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Whiplash is a common injury and one that we are well acquainted with treating. First used in 1928, the term “whiplash” defined an injury mechanism whereby sudden hyperextension was followed by an immediate hyperflexion (both defined by an extension and flexion beyond normal physiological limits) of the neck, resulting in damage to the muscles, ligaments, and tendons, especially those supporting the head. Today, we know that hyperextension or hyperflexion do not cause whiplash injuries, but that an extremely rapid extension and flexion causes the injury.
Whiplash is a complicated injury that profoundly impacts people’s lives. Few health care topics create as much controversy as whiplash injuries. Unlike a broken bone where a simple x-ray confirms the fracture whereby health care professionals then handle the injury by following a standard of care, whiplash injuries involve an unpredictable disruption to the nervous system, muscles, joints, and connective tissue. This injury is difficult to diagnose and can be even more challenging to treat. To help understand the nature of whiplash injuries and how they should be treated, it is necessary to devote some time discussing the mechanics of how whiplash injuries occur.
The Four Phases of a Whiplash Injury
If you have ever had the unfortunate experience of being in a rear-end automobile collision, you know that this type of accident forces your body through an extremely rapid and intense acceleration and deceleration. In fact, all four phases involved in a whiplash injury occur in less than one-half of a second! During each phase, different forces act on the body that contribute to the overall injury. Such sudden and forceful movement causes a lot of damage to many different areas in your back and neck, including the vertebrae, nerves, discs, muscles, and ligaments of your neck and spine.
During this initial phase, your car begins to be pushed out from under you, causing your mid-back to flatten against the back of your seat. This causes an upward force on your cervical spine and compresses your discs and joints. As the back of your seat begins to accelerate your torso forward, your head moves backward, creating a shearing force in your neck. Even though a properly adjusted head restraint will limit the distance your head travels backward, most of the spinal damage occurs prior to your head reaching your head restraint. Studies show that head restraints reduce the risk of injury by only 11-20%.
During the second phase, your torso has reached its peak acceleration of 1.5 to 2 times that of your vehicle, but your head has not yet started to accelerate forward and continues to move backward. Your cervical spine develops an abnormal S-curve as your seat back recoils forward, much like a springboard, adding to the torso’s forward acceleration. Unfortunately, this forward recoil of the seat back happens while your head is still moving backward, resulting in a shearing force in the neck, one of the more damaging aspects of a whiplash injury. Many of the bone, joint, nerve, disc, and TMJ injuries that I treat occur during this phase.
During the third phase, your torso descends back down in your seat and both your head and neck are at their peak forward acceleration. At this time, your car slows down. If you released the brake pedal during the first phase of the collision, it would likely be reapplied during this phase. Reapplication of the brake causes your car to slow down quicker and increases the severity of the neck’s flexion injury. As you move forward in your seat, any slack in your seat belt or shoulder harness is taken up.
Probably the most damaging phase of the whiplash phenomenon, this fourth phase causes your seat belt and shoulder restraint to stop your torso while your head is free to move forward unimpeded. This results in the violent forward-bending motion of your neck, which strains muscles and ligaments, tears spinal disc fibers, and forces vertebrae out of their normal position. This phase also stretches and irritates your spinal cord and nerve roots, and your brain can strike the inside of your skull, causing a mild to moderate brain injury. If you are not adequately restrained by your seat harness, you may suffer a concussion or a more severe brain injury, as your head will likely thrust forward and may strike the steering wheel or windshield.
Injuries Resulting from Whiplash Trauma
As already mentioned, 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. Because many things factor into a whiplash trauma such as direction of impact, vehicle speed as well as sex, age, and physical condition of the driver, it is impossible to predict the symptoms each person might suffer. In addition, whiplash symptoms often incur a delayed onset, taking weeks or months to present. There are, however, several conditions that are very common among those suffering whiplash.
Ninety percent of patients complain that neck pain is the single most common occurrence in whiplash trauma. This neck pain often radiates across the shoulders, up into the head, and down between the shoulder blades. Whiplash injuries tend to affect all neck tissues, including the facet joints and discs between the vertebrae as well as all the muscles, ligaments, and nerves.
Facet joint pain is the most common cause of neck pain after 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 sensitive to touch. Facet joint pain cannot be determined from x-rays or MRIs; it can only be diagnosed by a physical palpation of the area.
Disc injury is another common cause of neck pain and is often chronic. The disc’s outer wall (anulus) is constructed of fiber bundles that can tear during whiplash trauma. These tears can lead to disc degeneration or herniation, and result in the irritation or compression of the nerves that run through the area. The pain of this compression or irritation commonly radiates into the arms, shoulders, and upper back and can result in muscle weakness.
