Whiplash injury is a common consequence of vehicular accidents and can lead to debilitating pain and reduced quality of life.1 Photobiomodulation with a class 4 therapeutic laser is a promising modality for managing whiplash-associated pain and promoting tissue healing. This case study evaluates the effectiveness of class 4 laser therapy in the treatment of whiplash injury through a comprehensive analysis of a patient’s experience.
Whiplash injury, commonly occurring due to sudden acceleration-deceleration forces during motor-vehicle accidents, results in damage to the neck’s soft tissues, with potential for fractures, dislocations, and spinal cord injuries. Symptoms include neck pain, stiffness, headaches, and limited range of motion.
“Whiplash-associated disorder (WAD) is the most commonly reported clinical presentation by individuals involved in motor vehicle collisions (MVCs) with an annual incidence that has been estimated to be 300 per 100,000 people in North America.”2
Current data indicate that up to 50% of people who suffer a whiplash injury will never fully recover3 and up to 30% will remain moderately to severely disabled by their condition.4-5 The associated costs secondary to whiplash injury, including medical care, disability, lost work productivity, and personal costs, are substantial.
The Case
Photobiomodulation utilizes red and infrared wavelengths of laser light to stimulate cellular processes and accelerate tissue healing. This case study focuses on a patient with whiplash injury who underwent class 4 laser therapy treatments in a chiropractic office.
The patient was a 32-year-old male who presented with complaints of severe neck pain, restricted neck movement, and constant headaches following a rear-end car collision. Clinical examination revealed muscle tenderness, reduced cervical range of motion, and trigger points in the neck and upper back.
X-rays showed a slight loss of the lordotic curve compared to previous films and were negative for fracture. MRI confirmed loss of lordosis, and was negative for disc herniation, fracture and ligamentous injury.
The patient was diagnosed with grade II whiplash-associated disorder (WAD),6 indicating moderate soft-tissue injury. After a thorough assessment, a comprehensive treatment plan was devised, which included class 4 laser therapy sessions, exercise therapy, soft-tissue treatment, and specific chiropractic adjustments.
Photobiomodulation with a class 4 therapeutic laser is a non-invasive treatment that uses red and infrared wavelengths of laser light to stimulate tissue repair and reduce pain.7 The photons of light are absorbed by the mitochondria and other chromophores within cells, leading to increased adenosine triphosphate (ATP) production, improved cellular metabolism, and reduced inflammation. Class 4 lasers are used to deliver more photons to larger treatment areas, thus positively affecting greater volumes of tissue in the patient.8
Laser Treatment Parameters
Class 4 laser therapy was chosen as a key component of the treatment plan due to its potential to reduce pain and inflammation, enhance tissue repair, and improve blood circulation.9 The patient underwent a total of 18 laser therapy sessions over six weeks. Each session lasted approximately 15 minutes, during which laser treatment was applied to the affected areas on the neck, upper back, and shoulders.
A class 4 laser device with wavelengths of 650, 810, 915 and 980 nanometers (nm), delivering the laser light in continuous wave mode and pulse frequencies ranging from 2 Hz to 1,000 Hz, was used for treatments. The average power was 7 watts (W) and 2,940 joules of energy were applied to an area of 400 cm2, giving a superficial dosage of 7.4 J/cm2.
The patient was comfortably seated in a massage chair wearing laser-specific protective eyewear. The chiropractic assistant applied the laser directly to the cervical spinal area and affected muscles. The laser was moved in a slow, sweeping motion to ensure even coverage of the treatment area. The patient tolerated the treatment well, noting that it was a very soothing experience.
The doctor supervised the first laser therapy treatment, coaching the patient to gently perform active cervical range of motion within his level of comfort. This helps to stimulate neuromuscular activity and soften adhesions, as well as manage swelling in the tissues.
Outcome / Discussion
The patient’s progress was evaluated at regular intervals using subjective and objective measures. Subjective assessment involved self-reported pain levels, neck mobility, and quality of life. Objective assessment included range of motion measurements, trigger-point examination, and visual analog scale (VAS) scores for pain intensity.
After eight sessions of class 4 laser therapy, the patient reported a significant reduction in neck pain, with VAS scores decreasing from 8/10 to 2/10. The patient’s cervical range of motion improved by 60% after completing 12 laser therapy sessions. Trigger points in the neck and upper back showed marked improvement, with significantly decreased palpable tenderness.
The patient reported improved sleep quality, reduced headache frequency, and an overall increase in quality of life. He regained the ability to perform daily activities without significant discomfort.
The outcomes of this case study indicate that class 4 laser therapy can be an effective treatment modality for managing whiplash-associated pain and improving functional outcomes. The therapeutic mechanism of lasers involves photochemical effects, which stimulate cellular metabolism, increase collagen synthesis, and modulate inflammation.10 This, in turn, promotes tissue healing and pain reduction.
Class 4 laser therapy emerges as a promising intervention for whiplash injury, as demonstrated in this case study. The patient experienced significant pain reduction, improved mobility, and enhanced quality of life following a series of laser therapy sessions.
Being non-invasive and free of side effects makes class 4 laser therapy a valuable addition to the treatment arsenal for managing whiplash-associated pain and facilitating tissue healing. Further research is warranted to explore its efficacy across larger patient populations and to determine the most optimal laser parameters for various stages of whiplash injury.
References
- Al-Khazali HM, Ashina H, Iljazi A, et al. Psychiatric sequelae following whiplash injury: a systematic review. Front Psychiatry, 2022 Apr 22;13:814079.
- Ghorayeb JH. The nosological classification of whiplash-associated disorder: a narrative review. J Can Chiropr Assoc, 2021 Apr;65(1):76-93.
- Carroll LJ, Holm LW, Hogg-Johnson S, et al. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD). Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders. Eur Spine J, 2008;17(Suppl 1):83-92.
- Rebbeck T, Sindhausen D, Cameron ID, et al. A prospective cohort study of health outcomes following whiplash associated disorders in an Australian population. Inj Prev, 2006;12:93-8.
- Sterling M, Jull G, Kenardy J. Physical and psychological predictors of outcome following whiplash injury maintain predictive capacity at long term follow-up. Pain, 2006;122:102-8.
- Pastakia K, Kumar S. Acute whiplash associated disorders (WAD). Open Access Emerg Med, 2011 Apr 27;3:29-32.
- Cheng K, Martin LF, Slepian MJ, et al. Mechanisms and pathways of pain photobiomodulation: a narrative review. J Pain, 2021 Jul;22(7):763-777.
- Anders JJ, Arany PR, Baxter GD, Lanzafame RJ. Light-emitting diode therapy and low-level light therapy are photobiomodulation therapy. Photobiomodul Photomed Laser Surg, 2019 Feb;37(2):63-65.
- Ramezani F, Neshasteh-Riz A, Ghadaksaz A, et al. Mechanistic aspects of photobiomodulation therapy in the nervous system. Lasers Med Sci, 2022 Feb;37(1):11-18.
- Hamblin MR. Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophys, 2017;4(3):337-361.
