 Regional Hospital 72 Mexican Social Introduction General purpose Security Institute The whiplash injury is a ligamentous stretching the timely reincorporate the patient with cervical is. we Medical Center thousand cases were classified as accidents. Keywords Whiplash In Mexico. 2004 Final Version: July 4. 3 Manuel Diaz Vega. neck stiffness. 2 Clinical guide María del Rocío de la for the rehabilitation of patients with cervical Rosa Alvarado. The activities of daily living.solely neck pain. Avoid complications and group involved in greater proportion is 20 to 40 years. National Mexican Social Security Institute. The Traumatology "Dr. at the primary care level Juan Manuel González Guzmán.portioned on the first level Guzmán González. . the Mexican Social secu. muscle spasm Manuel Ortega spasm and aggregates symptoms. 2004 Susana Gonzalez Ramirez. and to return the patient to His job and to His daily living 4 Health Coordination activities as soon as possible.

2. Evidence for meta-analysis A. Developing guidelines. 43 (1): 61-68 . Direct evidence based a non-randomized controlled study category II evidence or extrapolated recommendations of category I IIb. 1. Direct evidence based category III no experimental as comparative studies. Evidence of at least B.4.6. 318: 593-596. D. the criteria of the guidelines for users of medical literature publication two JAMA between 1993 and systemization: clinical picture of compressibility root 2000 . whiplash. At least one other type of study Quasi-experimental or cohort study III. Whiplash associated disorders: It is presented in 16-44% of cases and manifest as headache. Grimshaw J. dermatoma and For the classification of the category of evi. one stage protocol. They were operational definitions included for the construction of this guide five systemized clinical reviews. biblio- that is transmitted gives the neck.7. regardless of their methodology. sore jaw. dizziness. Modified Shekelle P.10. Direct evidence based category I Ib randomized clinical trials. the whiplash or whiplash (whiplash) or forced Medline database for finding clinical trials pu. Class I or II evidence clinical reviews. atendi. Whiplash adults with grade I or II. Search keywords were neck sprain injury. Eccles M. Evidence of expert committee.9. opinions or clinical experience or extrapolating recommendations of authorities in the field or both Evidence Class I or II * The category of evidence indicates the user the origin of the issued recommendations. case-control.blicados flexoextension syndrome: ligament injury with was used after the date of systematized clinical review stretching the muscles of the cervical spine due to and three RCTs and other aggregates items were acceleration and deceleration mechanism of energy considered.13 graphy basic and clinical guidelines available practice in different electronic pages are included. IV. Direct evidence based category IV reports. Evidence of at least IIa clinical trial randomized controlled. Clinical guidelines. using of clinical symptoms and nasal mucus. neck disorders. shoulder or The material found was analyzed by the team back. or extrapolating recommendations correlation studies. Evidence of a descriptive study C.dence and osteoarticular reflex. BMJ 1999. clinic Whiplash whiplash injury. strength of recommendations. The database was consulted Cochrane Library. 62 Rev Med IMSS 2005.two on the guide rehabilitation first level of attention Mexicano Social Security Institute. 1. utili- table I Classification level of evidence and strength of recommendation on the contents of these guidelines * Evidence category Strength of recommendation Ia. vertigo. sion involving the myotome. whiplash. Susana white population Identification and selection of Gonzalez Ramirez data et al. Woolf S. dysphagia.14-16 builder guidance and eventual inclusion was Remission Whiplash: Remi sion considered the absence conducted by discussion among participants. sources of information dating from 1995 to July 2002.

