Today, we know that whiplash injuries frequently do not originate from hyperextension or hyperflexion (extension and flexion beyond normal physiological limits), but instead a very rapid extension and flexion that triggers injuries.
Chiropractic care utilizes adjustments, or manual manipulation on the spine to restore the normal movement and position of the spinal vertebrae. Because of their complicated nature and profound impact on peoples lives, few topics in medical care generate just as much controversy as whiplash injuries. Unlike a broken bone in which a simple x-ray can validate the presence of the fracture and standards of care can direct a health care professional for the best method to handle the injury, whiplash injuries involve an unpredictable combination of nervous system, muscles joints and connective tissue disruption that is not easy to diagnose and may be even more of a challenge to treat. In order to assist you know the nature of whiplash injuries and exactly how they must be treated, it is vital to spend a little bit of time discussing the mechanics of how whiplash injuries occur.
There are 4 Phases to a Whiplash Injury:
During a rear-end automobile collision, your body undergoes a very rapid and intense acceleration and deceleration. Indeed, all four phases of a whiplash injury occur in less than one-half of a second! At each phase, there’s a different force acting on your body that includes on the overall injury, and with such a sudden and forceful movement, injury to the vertebrae, nerves, discs, muscles, and ligaments of the neck and spine could be substantial.
During this first phase, your car begins to be pushed out from under you, causing your mid-back to be flattened from the back of your seat. This leads to 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, making a shearing force in the neck. If the head restraint is correctly adjusted, the length your head travels backward is restricted. However, most of the injury to the spine will occur before the head reaches your head restraint. Studies have shown that head restraints only reduce the risk of injury by 11-20%.
During phase two, your torso has reached peak acceleration 1.5 to two times that of your automobile itself but your head has not yet begun to accelerate forward and will continue to move rearward. An abnormal S-curve develops within your cervical spine as your seat back recoils forward, just like a springboard, contributing 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 on the neck which is one of the more damaging aspects of a whiplash injury. Many on the bone, joint, nerve, disc and TMJ injuries I see clinically occur on this phase.
Through the third phase, your torso has become descending back down in your seat and also your neck and head are in their peak forward acceleration. At the same time, your vehicle is slowing down. If you released pressure in your brake pedal on the first phases of the collision, it will likely be reapplied on this phase. Reapplication of the brake causes your vehicle to slow even quicker and improves the severity of the flexion injury of the neck. As you move forward in your seat, any slack in the seatbelt and shoulder harness is used up.
This might be the best damaging phase on the whiplash phenomenon. In this fourth phase, your torso is stopped by your seat belt and shoulder restraint and your head is free to go forward unimpeded. This makes a violent forward-bending motion of the neck, straining the muscles and ligaments, tearing fibers in the spinal discs, and forcing vertebrae out of their normal position. Your back and nerve roots get stretched and irritated, and also your brain can strike within your skull creating a mild to moderate brain injury. If you’re not properly restrained by your seat harness, you might suffer a concussion, or even more severe brain injury, from punching the controls or windshield.
Problems from Whiplash
As we discussed briefly in the introduction, whiplash injuries can manifest in the wide selection of ways, including neck pain, headaches, fatigue, upper back and shoulder pain, cognitive changes and back pain. Due to the fact that numerous factors play in the overall whiplash trauma, for example direction of impact, speed of the vehicles involved, and also sex, age and physical condition, it’s impossible to predict the pattern of symptoms that each individual would suffer. Additionally, whiplash symptoms commonly have a delayed onset, often taking weeks or months to give. There are, however, a number of conditions that are very common among those who may have suffered from whiplash trauma.
Cervical neck pain
It’s the single most common complaint in whiplash trauma, being reported by over 90% of patients. Often this pain radiates across the shoulders, up to the head, and down between your back. Whiplash injuries tend to affect the tissues on the neck, such as the facet joints and discs between the vertebrae, and also all of the muscles, ligaments and nerves.
Facet joint pain is the frequent cause of neck pain following a car crash. Facet joint pain is generally felt around the back of your neck, just to the right or left of center, and is usually tender to touch. Facet joint cannot be visualized on x-rays or MRIs. It could only be diagnosed by physical palpation on the area.
Disc injury is a common cause of neck pain; especially chronic pain. The outer wall on the disc (called the anulus) is made up of bundles of fibers which can be torn during a whiplash trauma. These tears, then, can result in disc degeneration or herniation, causing irritation or compression on the nerves running over the area. This compression or irritation commonly results in radiating pain into the arms, shoulders and upper back, and might lead to muscle weakness.
