For those who’ve suffered a car accident, whiplash type
injuries should be a very serious concern. Often times, the symptoms associated
with a whiplash injury can develop several weeks or even months after the
incident and it can be easy for an individual to believe there were no injuries
as a result of the auto collision. Because of this, a majority of people don’t
seek medical treatment following the car accident. Whiplash-associated injuries
are among the most common neck injuries. Whiplash is caused by an abrupt
movement of the head, either backward, forward, or sideways, which damages the
supporting muscles, ligaments and other connective tissues in the neck and
upper back.
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Unfortunately, when further complications begin to signal
the underlying presence of an injury, the damage from the injury may have
become permanent. An abundance of studies has demonstrated that approximately
half of all car accident victims with whiplash who’ve settled their insurance
claims still suffer with symptoms from their injuries. If you’ve been involved
in an automobile accident or any other type of accident, don’t jump into
conclusions and assume that you’ve evaded injury simply because you’re
currently not in any pain.
The term whiplash was initially utilized in 1928 to identify
an injury mechanism of sudden hyperextension followed by an immediate
hyperflexion of the neck, resulting in damaged muscles, tendons and ligaments,
most specifically, those supporting the head. Presently, we understand that
this type of injury doesn’t necessarily occur as a result of extension and
flexion beyond its natural range, instead, whiplash injuries are known to occur
from an extremely rapid extension and flexion of the neck in any direction.
Because of their misunderstood, complex nature and the
serious impact these could have on people’s lifestyles, only a limited amount
of topics in the healthcare field have created as much controversy as whiplash
injuries. Differentiating from a fractured bone where a simple X-ray can confirm
its presence and health care guidelines can address a medical professional as
to the best way in which to manage the injury, whiplash injuries could affect
an unpredictable combination of nerves, muscle joints and connective tissue
which is often difficult to diagnose and can be even more challenging to treat.
In order to help the individual better comprehend the nature of
whiplash-associated injuries and how these should be properly treated, it is
necessary to invest some time discussing the mechanics of how whiplash injuries
occur.
The Phases of a Whiplash Injury
During a rear-end car accident, the body undergoes through
an excessively rapid and forceful acceleration and deceleration. As a matter of
fact, all four phases of a whiplash injury occur in less than one-half of a
second. With each phase, a different force affects the body, contributing to
the overall injury, and with such an abrupt and intense movement, damage to the
vertebrae, nerves, discs, muscles, tendons and ligaments within the neck and
cervical spine can be substantial.
Phase 1
At the first phase of whiplash, the car starts to be pushed
out from under the involved individual, causing the mid-back to be flattened
against the back of the sear. This results in an upward force in the cervical
spine, compressing the discs and joints. The back of the seat then follows by
accelerating the torso forward, causing the head to move backwards, creating a powerful
force against the neck. If your head restraint is properly adjusted, the
distance the head moves backwards at this point is decreased. However, the
majority of the damage to the spine will have already occurred before the head
reaches the head restraint. Several studies indicate that head restraints
merely reduce the risk of injury by 11 to 20 percent.
Phase 2
By phase two, the individual’s torso will have reached peak
acceleration, up to 1.5 or 2 times that of the vehicle itself, but at this
point, the head has not yet begun to accelerate forward and it still continues
to move backwards. An abnormal S-shaped curvature develops in the cervical
spine as the car seat rebounds forward, similar to a springboard, increasing
the forward acceleration of the torso. This forward seat recoil unfortunately
occurs while the head is still moving backwards, and the shearing force which
is placed in the neck during this phase is one of the most damaging aspects of
a whiplash injury. Many bone, joint, nerve, disc and even TMJ injuries occur
during phase 2.
Phase 3
During phase three, the torso now begins to settle back down
into the seat while the head and neck are at their peak forward acceleration. Simultaneously,
the car begins slowing down. If the individual released the pressure on the
brake pedal during the first and second phases of the collision, it will most
likely be re-applied during this phase. By re-applying the brake, the individual
causes the vehicle to slow down more rapidly, increasing the severity of the
flexion injury in the neck. As the involved victim moves forward into their
seat, the loose seat belt and shoulder harness is used up.
