If you have been involved in a significant automobile accident, whiplash injuries need to be taken very seriously, and you should stay aware of how your body is feeling and functioning. Although some symptoms will begin immediately, other symptoms of a whiplash injury are not always immediate and can sometimes take a few days to a few weeks to fully manifest.
The most common injury, from motor vehicle collisions, to the neck is a whiplash injury. Whiplash is caused by a sudden movement of the head, either backward, forward, or sideways, that may result in damage to the supporting muscles, ligaments and other connective tissues in the neck and upper back. It is a sprain/strain injury to the cervical spine and the surrounding soft tissue.
If you have been in a motor vehicle or any other kind of accident, and your symptoms have been lingering even after self medicating, ice applications, heat applications, and stretching. Contact us today!
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 can result 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, as well as the vast amount of insurance fraud, 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 always 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 high impact 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 can contribute to the overall injury. When very sudden and very forceful movements occur in the body, damage to the vertebrae, nerves, discs, muscles, and ligaments of your neck and spine can be substantial.
During this first phase of a high impact rear end collision, 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, some of the damage to the spine will occur before your head reaches your head restraint. Studies have shown that head restraints reduce the risk of injury by 11-20%. Always try to have your head restraint as high as possible.
During phase two, your torso has reached peak acceleration – sometimes 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 can occur during this phase, if the collision is a significant one.
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 could increase 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.
This can be 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 forward-bending motion of your neck, straining the muscles and ligaments, possibly tearing fibers in the spinal discs, and forcing vertebrae out of their normal posture and position. Your spinal cord and nerve roots can get stretched and irritated if enough force is generated, and your brain can strike the inside of your skull causing a mild to moderate brain injury. if the collision is significant enough, and if you are not properly restrained by your seat harness, you may suffer a concussion, or a 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 sometimes difficult to predict the pattern of symptoms that each individual will suffer. There are, however, a number of conditions that are very common among those who have suffered from whiplash trauma.
It is the single most common complaint in whiplash trauma, being reported by over 90% of patients in serious accidents. Sometimes this pain radiates into the arms, up into the head, or down between the shoulder blades. Whiplash injuries can affect the tissues in the neck, including the facet joints and discs between the vertebrae, as well as the muscles, ligaments and nerves.
Facet joint sprain and muscle strain is the most common causes of neck pain following a car accident. Facet joint and muscle 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. Pain cannot be visualized on x-rays or MRIs, but there may be gapping of the joints on special x-rays indicating overstretching of the ligaments. MRI scans may show a tear or disruption of a soft tissue structure. Most of the soft tissue injury is diagnosed by physical palpation and other provocative maneuvers and testing of the area.
Disc injury is sometimes the cause of neck pain; especially chronic pain. The outer wall of the disc (called the annulus fibrosis) is made up of bundles of fibers that can be torn during a significant whiplash trauma. These tears can eventually lead to disc degeneration or even herniation, resulting in irritation or compression of the nerves running through the area. This compression or irritation from the herniation can lead to radiating pain into the arms or hands and may result in muscle weakness and sensory changes. These symptoms may come from other reasons other than a disc lesion.
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. As the muscles, ligaments and the other soft tissue heal they usually cause less pain. Typically most mild sprains/strains that may have occurred from a low impact collisions should take up to 3 to 6 weeks to heal. Moderate sprain/strains could take up to 12 weeks to heal. Severe sprain/strain that include complete tears of ligaments, muscles and tendons can take many months to heal.
After neck pain, headaches are the next prevalent complaint among those suffering from whiplash injury, affecting more than 80% of all people surveyed in serious accident. 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. A complete examination of the cranial nerves and head structures are important when headaches are a main complaint after a serious collision.
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. Dr. Mathesie has a therapeutic laser that can treat the inflammation of the TMJ and has been able to get great results with TMJ disorders.
Mild to moderate brain injury has been found in patients following serious 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. It is important for your chiropractor to specifically evaluate the brain function, or refer you to a neurologist to evaluate the symptoms if present.
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, or inner ear may be a factor as well. Typically, this dizziness is very temporary and improves significantly with chiropractic treatment.
Low back pain
Although most people consider whiplash to be an injury of the neck, the low back can also be injured as well. In fact, low back pain is found in more than half of the significant 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 three to six weeks. However, in the more severe cases, or when victims received substandard care, there has been evidence that a up to 20% of those who suffer from serious whiplash injuries continue to suffer from pain, weakness or restricted movement up to two years after their accident. Unfortunately, the vast majority of these people may continue to suffer from some level of disability or pain for many years after that, if not for the rest of their lives, depending on the actual collision and treatment received.
Whiplash is a unique condition that requires the expertise of a skilled health professional specially trained to work with these types of injuries. The research supports that the most effective treatment for whiplash injuries is a combination of properly applied chiropractic care, physical rehabilitation of the soft tissues and taking care of yourself at home.
Chiropractic care utilizes manual manipulation and adjustments of the spine to restore the normal movement and posture/position of the spinal vertebrae. It is the single-most effective treatment for minimizing the long-term impact of whiplash injuries, especially when coupled with 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 order to minimize permanent impairment and disability, it is important to use therapies that stimulate the soft tissues to heal quickly and correctly. At first this would include passive modalities for up to the first 4 to 6 weeks if needed, such as ice, heat, electrical muscle stimulation, traction, and ultrasound sound. Then other transitional therapies such as trigger point therapy, massage therapy, manual therapy, stretching and other light rehabilitation techniques. Then rehabilitation protocols depending on the patients weaknesses and restrictions found on functional performance evaluations. With proper monitoring and disciplined patients, therapists, and doctors, most moderate sprain/strains should reach an end result in 12 weeks. Some may take longer depending on the severity of the injury.
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 treatment plan extends 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, heat, limitations on work or daily activities, specific stretches and floor exercises, taking nutritional supplements and enzymes and getting plenty of rest.
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 steroid spinal injections. These pharmacological therapies typically can be used for short-term relief of pain, but should not be the focus of treatment. After all, a drug cannot restore normal joint movement or stimulate healthy muscle, tendon or ligament repair. Fortunately, surgery is only needed in some cases of severe herniated discs, when the disc is pressing on the spinal cord, some cases of spine fractures, or the complete rupture of a ligament.