What Is Whiplash Injury?
The term ‘whiplash’ was first introduced by an American Orthopedist, Dr. H.E. Crowe in 1928. He described the syndrome as a spinal tissue insult-injury due to the sudden acceleration-deceleration event of the head and neck.
Proper Definition of Whiplash Injury:
“Whiplash is an acceleration-deceleration mechanism of energy transfer to the neck. It may result from rear-end or side-impact motor-vehicle collisions, or other driving mishaps. The impact may result in bony or soft tissue injuries (whiplash injury), which in turn may lead to a variety of clinical manifestations (whiplash-associated disorders) (WAD).”
Even if the crash seems minor, the damage to your neck and spine may not be. Sometimes, it takes weeks, even months, for inflammation and scar tissue from a whiplash injury to cause pain and suffering. So long, in fact, that you may not even associate it with the ‘little crash’.
Whiplash Injury Symptoms-Complaints
Neck sprain or strain is often the diagnosis given to the person injured in a car crash. However, the injuries may not be so simple as a ‘strain-sprain’ would suggest. People suffering from injuries sustained in a motor vehicle crash might have these common complaints:
• Neck Pain & Headaches
• Upper back pain
• Low Back Pain
• Numbness & Tingling of Extremities
• Cognitive Difficulties
• Visual Disturbances
Who Does Whiplash Injury Affect?
In the year 2000, an estimated 901,442 persons with neck strain/sprain injury were treated in US hospital ER departments. For car occupants, neck strain/sprain was the most frequent type of injury, comprising 27.8% of all injuries.26
“Motor vehicle (MV)-related trauma is the leading cause of injury-related death (National Center for Health Statistics, 2001) and the third leading cause of nonfatal injuries (CDC, 2001) treated in hospital emergency departments (EDs) in the US.”
“Soft tissue injuries of the neck are a frequent injury type among MV crash victims.”26
I) Risk of Injury & Risk of Delayed Recovery or Chronic Impairments18-25
There are a number of patient characteristic factors that have been associated with increased risk of injury during motor vehicle crashes (MVC’s). These risk factors can predispose the occupant to risk of: 1) acute injury, delayed recovery, and/or permanency or chronic injury. The greater the number of risk factors a given patient has can be linked to probability and severity of injury. The following is a list of the most relevant patient and type of crash characteristic risk factors:
A. Patient Characteristics That Increase the Likelihood of Whiplash Injury18-25
· The patient’s gender and body mass are important factors to consider in any car crash injuries. Several studies have demonstrated that women (especially small framed women) are more likely to be injured and more seriously injured than men.1-4
- Immediate or early onset of symptoms following the MVC.5,6
- Severe initial symptoms following the MVC.5,6
- Greater number of initial symptoms, specifically 3 or more, following the MVC.7
- Initial examination finding of a loss of cervical range of motion following the MVC.7
- Head out of the neutral position immediately prior to impact.12.
- Middle aged and above. 13,14
- A previous history of head and neck injury or pain.15,16
- Straightened or reversal of the normal cervical lordosis at the time of MVC.7-11
Pre-existing Spinal Arthritis and Disc Disease (S.A.D.D.)7 See Figure 2.
Whiplash injuries can cause abnormal neck curves to occur. Also, when a patient has an abnormal neck curve this can stretch and irritate the neck joints more during a whiplash event as compared to if a patient had a normal neck curve. Thus, abnormal neck curves are problematic when it comes to Whiplash Injury and pain. Only spinal x-rays can show a Chiropractor what the state of your neck curve is.
B. Crash Characteristics
- Front seat position during the MVC impact.6
- Rear end collisions compared to other directions of impact.17,18
- The mass of the vehicle being struck compared to the mass of the vehicle striking. Specifically a 25% difference in vehicular masses.
- The velocity and accelerations of the vehicles involved in the MVC and acceleration (g-forces) experienced by the patient’s head and cervical spine. A threshold of change in velocity δv= 2.5-5 m.p.h. has been linked to injury of occupants involved in MVA’s.17
What Causes Whiplash Injury Symptoms?
The Whiplash event causes complex forces to act on the tissues of the spine: compression, bending, shear, and tension. These forces can cause micro-scopic tearing and in some cases visible tearing of the soft tissues of the spine. The most common injuries to the spine due to Whiplash are damaged spinal neck ligaments. These ligaments are the primary cause of many patient’s pain (See Figure 3). The tissues that can be injured included:
• Vertebral Facet Capsular Ligaments,
• Intervertebral Discs,
• Spinal Ligaments (ALL, PLL, ISL, SSL),
• Cervical Muscles,
• Specific Upper Cervical Ligaments:
Figure 3. Pain originating from the joints and ligaments of the neck spine can be felt from the back of the head, into the neck, upper shoulders, and the upper back or shoulder blade region. The neck is comprised of 7 cervical vertebra; these are referred to as C1-C7. Injury to the different components (ligaments, disc muscle) causes pain in different locations. Here, the different colors show the area that injury to the different cervical joints will be felt in.
These are the most common sites of pain for patients injured in a car accident. The pain is likely coming from damage to your NECK!
Examination Procedures for the Diagnosis of Whiplash Injury
The cause of pain due to a Whiplash Injury event is evaluated using multiple procedures to help determine a possible cause or source of the pain. These procedures can include:
· A history of the condition,
· Detailed posture analysis. See Figure 4,
· Neck or cervical spine x-rays. See Figure 2,
· Range of motion of the head and neck,
· Muscle strength and possibly Emg evaluation for muscle function,
· Neurological and orthopedic tests,
· Possibly an MRI to rule out other underlying and/or contributing conditions, such as disc herniations, ligament tears, or fractures.