Communication with the service (rectification or inversion lordosis) do not always Rehabilitation of primary care. semi-rigid or extension (ear closer to the shoulder) and rotation (move the head to the right and to the left). 10 times each. if acid peptic disease. Whiplash Annotations to the algorithm Add ranitidine 150 mg tablets. 14. 14 and 16 hours. muscle relaxation. once every 24 hours. no physical signs II Naproxen 250 mg tablets. tinnitus. to be performed three times a day.17 hygiene column (Annex 1) (Ia A. Drug treatment: one of the follow. must refer the patient to the emergency department of Teach patients the following therapeutic exercises traumatology. dis . signs and neurological symptoms hours. phosphenes. 10. Susana Gonzalez fication of more paracetamol 500mg tablets.schemes 5 to 7 days: 0 asymptomatic I cervical pain. since there is evidence that the radiological changes observed in the Indicate relative rest. * Quebec Task Force classification Grade symptomology 4. The family physician clinically corroborates the diagnosis of cervical sprain and classified into grades according to the classification of Quebec Task Force It is shown in 5. once every 24 hours. headache. given by because its origin puededeberse to post-tural defects the nurse service. . more paracetamol 500mg tablets. two within 12 hours. Diclofenac tablets 100 mg.Neck: actively mobilize the head flexion.They Zaron the characteristics described in Table I. on measures of postural (IIID.comminution * Criterion formulated by pain (IIIC. there is evidence linking early removal of the collar with a lower cia incidental complications or persistent pain. pain located paracetamol 500mg tablets. so it is recommended is removed at seven to 10 days of injury. Grade III sprains or to other cervical pathology braquialgia. a situation that is pre.tigo.sents in surface heat with water bag. The family physician initiates pharmacological and slowly: non-pharmacological treatment in patients with cervical sprain grade I or II. Ia a).ever. more Stiffness. 43 (1): 61-68 63 . systematization or complication. or infrared heating 44% of cases with grade I in 29% grade II and grade III pad on the affected area for 20 minutes or more 16% (IIIC). 10 to obtain the benefits of apy termote-: vasodilation. classi.15 2. lateral Using collar and type thereof (soft. one or two every 8 III Symptoms. Ia A. Non-drug treatment: Apply cryotherapy in the first Table II. guide rehabilitation clinic eight hours. IV Bone injury fracture / dislocation Piroxicam 20 mg tablets. Rev Med IMSS 2005. rigid) is controversial. to give the patient correlate with the mechanism degree sprain injury or a teaching session or group information. Aggregates are considered symptoms: 48 hours after injury (IIID). assessing the neutral state rológico and ensuring that the patient performed the treatment table II set to avoid residual pain.if. deafness.18 consensus by the manufacturer Radiologic studies are requested rule out bone or To of the guide team unlock degenerative lesions.14. 3.fagia. contracture. IIIC). how. one or two every eight Source: References 10. 3 dizziness. pain in jaw. dis. one every 12 hours. Indicate normal diet without physiological curvature of the cervical spine irritants. 3. one or two every Ramirez et al. ver. shoulder or back After 48 hours of injury. 1. Ia B). start the application of and emotional instability.

Root affected muscles Reflection Sensitivity C-5 Deltoid Bicipital lateral surface of the arm C-6 Wrist extensor brachioradialis outer surface of the forearm. guide rehabilitation 9. the patient refer.Joria or cervical sprain.Shoulders and upper extremities: raise 8. 6. and hypoesthesia diminished reflex triceps middle finger. Refer the patient to the rehabilitation of the first will depend on the clinical picture and labor level if the move. subsequent evaluation carried out on the seventh 11. or if further has a preexisting pathology (osteoarthrosis). table III Time disability in relation to labor activity of the patient (IIIC) 9 12. IV. including: Briefing construction team guide collar or stay for another week.for qualification. flexion. classifies the degree of injury and consensus by the remission of symptoms. Ia C. thumb and middle finger. ring and little fingers. Options supervised treatment: * interferential currents at the site of the lesion with analgesic Type of work Minimum Optimum Maximum and anti-edema mode for 15 to 20 minutes. abduction and of high medical home exercise and postural hygiene et al. Relaxation (Annex 1). altered sensitivity of the distal half of the forearm. It provides temporary inability to low according to clinical and patient physical activity at work (Table III) TRA. Neurological injury level C-6: weak wrist extensors and decreased sensitivity forearm.19. Neurological injury level C-7: flexor weakness wrist. and identify on postural hygiene column with load handling probable neurological or vascular complications.rar removal of the defines rehabilitative treatment. C-8 Flexor digitorum Any Forearm inner region 64 Rev Med IMSS 2005. The granting of temporary incapacity for work and its duration 10. 7. The rehabilitation doctor confirms diagnosis of * Criteria formulated by day of the injury to determine Me. not to give the basic treatment.8 measures column. III) 5. Refer to the patient to the emergency services trauma clinic Whiplash in the presence of systematisation (Table IV). If possible risk of work. C-7 Wrist flexor triceps outer side of the middle finger. index and middle finger half.20 Neurological injury level C-5: deltoid weakness. and brachioradialis thumb. extension. In the event of improvement. Moderate 3 7 14 Heavy 3 twenty-one 28 Very heavy 3 28 42 table IV Evaluation of neurologic injury to the cervical spine (Ia B. consider with indications Gonzalez Ramirez shoulders. compresahúmedo-surface heat with hot or Sedentary 1 1 7 infrared rays for 20 minutes. Establishes and oversees rehabilitation treatment. Service under traf. valo. 43 (1): 61-68 .4.RIR Health severe pain or bone lesions previously undetected. Susana .ment limiting muscle spasm or activity performed by the patient (Table III). IV). 2. decreased or absent biceps reflex and decreased sensitivity external face of shoulder and arm. adduction of the upper extremities (IIIC. Assesses whether drug treatment is continued. Neurological injury level C-8: weakness of the finger flexors. and neck exercises Light 1 3 7 and shoulder girdle .