Phase 4
Phase four is believed to be the most damaging phase of
whiplash. In this phase, the torso is stopped by the seat belt and shoulder
restraint while the head can freely move forward, unimpeded. This leads to a powerful
and violent, forward-bending motion of the neck which strains the muscles and
ligaments, tearing fibers in the spinal discs and forcing vertebrae out of
their natural placements. The spinal cord and nerve roots are stretched,
becoming irritated while the brain can often collide against the inside of the
skull, resulting in mild to moderate brain injury. If you are not properly
restrained by your seat belt, a concussion or more severe brain injury can
occur from striking the steering wheel or windshield of the car.
Types of Injuries Caused by Whiplash
As previously mentioned, whiplash injuries can develop into
a variety of symptoms, including neck pain, headaches, fatigue, upper back, shoulder
and low back pain and may cause cognitive alterations. Due to the fact that
numerous factors can play a huge part into the overall trauma from whiplash,
such as the direction of the impact, the speed of the cars involved as well as
sex, age and physical condition, it is considered impossible to predict the
pattern of symptoms that each individual will experience. In addition, the symptoms
of whiplash are frequently delayed, taking up to weeks or months to develop on
the individual. There are, however, a variety of injuries and conditions that
are very common among those who have suffered from whiplash trauma.
Neck Pain
Neck pain is the single, most common complaint among
individuals with whiplash, reported by over 90 percent of patients. The pain
frequently radiates across the shoulders, into the head and down between the
shoulder blades. The trauma from whiplash tends to damage a majority of the
tissues found within the neck, including the facet joints and discs between the
vertebrae as well as all of the surrounding muscles, ligaments and nerves.
Facet joint pain is the most frequent reason for neck pain
following a car accident. This type of pain is generally experienced on the
back of the neck, usually to the right of left of the center, and is commonly
tender to the touch. Facet joint pain cannot be diagnosed using X-rays or MRIs.
It can only be diagnosed by physical palpation of the area.
Disc injury is also a frequent cause for neck pain,
particularly chronic pain. The annulus, or outer wall of a vertebral disc, consists
of bundles of fibers which can be torn during whiplash injuries. These tears
can then lead to disc degeneration or herniation, causing irritation and/or
compression on the nerves running through the region. This compression or
irritation commonly leads to radiating pain down the arms, shoulders and upper
back, leading to muscle weakness.
The damage or injury to the muscles and ligaments within the
neck and upper back are the dominant cause of the pain experienced during the
first few weeks after an individual has suffered a whiplash injury and it’s the
main cause why the involved victims experience stiffness and limited range of
motion. Although, as the muscles begin to heal, they normally don’t cause as
much pain as they contribute to abnormal movement. Damage or injury to the
ligaments commonly causes irregular mobility and instability.
Headaches
Additionally, from experiencing neck pain, headaches are the
most widespread issue among those individuals suffering from whiplash injury,
affecting more than 80 percent of all people. While some headaches are the actual
result of direct brain injury, most are related to injury of the muscles,
ligaments and facet joints of the cervical spine, which cause pain to the
head. Due to this, it’s essential to treat the supporting tissues of the
neck in order to help decrease or eliminate the individual’s headaches.
TMJ Complications
A less frequent but almost equally as impairing disorder
which results from whiplash is temporomandibular joint dysfunction, best known
as TMJ. Temporomandibular joint dysfunction generally manifests as pain,
clicking and popping noises in the jaw during movement. If TMJ complications
are not properly evaluated and cared for, the issues may worsen further and
lead to headaches, facial and ear pain, and difficulty eating. Many doctors of
chiropractic specialize in treating TMJ issues or can refer the affected
individual to a TMJ specialist.
Brain Injury
Mild to moderate brain injuries are fairly common after a
whiplash injury, mainly because of the forces from the impact during the four
phases mentioned above. The human brain is a soft structure, suspended in a
watery fluid called cerebrospinal fluid. When the brain goes through the extreme
forward and backward motion, the brain bounces off the inside of the skull,
causing bruising or bleeding in the brain itself. In several cases, the
individual can lose consciousness and have symptoms of a mild concussion. More
often than not, there is no loss of consciousness, however, individuals report
feeling minor confusion or disorientation immediately after the car accident. The
long-term complications of a mild brain injury can include, mild confusion, concentration
problems, sleep disturbances, irritability, memory issues, loss of sex drive,
depression and emotional instability. Despite being less common, the nerves
that function to provide your sense of smell, taste and your vision may be
affected as well, leading to a muted sense of taste, changes in the sensation
of smell and visual disturbances.
