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Whiplash can be quite frightening due to the traumatic nature of the event. Although the typical whiplash injury is the result of a car accident, any trauma that involves the same violent whipping motion of the head is typically regarded as whiplash. It should also be noted that a more descriptive phrase of cervical acceleration/deceleration injury is preferred among many spine specialist. They feel that this term better describes the mechanics of the neck quickly extending backwards and then forward which stretches the tissues beyond their physiological limit. Many structures are involved, and the symptoms can extend long after the initial impact. The variety of tissues and structures affected by whiplash produce many symptoms that are known to change over the course of the condition. Whiplash injuries occur so easily and can be so debilitating because the neck is extremely susceptible to injury. This is because the neck is an area that lacks stability in favor of having a large range of motion. Because of the greater range of motion and decreased stability, soft tissue damage is fairly common following traumatic events such as whiplash.
Difficulty for physicians:
Because of the legal action involved with these injuries, there is often the concern of malingering. Sometimes whiplash has jokingly been described as “Any strain of the cervical spine that doesn’t resolve until all litigation is concluded”. Because of this conception, many times sufferers of whiplash are thought to be fabricating their pain in hopes of securing a large settlement. Equally as troubling is that whiplash injuries usually do not result in the type of damage that can be detected by imaging such as X-Ray or MRI. These imaging modalities are used to detect broken bones or complete ruptures, but they absolutely do not reveal the soft tissue damage that is so common in this delicate area of the body. Unfortunately, many investigations have revealed that a large percentage of whiplash sufferers still complain of neck pain long after the injury, and after all litigation and settlements have been concluded (Whiplash Injuries, The Cervical Acceleration/Deceleration Syndrome Third Edition, Stephen M. Foreman and Arthur Croft). With Proper detection and treatment however, we can help tissues heal properly and prevent chronic pain from occurring.
Signs and symptoms:
The constellation of symptoms these patients complain about are relatively typical, consistent, and somewhat predictable. The most common complaints of whiplash are neck pain, shoulder pain, jaw pain, headaches, dizziness, nausea, ringing in ears, and numbing or tingling into shoulders or arms. It is also important to note that injuries sustained do not necessarily correlate with the amount of damage done to the vehicle. It has been found that trivial rear end crashes that cause little or no damage to the vehicle can actually cause considerable neck injury and disability to the occupants. The explanation for this has to do with energy transfer. When minimal damage is done to the vehicle, the majority of the energy is displaced to the occupants.
Mechanism of injury:
At initial impact the body is usually static as the seatback quickly moves forward into the body causing the thoracic spine to flatten. This immediately causes a vertical acceleration leading to cervical spine compression. Simultaneously the torso is aggressively shifted forward causing hyperextension in the cervical spine. Even if the headrest is in its proper position, the head may still clear it because of the upward shift in the neck. As the car decelerates the body will then be thrown forward. If a seatbelt is worn the neck will undergo hyperflexion. As mentioned earlier, typically whiplash does not result in broken bones. This however, does not mean significant damage has not occurred. The soft tissues of the neck, which include muscles, tendons, ligaments, and joints, are very vulnerable to injury. If not treated properly the result may be poor healing, muscular imbalances, and eventually chronic pain.
Treatment:
Traditionally the treatment for whiplash injuries were a soft collar, rest, pain medications, and a little physical therapy in the later stages. It has been found that this absolutely does not work well for most individuals. Greater than 50% who receive this treatment still have pain 6 months to 2 years later (Rehabilitation of the spine 2nd edition, Craig Liebenson). The treatment that has been shown to be the most effective according to the Quebec Whiplash-Associated Disorders (WAD) guidelines is early, active treatments including spinal manipulation, interferential therapy, ultrasound, and myofascial release. In most cases patients should not be immobilized for greater than 2-4 days. Our office provides all of these treatments as well as education on how to safely resume activities. We also highly encourage patients to regularly perform proper stretches and exercises to maintain progress and prevent reoccurrence.
