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.
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.
A whiplash accident occurs when one motor vehicle strikes another 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.
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 affects 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.
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
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 (43% failed to recover on average)
· 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.
Recovery from Whiplash
With proper care, many mild whiplash injuries heal within six to nine months. However, more than 20% of those who suffer from whiplash injuries continue to suffer from pain, weakness or restricted movement two years after their accident. Unfortunately, the vast majority of these people will continue to suffer from some level of disability or pain for many years after that, if not for the rest of their lives.
Whiplash is a unique condition that requires the expertise of a skilled health professional specially trained to work with these types of injuries. The most effective treatment for whiplash injuries is a combination of chiropractic care, rehabilitation of the soft tissues and taking care of yourself at home.
Chiropractic care utilizes manual manipulation of the spine to restore the normal movement and position of the spinal vertebrae. It is by far the single-most effective treatment for minimizing the long-term impact of whiplash injuries, especially when coupled with massage therapy, trigger point therapy, 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 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 motion exercises.
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 plan of care extend 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 packs, limitations on work or daily activities, specific stretches and exercises, taking nutritional supplements 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 spinal injections. These therapies should be used for short-term relief of pain, if necessary, and not 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 on the spinal cord, and in some cases of spine fractures.