Dizziness
After a whiplash injury, dizziness usually results from
injury to the facet joints of the cervical spine, however, in various cases,
injury to the brain or brain stem may be a contributing factor as well. Typically,
dizziness from whiplash is only temporary, improving considerably after
chiropractic treatment.
Low Back Pain
Albeit a majority of people recognize whiplash as an injury
of the neck, injury to the low back may also occur. As a matter of fact, low
back pain can be found in more than half of rear impact collisions in which
injury was reported and in almost three-quarters of all side impact crashes.
This is mostly due to the fact that the low back also suffers tremendous
compression during the first two phases of a whiplash type injury, regardless
if it does not have the degree of flexion-extension damage experienced in the
neck.
Recovering from Car Accident Whiplash
With appropriate care from specialized healthcare providers
in automobile accident injuries, a majority of mild whiplash injuries heal
within six to nine months. However, more than 20 percent of individuals who’ve
experienced whiplash may continue to suffer from pain, weakness or limited
mobility for up to two years after the initial car accident. The wide majority
of these people will unfortunately continue to experience some degree of
impairment or pain for many years after that, if not for the rest of their
lives.
Whiplash is a unique and challenging condition, that’s why
it requires the expertise of a skilled health professional specially trained to
work with these types of injuries. The most effective treatment for whiplash-associated
injuries involves a combination of chiropractic care, rehabilitation of the
soft tissues and self-care at home.
Chiropractic Care
Through the use of spinal adjustments and manual
manipulations of the spine, chiropractic treatment focuses on restoring the
normal movement and position of the spinal vertebrae. According to research,
chiropractic is by far the single-most effective treatment for eliminating the
long-term impact of whiplash injuries, especially when combined with massage
therapy, trigger point therapy, exercise rehabilitation and other soft tissue
rehabilitation techniques.
Soft Tissue Rehabilitation
The tem soft tissue is utilized to refer to a specific
tissue that is not bone, such as muscles, tendons, ligaments, nervous system,
spinal discs and internal organs. When whiplash occurs, the tissues that are
affected the most are the soft tissues, particularly the muscles, ligaments and
discs. In order to minimize permanent disability and impairment, it’s essential
to utilize treatments and therapies that focus on stimulating the soft tissues
to heal properly. These include massage therapy, electro-stimulation, trigger
point therapy, stretching and specific strength and range of motion exercises.
Self-Care
Even the most effective chiropractic care and soft tissue
rehabilitation may be restricted in its benefits if your home or work
activities stress or re-injures the individual on a regular basis. Because of
this, it’s crucial to prepare a detailed, extensive plan of care between the
hours and days of your clinic visits to help speed up the recovery process.
Some of the most common home self-care therapies include the use of ice
therapy, limitations on daily or work activities, an appropriate set of
stretches and exercises, taking nutritional supplements and getting plenty of
rest.
Medical Intervention
With more severe cases of whiplash, it may be necessary for
the individual to receive some medical care as part of their overall treatment
plan. The most common medical intervention treatments include the use of
anti-inflammatory medications, muscle relaxants, trigger point injections and,
in some cases, epidural spinal injections. Drugs should be used for short-term
relief of pain as the medications can only temporarily decrease the symptoms
and cannot restore normal joint movement or stimulate healthy muscle repair. Fortunately,
surgery is only required in more severe cases of whiplash where herniated discs
develop, when a disc is pressing on the spinal cord, and during several cases
of spinal fractures. Your healthcare provider should be able to determine if medical
care is needed alongside chiropractic treatment.
Documenting an Injury
It’s extremely important to document the progress of an
injury with a chiropractic physician. The whiplash injury sustained by the
individual may be permanent or may have left residual symptoms after treatment
is completed. Once an insurance company has settled a case, health care is no
longer covered. You may need care in the future and this needs to be
documented. It’s essential to seek the help of a doctor with plenty of
experience and someone who understands the mechanisms of injury and their
long-term effect.
By Dr. Alex Jimenez