In the first few weeks following a whiplash injury, damaged neck and upper back muscles and ligaments are the major cause of pain. This damage also causes stiffness and restricts range of motion. Healing muscles don't cause much pain, but do contribute to abnormal movement. This abnormal movement along with instability damages the ligaments.
Second to neck pain, headaches are the most prevalent complaint among sufferers of whiplash, affecting more than 80% of all people. While some headaches are actually the result of direct brain injury, most are related to injury to the muscles, ligaments, and facet joints of the cervical spine, which refer pain to the head. Because of this, treating the supporting structures of your neck is important to alleviate headaches.
Temporomandibular joint dysfunction or TMJ is less common but still a very debilitating disorder that results from whiplash. TMJ usually begins as jaw pain accompanied by clicking and popping noises during movement. If not properly evaluated and treated, TMJ problems can worsen and lead to headaches, facial pain, ear pain, and difficulty eating. Our chiropractic clinic in Arlington Heights is specially trained to treat TMJ problems or, if necessary, to refer you to a TMJ specialist.
Because of the forces the brain incurs during the four phases of whiplash trauma, mild to moderate brain injury is common following whiplash injury. The human brain is a soft structure suspended in a watery fluid called cerebrospinal fluid and protected by our skull. When the brain is forced forward then backward, it bounces off the inside of the skull, which leads to bruising or bleeding in the brain itself. In some cases, patients temporarily lose consciousness and can show symptoms of a mild concussion. More often, while there is no loss of consciousness, patients complain of mild confusion or disorientation just after the crash. The long-term consequences of a mild brain injury include mild confusion, difficulty concentrating, sleep disturbances, irritability, forgetfulness, loss of sex drive, depression, and emotional instability. Less common effects include a loss in one's sense of taste, loss of olfactory sensation, and visual disturbances.
Dizziness following a whiplash injury usually results from an injury to the facet joints of the cervical spine. However, in some cases, injury to the brain or brain stem may also factor in. Typically, this dizziness is temporary and should improve greatly with chiropractic treatment.
Low back pain
Although most people this of whiplash as a neck injury, the low back is often injured as well. In fact, low back pain occurs in over half of all reported rear-impact collisions and in almost three-quarters of all side-impact crashes. This is most often due to the tremendous compression of the low back during the first two phases of a whiplash injury, despite it not having the degree of flexion-extension injury that is experienced by the neck.
Recovery from Whiplash
With proper care, many mild whiplash injuries heal in six to nine months. However, more than 20% of people who suffer whiplash injuries continue to experience pain, weakness, or restricted movement two years after the accident. Unfortunately, the large majority of these people continue suffering from a disability or chronic pain for years to come if not the rest of their lives.
A unique condition, whiplash requires a specially trained, skilled health professional's expertise to relieve the pain and damage that accompanies these types of injuries. The most effective and complete whiplash treatment involves a combination of chiropractic care, soft tissue rehabilitation, and taking care of yourself to encourage proper healing.
To return the spinal vertebrae to its normal movement and position, Chiropractic treatment includes manual manipulation of the spine. This is by far the single-most effective treatment for minimizing the long-term impact of whiplash injuries, especially when treatment is applied in concert with massage therapy, trigger point therapy, exercise rehabilitation, and other soft tissue rehabilitation modalities.
Soft Tissue Rehabilitation
Anything that isn't bone is referred to as soft tissue, including muscles, ligaments, tendons, the nervous system, spinal discs, and internal organs. The affected areas from a whiplash injury are mostly soft tissue, muscle, ligaments, and discs. To minimize permanent tissue impairment and disability and encourage proper soft tissue repair, it is important to employ therapies that stimulate healing, including massage therapy, electro-stimulation, trigger point therapy, stretching, and specific strength and range of motion exercises.
You will delay your recovery even if you employ the most effective chiropractic care and soft tissue rehabilitation if your activities at home or work stresses or re-injures you on a daily basis. Because of this, the actions you perform, including therapeutic exercise, is important between chiropractic visits in order to help speed your recovery. Common home-care therapies include applying ice packs, limiting work and daily activities, stretching and exercising, taking nutritional supplements, and getting plenty of rest.
For severe whiplash injuries, it may be necessary to include medical care in your overall treatment plan. Common medical treatments include the use of anti-inflammatory medications, muscle relaxants, |rigger point injections, and in some cases, epidural spinal injections. These therapies are meant as a short-term pain relief treatment if necessary. They should not be the focus of your treatment because drugs cannot restore normal joint movement or stimulate the repair of healthy muscles. Fortunately, few instances of herniated discs need surgery, as in the case of a disc pressing on the spinal cord or some spinal fractures. Let Dr. O’Hara, your Arlington Heights Chiropractor, help alleviate your pain. Call to make an appointment today!