Whiplash!

Understanding Whiplash

Your neck does more than simply connect your head to the rest of your body. Without your neck, you couldn’t hold up your head, or turn it easily from one side to the other. Many complex parts of your neck work together to perfume a delicate balancing out. But your head is tossed around like the head of a flimsy rag doll. Your neck can be seriously injured. Then it is unable to move and support your head the way it normally does. If not corrected early, whiplash can lead to other problems such as arthritic degeneration.

Before Whiplash:

Imagine balancing a 10- pound ball on the end of a stick. That’s the delicate balancing act your neck performs throughout the day. Soft tissue (muscles and ligaments) is really the only thing keeping your head poised on the top of your spine. If your cervical spine is aligned and neck anatomy is healthy, your head’s weight is evenly balanced.

The Powerful Force of Whiplash

Whiplash turns your head’s weight into a powerful force, hurling your neck past its normal range of motion. In the typical whiplash injury, your head is whipped backward, injuring muscles, ligaments, discs and nerves. As your head whips forward, its speed greatly increases, adding to the force on your neck. If your head is turned to the side injury is often more severe.

Your Neck out of balance

After a whiplash injury, your neck’s balance is upset. Your neck’s lordotic curve may be reversed, which unevenly distributes your heads weight and further misaligns your vertebrae. Your fragile damaged neck must now strain to hold up your head. If not corrected, scaring- and even arthritic degeneration – may develop. You may also have recurring pain.

Common Syndromes following Whiplash

1. Neck pain and stiffness
2. Shoulder pain
3. Upper back pain
4. Suboccipital (or frontal) headache
5. Post concussion syndrome
6. Diffuse pain and/or parasthesias in upper extremities (numbness and tingling)
7. Mild and often non-dermatomal sensory abnormalities in the upper and lower extremities
8. Scapular and interscapular pain (between shoulder blades)
9. Development of trigger points in neck and upper back
10. Lower back pain and sciatica

Your Examination

An in depth history and orthopedic neurological examination will help your chiropractic physician diagnose a whiplash injury, discover the extent of damage, and determine the most suitable treatment for you. Your health history begins to uncover your symptoms and the cause of your injury. It may also reveal other, pre existing problems with your spine, shoulders, arms, hips, hands, knees, or legs. A physical exam helps identify the nature and mechanism of injury. Dr. Boss who is a specialist in whiplash injuries will use special techniques to identify spine related problems to determine your injuries that other physicians miss on a routine basis. You will have x-rays unless the appropriate x-rays have already been taken, and if needed CT scans, MRI’s or other diagnostic tests will be ordered to help diagnose a whiplash injury or rule out other problems.

Your Chiropractic Treatment

Dr. Boss recommends one or more kinds of treatment to help heal your neck and back, relieve symptoms, and restore your body’s function. These techniques work in a variety of ways – often by disrupting pain cycles, reducing swelling, relaxing and strengthening muscles as well as improving your function by moving through a normal range of motion without “locked” or restricted function. Because whiplash injuries can produce a “ chronic effect,” one problem leading to another, early treatment helps to prevent further dysfunction or degeneration in your spine.

Types of treatment

1. Manipulation/Mobilization: a gentle technique to return motion to spinal joints that have locked up and became restricted as a result of the injury.
2. Trigger point therapy, myofascial release, and massage: This type of therapy helps release restricted muscles and fascial restriction as well as pain and stiffness.
3. Microcurrent Therapy: has a direct chemical effect on cells. This includes increasing the production of ATP, which is the cellular fuel our body uses to function. The more ATP in our cells, the faster healing occurs. This results in homeostasis which means that waste products in the cell can be removed more efficiently and nutrients can move into the cell.
4. Traction/ Decompression: A computerized traction device on the decompression table is preprogrammed for patterns of ramping up and down. This distraction helps eliminate muscle guarding and creates a negative pressure on the disc and spinal facet joint, as well as helping to realign spinal vertebrae.
5. Ultrasound: A high frequency sound wave which creates a deep heat and micromassage, to disrupt scar tissuem, adhesions, increases blood flow, relax muscles, and create a analgesic effect.
6. Acupuncture: A technique which uses very fine needles inserted into acupoints to treat pain or muscle spasm. Used as a primay therapy or treatment when other physical therapy techniques or rehabilitation techniques have not be successful.
7. Laser Therapy: A new technology offers advanced pain relief and expedites healing times through a process known as photobiostimulation.
8. Therapeutic Exercises: to improve joint mechanics (return of normal spinal motion)
9. Nutrition: to help promote healing and provide cellular support of damaged tissues.

Risk of Acute Injury:

1. Female Gender
2. History of neck injury
3. Poor head restraint
4. Rear vs. other (frontal and side impact are usually more severe)
5. Use of seat belts/shoulder harness (although heps prevent life threatening injuries)
6. Body Mass index/head neck index decrease risk with increasing mass and neck size
7. Out of position occupant ( leaning forward or slumped)
8. Non failure of seat back
9. Having neck turned at impact
10. Non awareness of impending impact
11. Increasing age (middle age and older)
12. Front vs rear seat position
13. Impact by vehicle of greater mass or weight
14. Crash speed under 10mph

Facts about whiplash: In Summary

1. In a series of recent human volunteer crash tests of low speed rear impact collisions, it was reported that the threshold for cervical spine soft tissue injury was 10 mph.

2. Other reports have shown that crushed cars can often withstand collision speeds of 10 mph or more without sustaining damage. Thus, the concept of “no crush, no cash” is simply not valid.

3. Recent epidemiological studies have shown that most injury rear impact accidents occur at crash speeds of 6 mph to 12 mph the majority at speed below the threshold for property damage to the vehicle.

4. A number of risk factors in rear impact accident injury have now been verified including: rear impact, loss of cervical curve , pre existing degeneration changes, the use of seat belts and shoulder harness, poor head restraint geometry, awareness of the impending collision, female gender, and head rotation at impact.

5. The notion of litigation has been rather definitively dispelled due to car accident.

6. Once thought to suggest minimal injury, a delay in onset of symptoms has been shown to be the norm, rather than the exception.

7. Mild traumatic brain injury can result from whiplash trauma. Often the symptoms are referred to as the post concussion syndrome. This condition, often maligned in the past has now been well validated in recent medical literature.

8. A recent outcome study of whiplash patients reported in the European Spine Journal found that between one and two years post injury, 22 % of patients conditions deteriorated. This second wave of symptoms has been observed by others as well.

9. Radanov followed whiplash patients through time and reported that 45% remained symptomatic at 12 weeks, and 25% were symptomatic at 6 months. Other researchers have reported time to recovery in the most minor of cases at 8 weeks; time to stabilization in the more severe cases at 17 weeks; and time to in the most severe categories at 20.5 weeks. Thus, the notion that whiplash injuries heal in 6-12 weeks is challenged.

10. Each year, 3 million Americans are injured in whiplash accidents.

11. Of the 31 inpatient whiplash outcome studies published since 1956 (19 published since 1990), pooling patients from all vectors of collision (rear, frontal and side impacts), a mean of 40 % still symptomatic is found. For rear impact only, a mean of 59 % remain symptomatic at long-term follow up.

12. Although estimates vary about 10% of all whiplash victims becomes disabled.

More specific information about whiplash injuries is available upon request, patient or friends of patients are welcome to stop by for information or to view information on whiplash injuries at no charge.

Dr. Boss has had special training from The Spine Research Institute of San Diego. Dr. Boss has been treating whiplash relate injuries for 30 years.