The
term "whiplash" was first used in 1928 to define an injury mechanism of
sudden hyperextension followed by an immediate hyperflexion of the neck
that results in damage to the muscles, ligaments and tendons –
especially those that support the head. Today, we know that whiplash
injuries frequently do not result from hyperextension or hyperflexion
(extension and flexion beyond normal physiological limits), but rather
an extremely rapid extension and flexion that causes injuries.
Due
to their complicated nature and profound impact on peoples lives, few
topics in health care generate as much controversy as whiplash injuries.
Unlike a broken bone where a simple x-ray can validate the presence of
the fracture and standards of care can direct a health care professional
as to the best way in which to handle the injury, whiplash injuries
involve an unpredictable combination of nervous system, muscles joints
and connective tissue disruption that is not simple to diagnose and can
be even more of a challenge to treat. In order to help you understand
the nature of whiplash injuries and how they should be treated, it is
necessary to spend a bit of time discussing the mechanics of how
whiplash injuries occur.
The Four Phases of a Whiplash Injury
During
a rear-end automobile collision, your body goes through an extremely
rapid and intense acceleration and deceleration. In fact, all four
phases of a whiplash injury occur in less than one-half of a second! At
each phase, there is a different force acting on the body that
contributes to the overall injury, and with such a sudden and forceful
movement, damage to the vertebrae, nerves, discs, muscles, and ligaments
of your neck and spine can be substantial.
Phase 1
During
this first phase, your car begins to be pushed out from under you,
causing your mid-back to be flattened against the back of your seat.
This results in an upward force in your cervical spine, compressing your
discs and joints. As your seat back begins to accelerate your torso
forward, your head moves backward, creating a shearing force in your
neck. If your head restraint is properly adjusted, the distance your
head travels backward is limited. However, most of the damage to the
spine will occur before your head reaches your head restraint. Studies
have shown that head restraints only reduce the risk of injury by
11-20%.
Phase 2
During phase two, your torso has reached peak
acceleration - 1.5 to 2 times that of your vehicle itself - but your
head has not yet begun to accelerate forward and continues to move
rearward. An abnormal S-curve develops in your cervical spine as your
seat back recoils forward, much like a springboard, adding to the
forward acceleration of the torso. Unfortunately, this forward seat back
recoil occurs while your head is still moving backward, resulting in a
shearing force in the neck that is one of the more damaging aspects of a
whiplash injury. Many of the bone, joint, nerve, disc and TMJ injuries
that I see clinically occur during this phase.
Phase 3
During
the third phase, your torso is now descending back down in your seat and
your head and neck are at their peak forward acceleration. At the same
time, your car is slowing down. If you released the pressure on your
brake pedal during the first phases of the collision, it will likely be
reapplied during this phase. Reapplication of the brake causes your car
to slow down even quicker and increases the severity of the flexion
injury of your neck. As you move forward in your seat, any slack in your
seat belt and shoulder harness is taken up.
Phase 4
This is
probably the most damaging phase of the whiplash phenomenon. In this
fourth phase, your torso is stopped by your seat belt and shoulder
restraint and your head is free to move forward unimpeded. This results
in a violent forward-bending motion of your neck, straining the muscles
and ligaments, tearing fibers in the spinal discs, and forcing vertebrae
out of their normal position. Your spinal cord and nerve roots get
stretched and irritated, and your brain can strike the inside of your
skull causing a mild to moderate brain injury. If you are not properly
restrained by your seat harness, you may suffer a concussion, or more
severe brain injury, from striking the steering wheel or windshield.
Injuries Resulting from Whiplash Trauma
As
we discussed briefly in the introduction, whiplash injuries can
manifest in a wide variety of ways, including neck pain, headaches,
fatigue, upper back and shoulder pain, cognitive changes and low back
pain. Due to the fact that numerous factors play into the overall
whiplash trauma, such as direction of impact, speed of the vehicles
involved, as well as sex, age and physical condition, it is impossible
to predict the pattern of symptoms that each individual will suffer.
Additionally, whiplash symptoms commonly have a delayed onset, often
taking weeks or months to present. There are, however, a number of
conditions that are very common among those who have suffered from
whiplash trauma.
Neck pain
It is the single most common
complaint in whiplash trauma, being reported by over 90% of patients.
Often this pain radiates across the shoulders, up into the head, and
down between the shoulder blades. Whiplash injuries tend to affect all
of the tissues in the neck, including the facet joints and discs between
the vertebrae, as well as all of the muscles, ligaments and nerves.
Facet
joint pain is the most common cause of neck pain following a car
accident. Facet joint pain is usually felt on the back of the neck, just
to the right or left of center, and is usually tender to the touch.
Facet joint pain cannot be visualized on x-rays or MRIs. It can only be
diagnosed by physical palpation of the area.
Disc injury is also a
common cause of neck pain; especially chronic pain. The outer wall of
the disc (called the anulus) is made up of bundles of fibers that can be
torn during a whiplash trauma. These tears, then, can lead to disc
degeneration or herniation, resulting in irritation or compression of
the nerves running through the area. This compression or irritation
commonly leads to radiating pain into the arms, shoulders and upper
back, and may result in muscle weakness.