Rene C. Whiplash disorders-review. Acute treatment of whiplash injuries neck sprain. A randomized trial of treatment During the first 14 days after a car ficial wet-hot compress or infrared rays for 20 _ information / back-neck_disorders / neck_sprain_ outline. The medical rehabilitation refer the patient to the 14. Bie RA. Evidence-Based Panel Philadelphia Clinical Practice. CH Goldsmith. Gross AR. 16. p. Moderno. 2002. Buenos Aires. Health statistics memory clinically cervical mobility. 2003. Int J Care Injury 2002. Reassessment by the rehabilitator doctor who evaluated 12. CERVICAL. 2002. Bertholus P. The Cochrane Database neurologic compromise (Table IV). Medical-Surgical Encyclopedia. Stikes TC. Neurology Orthopedic Mexico: El Manual 2. Mexico: El Manual Encyclopedia. (4): 749-759. Pain Syndromes neck and arms. Brault JF. Argentina: Pan American. improvement or remission of symptoms. Goldsmith CH. Lereim L. Koe B. Legrand C. Home Program: includes exercises and muscle Review.tion of Moderno 1981. Barkin R. reeducation column hygienic measures (Annexes 1 Conservative treatment for whiplash. Spine 1998. Phys Med Rehabil Clin N Am 1996. The Cochrane neck flexion of 20 to 30 degrees for 10 minutes. 4 th for the neck and shoulder girdle. galvanic currents in 81 (10): 1701-1717. and neck exercises and shoulder girdle. Verhaeghe M. p. Preventing chronic whiplash pain. Phys Ther 2001. Galasko CSB. France: Elsevier.htm 15 minutes with húmdo-surface heat or hot 09/07/2002. Ultrasound at doses of 0. heat super. affected area. girdle. Soft tissue injuries and back pain spine. and neck exercises and shoulder 6. Givens Injuries the cold treatment. Neck sprain or strain (sometimes Known as Whiplash). 153-164. 2002. IMSS. 7. Coordination Health at Work. Tens to 80 Hz for 15 minutes.chosocial rehabilitation for traction preferably supine or sitting position. cervical Hurri H. Borchgrevink GE. National Institute of Arthritis and Musculoskeletal and Skin Diseases Susana Gonzalez minutes. Peeters GG.html + training + + + cervical sprain & hl = en Charpentier P. 5-27. ? Sprained cervical. Paris.physsportsmed. p. Gross AR. The Physician and Sports Medicine. with previous strains. 1998. 26 (294): 1-19. at work. Ultrasound at doses of 0. compress infra. Ramirez et al. Aker P. Stanford B. Apsit muscle reeducation of cervicalgias. 11. Louis: Mosby.5 to 1 w / cm 2 for 7 4. 15. St. Verhagen A. guide www. 878-905. Roine R. Multidisciplinary biopsy. 20. 26 (285): 1-15. Mishra A. Cervicobraquialgias. 8. editors. bone lesions previously undetected. Database Systematic Review. 2003. 26 (160): 1-25. France: Elsevier. Bebión And Haffray H. 2003. Paris. 1. shoulder girdle and shoulders.5 to selected rehabilitation interventions for neck pain. Karjalainen K. Medical-Surgical 19. Van Tulder M. 24 (3): 1-4. In: www.www. injuries of the cervical spine in the absence of neurological 21. Doctor Back. Bruce C. Medical-Surgical Encyclopedia. This alternative is recommended as first choice in 10. starting with 3 kg weight and increase half kilo per day up to 10% of patient body weight. The Cochrane and 3). exercises 9. Warren J. Rosen P. Haraldseth O.rrojos rays for 20 minutes. 17. 97-101. Aker search q = lesions. Physical medicine Peloso emergency services trauma in the presence of Modalities for mechanical neck disorders. Aker PD. FORMACION_CONTINUADA / ESGUINCE_ continued 3. 43 (1): 61-68 65 . Drug therapy for mechanical neck disorders. p. Emergency Medicine. 23 (1): 25-31. Badelon BF. 2002. develops and 13. Rev Med IMSS 2005. Manual medicine approach to the cervical cases of pre-existing pathology (osteoar. Hoppenfeld S. performs high service liaison with the family doctor. Malmivaara A.trosis) or spine and whiplash injury.emedx. Database Systematic Review.Gesica mode for rehabilitation clinic infrared rays for 20 minutes. 1996 March. Bilkey Jr. 33. Guidelines on Whiplash and shoulder girdle. muscle strength and neurological status. McDonah D. 18. Oostendorp RA. and neck exercises 5. surface heat with hot damp pad or (NIAMS). Peloso P. The Cochrane Database Systematic 15. minutes. Jauhiainen M. Lovell ME. France: Elsevier. rehabilita. temporary devices. Kaasa A. cache: AXbR_5QH1AEJ: cuidelaespalda. Burlot PM. 2002. interferential currents with anal. (Appendix 2). 2001. If you determine 2000. Cibeira JB. The Cochrane Database References Systematic Review. severe pain or Systematic Paris. Peloso P.htm cold. with neck and shoulder pain working age adults Among. Goldsmith CH. 165-210. 1991. edition. Mexico: Directorate of Medical Services. Gross AR.clinicaltrials. 1 w / cm 2 for 7 minutes. Badelon I. Microtrauma disease. E. Patient education for mechanical neck disorders.

