Car Accident Treatment

WHIPLASH INJURY INFORMATION

What Is Whiplash?
Whiplash is a term that describes injury to the neck that occurs as a result of a motor vehicle or car accident. The most common type of car accident is the rear impact, and most typically, the occupant in the vehicle that gets “rear-ended” (hit from behind) is at the greatest risk of injury, including whiplash.

What Is Now Known about Whiplash
Until recently, the reason for the extent of whiplash injuries was poorly understood. In addition, due to the legal and insurance issues, the veracity of complaints of neck pain and other symptoms by people who suffer from whiplash is commonly viewed as suspect.

However, recent research has helped clarify why occupants struck from behind experience more extensive whiplash injuries than those in other types of crashes. This new information is important for the physician treating whiplash pain, as it impacts the physician’s case management strategy.

Related Whiplash Symptoms/Conditions
Whiplash injuries can be quite complex and may include a variety of related problems, such as:

• Joint dysfunction. As a result of the whiplash, one of the joints in the spine or limbs may lose its normal resiliency and shock absorption (referred to as the joint play), possibly leading to restricted range of movement and pain.
• Disc herniation. A whiplash accident may injure the discs between the vertebrae, lead to small tears and cause the inner core of the disc to extrude through its outer core. If the disc’s inner core comes in contact with and irritates a nearby spinal nerve root, a herniated disc occurs, with symptoms possibly including sharp, shooting pain down the arm and even neurological symptoms like numbness, tingling and muscle weakness.
• Faulty movement patterns. It is believed that the nervous system may change the way in which it controls the coordinated function of muscles as a result of a barrage of intense pain signals from the whiplash injury.
• Chronic pain. While often resulting in minor muscle sprains and strains that heal with time, more severe whiplash injuries may produce neck pain and other symptoms that are persistent and long-lasting (chronic).
• Cognitive and higher center dysfunction. In some instances,whiplash may affect the patient’s mental functioning, possibly leading to difficulties concentrating, as just one example.

How Does Whiplash Occur?
A whiplash accident occurs when one motor vehicle strikes another, typically from behind, causing certain forces to be transmitted from the striking vehicle to the struck vehicle. These forces are then transmitted to the occupant(s) of the struck vehicle, where they have the potential to cause whiplash injury.

Research Findings on Whiplash Accidents
Research both in the Biomechanics Laboratory at Yale University in New Haven and in live crash tests using human volunteers has shed relatively new light on the contortions the cervical spine (neck) undergoes as a result of impact culminating in whiplash.

Shortly after impact (about 150 milliseconds), the cervical spine undergoes what is called an S-shaped curve. In this configuration, the cervical spine,rather than simply being curved to the front in a normal C-shape, as it would normally be at rest, takes on an altered shape:

• The lower part of the cervical spine moves into extension (bent backward)
• The upper part of the cervical spine moves into flexion (bent forward).

When a whiplash accident occurs, the lower part of the cervical spine moves well beyond its normal range of motion, causing the potential for injury to the ligaments and discs in that area. The upper part of the cervical spine also moves beyond its normal range of motion, but to a lesser extent.

Cervical Spine Reactions to a Whiplash Accident
There is an inherent stabilization response in the cervical spine that helps protect it from potential whiplash injury:

• The nervous system detects the presence of the impact
• The muscles of the cervical spine, under the direction of the nervous system, contract quickly to try to minimize the effects of the impact on the ligaments and discs.

If this stabilization response is working efficiently following the whiplash accident, there is a greater likelihood of protection and less potential for whiplash injury. But if the response is inefficient, an injury is more likely, with various types of whiplash pain possibly resulting and whiplash treatment potentially necessary.

Factors Affecting the Whiplash Injury
There are several factors that affect the efficiency of the stabilization response to whiplash injury, including:

• Posture at impact
• Overall physical condition
• Awareness of coming impact
• Gender
• Others

It should be known that some of these stabilization responses to whiplash are within the patient’s capacity to control while others are not.

Postural Impact on Whiplash Injury

The posture in which a person is sitting at the moment of impact helps determine the efficiency of the stabilization response that will affect the severity of the whiplash injury.

Sitting in a correct posture promotes an efficient stabilization response. Sitting in a poor posture, particularly a “slumped” type posture, promotes an inefficient stabilization response.

Overall Physical Condition and Whiplash Injuries

The better conditioned the body is in general, the more efficient the stabilization response will be. This particularly relates to the condition of the nervous system, as a well-functioning nervous system is essential to a proper stabilization response.

Awareness of Coming Impact on Whiplash Injury Severity

Perhaps the most important factor that affects the efficacy of the stabilization response in relation to whiplash injuries is awareness of the impending impact.

Scenario 1: Aware of impending impact. This person is able to automatically prepare the stabilization system to respond quickly and efficiently.