Damage to the muscles and ligaments on the neck and shoulders would be the major reason for the pain experienced in the first few weeks following a whiplash injury, and is also exactly why you feel stiffness and restricted range of motion. But as the muscles have the opportunity to heal, they typically don’t cause as much actual pain since they contribute to abnormal movement. Damage on the ligaments often results in abnormal movement and instability.
After neck pain, headaches will be the most prevalent complaint of those suffering from whiplash injury, affecting more than 80% of the people. While some headaches are actually the result of direct brain injury, they are related to injury of the muscles, ligaments and facet joints of the cervical spine, which refer pain on the head. Because of that, it is important to treat the supporting structures of the neck to help alleviate your headaches.
Problems with the TMJ
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 on the jaw during movement. If improperly evaluated and treated, TMJ problems could 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.
Injury to the Brain
The truth is, mild to moderate brain injury is normal following a whiplash injury, because of the forces on the brain through the four phases mentioned earlier. The brain is a very soft structure, suspended in a watery fluid called cerebrospinal fluid. When the brain is forced backward and forward on the skull, the brain bounces off of the inside the skull, resulting in bruising or bleeding in the brain itself. In some cases, patients temporarily lose consciousness and have symptoms of a mild concussion. Often, there is no loss of awareness, but patients complain of mild confusion or disorientation after the crash. The long-term consequences of the mild brain injury can include mild confusion, difficulty concentrating, sleep disturbances, irritability, forgetfulness, lack of sex drive, depression and emotional instability. Although less common, the nerves accountable for your sense of smell, taste and even the vision could be affected also, resulting in a muted feeling of taste, changes in your sensation of smell and visual disturbances.
Dizziness after having a whiplash injury usually comes from problems for the facet joints of the cervical spine, although in some cases injury to the brain or brain stem may be a factor too. Typically, this dizziness is very temporary improves significantly with chiropractic treatment.
Low back pain
Even though most people consider whiplash to be an injury on the neck, the low back is also commonly injured as well. In fact, low back pain can be found in more than half of rear impact-collisions in which injury was reported, and almost three-quarters of the side-impact crashes. This is mostly due to the fact that the low back still experiences a huge compression during the first 2 phases of the whiplash injury, although it does not have the quality of flexion-extension injury experienced with the neck.
With proper care, many mild whiplash injuries heal within 6 to 9 months. However, more than 20% of people who experience whiplash injuries continue to experience pain, weakness or restricted movement two years after their accident. Unfortunately, most of these individuals continues to suffer from some level of disability or pain for several years after that, if not for the rest of their lives.
Whiplash is the unique condition that needs the assistance of an experienced medical expert specially educated to work with these types of injuries. The effective strategy for whiplash injuries is the mixture of chiropractic care, rehabilitation on the soft tissues and taking care of yourself in your own home.
Chiropractic Care for Whiplash
Chiropractic care utilizes manual manipulation on the spine to restore the normal movement and position on the spinal vertebrae. It is certainly the single-most effective cure for minimizing the long-term impact of whiplash injuries, especially when joined with massage therapy, trigger point therapy, exercise rehabilitation and other soft tissue rehabilitation modalities.
Rehabilitation for the Soft Tissue
The term “soft tissue” simply refers to anything that is not bone, like your muscles, ligaments, tendons, nervous system, spinal discs and bodily 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 flexibility exercises.
Post injury care at Home
The best chiropractic care and soft tissue rehabilitation will be limited in the benefit if everything you do at home or at the job stresses or re-injures yourself on a daily basis. For this reason, it is essential that your plan of care extend into the hours and days involving the clinic visits to assist speed your recovery. Some on the more common home care therapies will be the use of ice packs, limitations on work or daily activities, specific stretches and exercises, taking nutritional supplements and getting a lot of rest.
Intervention from the Medical Community
In some severe cases of whiplash, it might be necessary to have some health care as part of your overall plan for treatment. The most common treatments are the usage of anti-inflammatory medications, muscle relaxants, trigger point injections and, in some instances, epidural spinal injections. These therapies needs to be used in short-term relief of pain, if required, and not to 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 around the spinal cord, and in many cases of spine fractures.
If you or someone you know has suffered from whiplash, call and set an appointment at the Back Pain Relief Clinics immediately.