classification and treatment Whiplash 66 Rev Med IMSS 2005.Algorithm. 43 (1): 61-68 . Diagnosis.

Lying above without a pillow in the head and with two or three pillows under the knees. B Ia. To load heavy objects it should help with shopping. Ia A. postural Lying above: It should be placed a small pillow cover head without shoulders. the weight should be exchanged in each arm. Seated: using preferably a straight back chair with hip flexion 90 degrees and 90 degrees knees. Lying above.14. placing a pillow under the waist and another small low ankles. Also. Rotate the head side desired.17. you must toggle the semiflexion knee with both legs. with a small pillow to head level without embracing shoulders. To push or pull objects should be placed one leg forward. maintain function and delay the degenerative process. guide column hygienic measures (IIIC IIIC.21 rehabilitation clinic Whiplash Column hygienic measures are recommendations that are intended to prevent injury.10.15. 43 (1): 61-68 67 . Relaxation Lying for 20 or 30 minutes. hooks and hoists. rotate the head side desired. Lying On Side: place a large pillow between your neck and shoulder and a pillow between your knees. Loading two objects must perform symmetrically to level the load. for 20 or 30 minutes. Standing: semiflexionar recommended knee (rest position soldier) or leaning on a stool of about 20 centimeters high. weighing or not. you should crouch with knees bent and load the object close to the body. Appendix 1 Susana Gonzalez Ramirez et al. Rev Med IMSS 2005. Laying face down: place a pillow under the waist and ankles a little low. Ia A. Load handling When picking up objects from the floor. Inhale air through the nose hold three seconds and exhale through the mouth. and another small pillow under your knees to maintain a flexion of 15 degrees. and a small pillow under your knees to maintain a flexion of 15 degrees. flexing the knee to perform the movement. Loading an object. IV) 9. By performing these relaxation techniques to concentrate and think about nice things. Adopt positions to activities of daily life and work.

Susana Annex 2 Gonzalez Ramirez Cervical traction et al. 43 (1): 61-68 . guide rehabilitation clinic Whiplash Annex 3 Muscle rehabilitation exercises 68 Rev Med IMSS 2005.