Damage to the
muscles and ligaments in the neck and upper back are the major cause of
the pain experienced in the first few weeks following a whiplash injury,
and is the main reason why you experience stiffness and restricted
range of motion. But as the muscles have a chance to heal, they
typically don’t cause as much actual pain as they contribute to abnormal
movement. Damage to the ligaments often results in abnormal movement
and instability.
Headaches
After neck pain, headaches are the
most prevalent complaint among those suffering from whiplash injury,
affecting more than 80% of all people. While some headaches are actually
the result of direct brain injury, most are related to injury of the
muscles, ligaments and facet joints of the cervical spine, which refer
pain to the head. Because of this, it is important to treat the
supporting structures of your neck in order to help alleviate your
headaches.
TMJ problems
A less common, but very debilitating
disorder that results from whiplash is temporomandibular joint
dysfunction (TMJ). TMJ usually begins as pain, clicking and popping
noises in the jaw during movement. If not properly evaluated and
treated, TMJ problems can continue to worsen and lead to headaches,
facial pain, ear pain and difficulty eating. Many chiropractors are
specially trained to treat TMJ problems, or can refer you to a TMJ
specialist.
Brain injury
Believe it or not, mild to moderate
brain injury is common following a whiplash injury, due to the forces on
the brain during the four phases mentioned earlier. The human brain is a
very soft structure, suspended in a watery fluid called cerebrospinal
fluid. When the brain is forced forward and backward in the skull, the
brain bounces off the inside of the skull, leading to bruising or
bleeding in the brain itself. In some cases, patients temporarily lose
consciousness and have symptoms of a mild concussion. More often, there
is no loss of consciousness, but patients complain of mild confusion or
disorientation just after the crash. The long-term consequences of a
mild brain injury can include mild confusion, difficulty concentrating,
sleep disturbances, irritability, forgetfulness, loss of sex drive,
depression and emotional instability. Although less common, the nerves
responsible for your sense of smell, taste and even your vision may be
affected as well, resulting in a muted sense of taste, changes in your
sensation of smell and visual disturbances.
Dizziness
Dizziness
following a whiplash injury usually results from injury to the facet
joints of the cervical spine, although in some cases injury to the brain
or brain stem may be a factor as well. Typically, this dizziness is
very temporary improves significantly with chiropractic treatment.
Low back pain
Although
most people consider whiplash to be an injury of the neck, the low back
is also commonly injured as well. In fact, low back pain is found in
more than half of rear impact-collisions in which injury was reported,
and almost three-quarters of all side-impact crashes. This is mostly due
to the fact that the low back still experiences a tremendous
compression during the first two phases of a whiplash injury, even
though it does not have the degree of flexion-extension injury
experienced in the neck.
Recovery from Whiplash
With proper
care, many mild whiplash injuries heal within six to nine months.
However, more than 20% of those who suffer from whiplash injuries
continue to suffer from pain, weakness or restricted movement two years
after their accident. Unfortunately, the vast majority of these people
will continue to suffer from some level of disability or pain for many
years after that, if not for the rest of their lives.
Whiplash is
a unique condition that requires the expertise of a skilled health
professional specially trained to work with these types of injuries. The
most effective treatment for whiplash injuries is a combination of
chiropractic care, rehabilitation of the soft tissues and taking care of
yourself at home.
Chiropractic Care
Chiropractic care
utilizes manual manipulation of the spine to restore the normal movement
and position of the spinal vertebrae. It is by far the single-most
effective treatment for minimizing the long-term impact of whiplash
injuries, especially when coupled with massage therapy, trigger point
therapy, exercise rehabilitation and other soft tissue rehabilitation
modalities.
Soft Tissue Rehabilitation
The term ‘soft tissue’
simply refers to anything that is not bone, such as your muscles,
ligaments, tendons, nervous system, spinal discs and internal organs.
During a whiplash injury, the tissues that are affected most are the
soft tissues, the muscles, ligaments and discs in particular. In order
to minimize permanent impairment and disability, it is important to use
therapies that stimulate the soft tissues to heal correctly. These
include massage therapy, electro-stimulation, trigger point therapy,
stretching and specific strength and range of motion exercises.
Home Care
The
most effective chiropractic care and soft tissue rehabilitation will be
limited in its benefit if what you do at home or at work stresses or
re-injures you on a daily basis. For this reason, it is important that
your plan of care extend into the hours and days between your clinic
visits to help speed your recovery. Some of the more common home care
therapies are the application of ice packs, limitations on work or daily
activities, specific stretches and exercises, taking nutritional
supplements and getting plenty of rest.
Medical Intervention
In
some severe cases of whiplash, it may be necessary to have some medical
care as part of your overall treatment plan. The most common medical
treatments include the use of anti-inflammatory medications, muscle
relaxants, trigger point injections and, in some cases, epidural spinal
injections. These therapies should be used for short-term relief of
pain, if necessary, and not be the focus of treatment. After all, a drug
cannot restore normal joint movement and stimulate healthy muscle
repair. Fortunately, surgery is only needed in some cases of herniated
discs, when the disc is pressing on the spinal cord, and in some cases
of spine fractures.
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