The term "whiplash" was first used in 1928 to define an injury mechanism of sudden extension followed by an immediate flexion of the neck that results in damage to the muscles, ligaments and tendons – especially those that support the head. Due to their complicated nature and profound impact on peoples lives, few topics in health care generate as much controversy as whiplash injuries. Unlike a broken bone where a simple x-ray can validate the presence of the fracture and standards of care can direct a health care professional as to the best way in which to handle the injury, whiplash injuries involve an unpredictable combination of nervous system, muscles joints and connective tissue disruption that is not simple to diagnose and can be even more of a challenge to treat. Many whiplash iinjuries occur during a car wreck, but they can also occur when a football player is tackled, during a fall, when skiing, any time the head is thrown backwards and forward rapidly. In fact, all four phases of a whiplash injury occur in less than one-half of a second. At each phase, there is a different force acting on the body that contributes to the overall injury, and with such a sudden and forceful movement, damage to the vertebrae, nerves, discs, muscles, and ligaments of your neck and spine can be substantial.
Injuries Resulting from Whiplash Trauma
Whiplash injuries can manifest in a wide variety of ways, including neck pain, headaches, fatigue, upper back and shoulder pain, cognitive changes and low back pain. Due to the fact that numerous factors play into the overall whiplash trauma, such as direction of impact, speed of the vehicles involved, as well as gender, age and physical condition, it is impossible to predict the pattern of symptoms that each individual will suffer. Whiplash symptoms commonly have a delayed onset, often taking days to weeks to begin. There are a number of conditions that are very common among those who have suffered from whiplash trauma.
Neck pain
It is the single most common complaint in whiplash trauma, being reported by over 90% of patients. Often this pain radiates across the shoulders, up into the head, and down between the shoulder blades. Whiplash injuries tend to affect all of the tissues in the neck, including the facet joints and discs between the vertebrae, as well as all of the muscles, ligaments and nerves.
Facet joint pain is the most common cause of neck pain following a car accident and is felt just to the right or left of center of the neck and is usually tender to the touch. Facet joint pain cannot be visualized on x-rays or MRIs, it can only be diagnosed by physical palpation of the area.
Disc injury is also a common cause of neck pain; especially chronic pain. The outer wall of the disc (called the annulus) is made up of bundles of fibers that can be torn during a whiplash trauma. These tears can lead to disc degeneration or herniation, resulting in irritation or compression of the nerves running through the area. This compression or irritation commonly leads to radiating pain into the arms, shoulders and upper back, and may result in muscle weakness.
Damage to the muscles and ligaments in the neck and upper back are the major cause of the pain experienced in the first few weeks following a whiplash injury, and is the main reason stiffness and restricted range of motion are experienced. As the muscles heal, they typically contribute to abnormal movement instead of pain. Damage to the ligaments often results in abnormal movement and instability.
Headaches
After neck pain, headaches are the most prevalent complaint among those suffering from whiplash injury, affecting more than 80% of all people. While some headaches are actually the result of direct brain injury, most are the result of injury of the muscles, ligaments and facet joints of the cervical spine, which refer pain to the head. Because of this, it is important to treat the supporting structures of your neck in order to help alleviate your headaches.
TMJ problems
A less common, but very debilitating disorder that results from whiplash is temporomandibular joint(TMJ) dysfunction. TMJ dysfunction usually begins as pain, clicking and popping noises in the jaw during movement. If not properly evaluated and treated, TMJ problems can continue to 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.
Brain injury
Mild to moderate brain injury is common following a whiplash injury, due to the forces on the brain during the trauma. The human brain is a very soft structure, suspended in a watery fluid called cerebrospinal fluid. When the brain is forced forward and backward in the skull, the brain bounces off the inside of the skull, leading to bruising or bleeding in the brain itself. In some cases, patients temporarily lose consciousness and have symptoms of a mild concussion. More often, there is no loss of consciousness, but patients complain of mild confusion or disorientation just after the injury.
The long-term consequences of a mild brain injury can include mild confusion, difficulty concentrating, sleep disturbances, irritability, forgetfulness, loss of sex drive, depression and emotional instability. Although less common, the nerves responsible for your sense of smell, taste and even your vision may be affected as well, resulting in a muted sense of taste, changes in your sensation of smell and visual disturbances.
Dizziness
Dizziness following a whiplash injury usually results from injury to the facet joints of the cervical spine, although in some cases injury to the brain or brain stem may be a factor as well. Typically, this dizziness is very temporary improves significantly with chiropractic treatment.
Low back pain
Although most people consider whiplash to be an injury of the neck, the low back is also commonly injured as well. Low back pain is found in more than half of the whiplash injuries reported
Recovery from Whiplash
With proper care, many mild whiplash injuries heal within six to nine months. 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 following the home care instructions given to you by your doctor of chiropractic.
Chiropractic Care
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 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, deep friction massage (SASTM), stretching and specific strength and range of motion exercises.
Home Care
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.
Medical Intervention
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.It is vital to reestablish the normal joint movement and stimulate healthy muscle repair. Surgery may be needed in some cases of herniated discs, when the disc is pressing on the spinal cord, and in some cases of spine fractures.