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Whiplash
Injuries to the neck caused by a rapid movement of the head backward,
forward, or side to side, is referred to as "Whiplash." Whether a result of
a car accident, sport, or work injury, whiplash or other neck injuries
warrant a thorough chiropractic check-up. The biggest danger with these
injuries is that the symptoms can take years to develop. Too often people
don't seek treatment until more serious complications develop. Even after
whiplash victims settle their insurance claims, between 39%-56% report they
still suffer with symptoms two years later.
In the past, a typical whiplash injury where no bones
were broken, was hard to document. Soft tissue injuries do not show up on
x-ray and insurance companies would deny coverage. Literally adding insult
to injury, the patient suffering all too real pain was considered to be a
fraud, a liar, or at best a hypochondriac. New imaging devices (CAT Scans,
Magnetic Imaging, and Ultra-Sound) may now show soft tissue injury and now
insurance companies cover most whiplash injuries.
When no bones are broken and the head doesn't strike
the windshield, typical symptoms are as follows: 92% complain of neck pain,
which typically starts two hours up to two days after the accident. This is
often the result of tightened muscles that react to either muscle tears or
excessive movement of joints from ligament damage. The muscles tighten in an
effort to splint and support the head, limiting the excessive movement.
About 57% of those suffering from whiplash complain
of headaches. The pain may be on one side or both, on again off again or
constant, in one spot or more generalized. These headaches, like the neck
pain, are often the result of tightened, tensed muscles trying to keep the
head stable and, like tension headaches, they are often felt behind the
eyes.
Shoulder pain often described as pain radiating down
the back of the neck into the shoulder blade area, may also be the result of
tensed muscles, accounting for 49% of injuries caused by whiplash.
Muscle tears are often described as burning pain,
prickling or tingling. More severe disc damage may cause sharp pain with
certain movements, with or without radiation into the arms, hand and
fingers, which are relieved by holding your hand over your head.
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Children
Whiplash associated disorders do not exclude children. In fact,
children involved in automobile accidents are often neglected in these types
of injuries when in actuality, they suffer from the same symptoms and are at
a greater risk for damages. Adding fuel to the fire,
a number of insurance companies object to paying for the care
of children when the literature shows that they are at two-thirds the risk
of adults. <Back to Top>
Symptoms
The following lists the most common whiplash symptoms as well as
their rate of occurrence. If you experience any of these symptoms, play it
safe and get a chiropractic check up.
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Neck pain and/or stiffness |
92% |
Headache |
57% |
Fatigue |
56% |
Shoulder pain |
49% |
Anxiety |
44% |
Pain between the shoulder blades |
42% |
Low back pain |
39% |
disturbance |
39% |
Upper limb paresthesia |
30% |
Sensitivity to noise |
29% |
Difficulty concentrating |
26% |
Blurred vision |
21% |
Irritability |
21% |
Difficulty swallowing |
16% |
Dizziness |
15% |
Forgetfulness |
15% |
Upper limb pain |
12% |
Upper limb weakness |
6% |
Ringing in the ears |
4% |
Pain in the jaw or face |
4%+ |
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Mechanics of a
whiplash injury
Whiplash is most commonly received from being struck from behind,
whether from something as light as a fender bender or from something as
powerful as a football tackle. When the head is suddenly jerked back and
forth beyond its normal limits, the muscles and ligaments supporting the
spine can be over-stretched or torn.
In a rear end collision for example, whiplash can be divided into
four basic phases:
Phase 1
During Phase 1 the car is first pushed or accelerated forward within
milliseconds. Your car is essentially pushed out from under you and your
back loads the seat. High shearing forces develop within the neck and your
spinal curves straighten and compress. High pressures develop within the
brain and shearing forces on the brain stem.
Phase 2
Upward rise of your neck as your head snaps into full extension over
the headrest and collapses it. This acts as a fulcrum and TMJ injury is
possible with high compression within the joint and some of the muscles and
ligaments are stretched or torn in the neck.
Phase 3
The head begins its forward motion as the torso descends into the
seat. Seat back bounce increases your velocity 30-70% greater than that of
your car. Slack in the seatbelt shoulder harness begins to tighten. Your
neck muscles, in a reflex action, contract to bring the head forward as they
are thought to be in extension (phase 2), in an attempt to prevent
excessive injury. But, because the head is already traveling in a forward
direction as the car decelerates, there is an overcompensation.