Scenario 2: Unaware of the impending impact. This person cannot prepare the stabilization system, thus slowing the response and decreasing its efficiency. This person is likely to sustain greater whiplash injury than is the person who is aware.

This may help explain the findings of some studies that have shown a passenger in a struck vehicle is likely to sustain greater whiplash injury than the driver. The driver is more likely to see the vehicle coming in the rear view mirror.

Whiplash Injuries and Gender

Women in general are more frequently and more seriously injured by whiplash than men due to the differences in muscular bulk and the female’s smaller bony structures. These factors result in less protection of the cervical spine to the abnormal forces such as those that occur in a whiplash-type of injury.

Other Factors Affecting Whiplash Injury

Risk factors influencing prognosis of a whiplash injury include:

• Whiplash pain /symptoms persisting beyond 6 months
• Significant ligament, disc,nerve, or joint capsule injury
• Delay in initiating treatment
• Need to resume treatment for more than one flare-up of pain
• Occupant age over 65
• Head restraint more than 2″ away from occupant’s head
• Occupant in a small car
• Alcohol intoxication at time of automobile accident
• Pre-existing x-ray evidence of degenerative changes
• Prior whiplash injury
• Prior cervical spine fusion
• Patient having initial radicular (arm pain, numbness, tingling) symptoms
• A cervical collar used for more than 2 weeks.

Common Misconception about Whiplash Injury

A common misconception about whiplash injury is that if the vehicle does not sustain damage in a low speed impact, then whiplash injury to the occupant does not occur.

In reality, low impact collisions can produce correspondingly higher dynamic loading on the occupants because the lack of crushing metal to absorb the forces results in a greater force applied to items or occupants within the vehicle.

Sources of Whiplash Pain

When the cervical spine (neck) is subject to whiplash, there is usually a combination of factors that contribute to whiplash pain in the neck and back, and ultimately need to be addressed individually by a chiropractor.

The doctor of chiropractic maintains a “holistic” view of the patient’s whiplash pain, specifically focusing on one or more of the following:

• Joint dysfunction
• Muscle dysfunction
• Faulty movement patterns
• Disc derangement

Whiplash Pain Management for Joint Dysfunction

Joint dysfunction from whiplash occurs when one of the joints in the spine or limbs loses its normal joint play (resiliency and shock absorption). It is detected through motion palpation, a chiropractic technique in which the chiropractor gently moves the joint in different directions and assesses its joint play. When a joint develops dysfunction, its normal range of movement may be affected and it can become painful.

Additionally, joint dysfunction can lead to muscle imbalance and pain,and a vicious cycle:

• The loss of joint play can cause abnormal signals to the nervous system (there are an abundance of nerve receptors in the joint)
• The muscles related to that joint can subsequently become tense or, conversely, underactive
• The resulting muscle imbalance can place increased stress on the joint, aggravating the joint dysfunction that already exists.

Muscle Dysfunction from Whiplash Injuries

When joint dysfunction develops, muscles are affected. Some muscles respond by becoming tense and overactive, while others respond by becoming inhibited and underactive. In either case, these muscles can develop trigger points that may necessitate whiplash treatment involving muscle relaxation or stimulation.

Trigger points are areas of congestion within the muscle where toxins accumulate. These toxins can irritate the nerve endings within the muscle and produce pain. This whiplash pain can occur in the muscle itself or can be expressed as referred pain (perceived in other areas of the body).

The muscle can also send abnormal neurological signals into the nervous system, which can then cause disruption of the ability of the nervous system to properly regulate muscles in other parts of the body, leading to the development of faulty movement patterns.

Faulty Movement Patterns and Whiplash Pain

It is thought that the intense barrage of pain signals from a traumatic whiplash injury to the cervical spine can change the way the nervous system controls the coordinated function of muscles. The disruption of coordinated, stable movement is known as faulty movement patterns.

Faulty movement patterns can cause increased strain in the muscles and joints, leading to neck pain and back pain. They can involve the neck itself or can arise from dysfunction in other areas of the body such as the foot or pelvis.

Instability is also considered part of faulty movement patterns. There are 2 types of instability that can occur in whiplash:

• Passive instability-the ligaments of the neck are loosened, making it more susceptible to whiplash pain.
• Dynamic instability-the nervous system disruption causes a disturbance in the body’s natural muscular response to common, everyday forces.

As a result of instability, even mild, innocuous activities can be difficult to perform as they often exacerbate the whiplash pain.

Whiplash Pain from a Herniated Disc

The force of whiplash can cause injury to the discs between the vertebrae, and small tears can develop. If the gelatinous middle of the disc seeps out, it can irritate the nerve endings in this area. This is known as disc derangement.

Occasionally, the gel can seep all the way out and press on a nerve root exiting the spinal cord behind the disc, known as disc herniation.

A herniated disc may involve whiplash pain in the neck as well as sharp, shooting pain down the arm and possibly neurological symptoms such as numbness, tingling and muscle weakness.