Phase 4
This violently rocks the head forward, overstretching more muscles
and ligaments in the back of the neck. Full deceleration of the head, neck
and torso is aggravated by the shoulder harness. High tension and shear
forces in the spine can cause the soft pulpy discs between the vertebrae to
bulge, tear, or rupture. Vertebrae can be forced out of their normal
position, reducing range of motion (Vertebral Subluxation.) The brain stem,
spinal cord and nerve roots get stretched, irritated, and choked. If the
victim is not properly restrained the occupant's head may strike the
steering wheel or windshield, causing a concussion.
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Risk Factors
The resulting instability of the spine and soft tissues are noteworthy and
depend on several factors.
- Rear direction impact.
- Limited range of motion; neurological symptoms after the crash.
- Ligamentous instability after the accident.
- Degenerative disease, headaches or neck injury or pain prior to the
crash.
- Vehicle size. When both are equal, even an 8 mph collision produces two
times the force of gravity or a 2-G acceleration of the car, and a 5-G
acceleration of the head. This magnification of the force gives rise to the
name, Whiplash.
- Headrest position. This can make an injury much worse if too low, and
even at the right height, it must be close enough to catch the head in time
(about 2 inches). A seat that is reclined too far will increase this
distance, as will poor posture and driving habits if leaning forward. Some
older vehicles (trucks, vans) do not have head restraints, adding insult to
injury.
- The position of the head at impact. When turned to the side, for
instance, it can only move about half as far as a straightforward position.
Hence, all the G forces are localized to one side of the spine,
substantially increasing the severity of injuries.
- Age plays an important role because as the body becomes older, ligaments
become less pliable, muscles weaker and less flexible, and decreases in
range of motion.
- Women and children seem to be injured more seriously than men. This is
most notable due to the fact that they tend to have smaller necks. They may
also be too close to the steering wheel, airbag and/or have improper fitting
shoulder harnesses.
- Pre-existing health problems such as arthritis, lend to the severity of
the injuries.
- The use of the seatbelt and shoulder harness.
- Non-awareness of the impact.
- Non-failure of the seatback.
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Myths
- Low Speed Rear Impact Crashes don't cause injuries.
- Injuries heal in 6-12 weeks.
- Litigation has an effect on the patient's recovery.
- The patient's pre-injury psychological makeup affects recovery.
- Greater vehicle damage=greater occupant injury.
- Accident reconstructionists can predict injury potential.
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Crash Facts
- 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 5 mph.
- Most injuries occur at speeds below 12 mph.
- The peak acceleration of the head is greater than the peak acceleration
of the vehicle.
- A 5 mph delta V crash typically produces about 10-12 g of acceleration
of the occupant's head.
- Other reports have shown that crashed 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.
- Recent epidemiological studies have shown that most injury rear impact
accidents occur at crash speeds of 6 mph to 12 mph--the majority at speeds
below the threshold for property damage to the vehicle.
- A number of risk factors in rear impact accident injury have now been
verified including: rear (vs. other vector) impact, loss of cervical
lordotic curve, preexisting degenerative changes, the use of seat belts and
shoulder harness, poor head restraint geometry, non-awareness of the
impending collision, female gender, and head rotation at impact.
- The notion of litigation neurosis has been rather definitively
dispelled.
- Once thought to suggest minimal injury, a delay in onset of symptoms has
been shown to be the norm, rather than the exception.
- Mild traumatic brain injury can result from whiplash trauma. Often the
symptoms are referred as the post concussion syndrome. This condition, often
maligned in the past, has now been well-validated in recent medical
literature.
- 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.
- Radanov et al. 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 plateau in the most severe categories as 20.5 weeks. Thus, the
notion that whiplash injuries heal in 6-12 weeks is challenged.
(Incidentally, there never has been any real support for this common myth.)
- Each year, 1.99 million Americans are injured in whiplash accidents.
- Of the 31 important whiplash outcome studies published since 1956 (19
published since 1990 pooling patients from all vectors of collision (I. e.,
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.
- Although estimates vary, about 10% of all whiplash victims become
disabled.
- The Quebec Task Force on Whiplash-Associated Disorders has been
criticized on the basis of potential bias, study design, the use of
ambiguous and misleading terminology, and for developing conclusions that
are not supported by the literature.
- The chiropractic profession has developed its own guidelines for
management of whiplash patients.
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Most injuries don't
show on x-rays
This loss of normal cervical curve is the result of the cervical
acceleration/deceleration syndrome, and can be responsible for many positive
orthopedic and neurological examination findings contributing to the
patient's symptomotology. X-rays cannot demonstrate microscopic, tears nor
show inflammation in the soft tissue (ligaments, tendons, muscle, cartilage,
etc) which is one of the leading causes of the pain and soreness that you
feel. X-rays are the most cost effective study to rule out ligament
insufficiency, bone pathology, and vertebral misalignment.
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