Abnormal head posture causes the neck muscles to contract and this contraction increases pressure on the tissue of the neck causing pain.
Chiropractic & Conservative Treatments for Whiplash Injury
Even with minor car crashes, the old saying applies: it’s better to be safe than sorry. A visit to a chiropractor trained in treatment techniques developed and tested by Chiropractic BioPhysics® can check for whiplash injury. Early intervention can save needless suffering.
Treatment for Whiplash Injury pain is geared towards correcting the cause of the pain (eg. abnormal posture), increasing joint and postural movement and reducing pain and inflammation. Typically, Chiropractic and conservative treatment consists of:
· Chiropractic Joint Adjustments and Postural Adjustments (See Figure 5);
· Posture rehabilitation of the head, neck, shoulder girdle (See Figure 5);
· Corrective traction to restore the normal neck curvature (See Figure 5)
· Strengthening and conditioning Exercices;
· Massage Techniques (Myofascial release);
· Cryo-therapy –icing.
· Nutritional supplements to aid in inhibition of inflammation and promote healing.
Common Medical Interventions
The most common Medical treatment for whiplash injuries usually consists of non-steroidal anti-inflammatory drugs (NSAIDS), muscle relaxants, and/or cortisone injections.
Whether prescribed by a doctor or purchased over the counter, these medications may initially help with pains, However when the drugs wear off, the pain usually returns sometimes worse than before. Many patients with chronic whiplash induced pain get no lasting relief from medications.
More importantly, due to the common adverse risks associated with anti-inflammatory drugs (stomach bleeding, kidney damage, accidental death, etc…),27 it is our opinion that Chiropractic and other conservative treatments should be attempted initially for those patients with spinal and joint involvement.
Chiropractic Care May Have a Positive Influence on Whiplash Injuries
Chiropractic adjustments and rehabilitation procedures offers safe and effective means of an initial course of treatment for patients suffering from Whiplash induced disorders. Several clinical studies from randomized trials to case studies have shown the potential benefits of chiropractic care for improving Cervical Spine Pain.28-42
For example, the study by Woodward et al27 found that 93% of patients with chronic whiplash pain get relief from chiropractic even when medical care and physical therapy failed.
Significantly, Chiropractic BioPhysics® (CBP®) Technique care has been found to improve patients suffering from chronic whiplash associated disorders and disabilities.29-31 These whiplash treatment techniques developed and tested by Chiropractic BioPhysics® are available from a CBP®-trained Doctor of Chiropractic near you. Search our directory for more information.
- Hohl M. Soft-tissue injuries of the neck in automobile accidents. J Bone Joint Surgery 1974; 56A:1675-1682.
- Nygren A. Injuries to car occupants-some aspects of interior safety of cars. Acta Otolaryngol 1984; 394(suppl):1-127.
- Parmar HV, Raymakers R. Neck injuries from rear impact road traffic accidents: Prognosis in persons seeking compensation. Injury 1993; 24(2):75-78.
- Schutt CH, Dohan FC. Neck injury to women in auto accidents. JAMA 1968; 206(12):2689-2692.
- Radanov BP, Sturzenegger M, Di Stefan G, Schnidrig A: Relationship between early somatic, radiological, cognitive and psychosocial findings and outcome during a one-year follow-up in 117 patients suffering from common whiplash. Br J Rheum 1994;33:442-448.
- Parmar HV, Raymakers R: Neck injuries from rear impact road traffic accidents: prognosis in persons seeking compensation. Injury 1993;24(2):75-78.
- Norris SH, Watt I. The prognosis of neck injuries resulting from rear-end vehicle collisions. J Bone and Joint Surgery 1983;65-B:608-611.
- Hohl M. Hohl M. Soft-tissue injuries of the neck in automobile accidents. J Bone and Joint Surgery 1974;56-A:1675-1682.
- Kai Y, Oyama M, Kurose S, Inadome T, Oketani Y, Masuda Y. Neurogenic thoracic outlet syndrome in whiplash injury. J Spinal Disorders 2001;14:487-493.
- Zatzkin HR, Kveton FW. Evalutation of the cervical spine in whiplash injuries. Radiology 1960;75:577-583.
- Foreman SM, Croft AC. Whiplash Injuries: The Cervical Acceleration Deceleration Syndrome. 2nd edition. Baltimore, Philadelphia, 1995; pgs. 443-449.
- Spine Head Rotation Study---.
- Satoh S, Naito S, Konishi T, Yoshikawa M, Morita N, Okada T, Kageyama T, Matsuzaki I: An examination of reasons for prolonged treatment in Japanese patients with whiplash injuries. J Musculoskel Pain 1997;5(2):71-84.
- Radanov BP, Di Stefano GD, Schnidrig A, Ballinari P: Role of psychological stress in recovery from common whiplash. Lancet 1991;338:712-715.
- Dolinis J: Risk factors for 'whiplash' in drivers: a cohort study of rear-end traffic crashes. Injury 28(3):173-179, 1997.
- Gun RT, Lorenzo O, O’Riordan A, Mpelasoka F, Eckerwall CGM, Smyth JF. Risk factors for prolonged disability after whiplash injury: A prospective study. Spine 2005;30:386-391.
- Gargan MF, Bannister GC: The rate of recovery following whiplash injury. Eur Spine J 3:162-164, 1994.
- Radanov BP, Sturzenegger M, Stefano GD: Long-term outcome after whiplash injury: a two-year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial factors. Medicine 74(5):281-297, 1995.
- Parmar HV, Raymakers R: Neck injuries from rear impact road traffic accidents: prognosis in persons seeking compensation. Injury 24(2):75-78, 1993.
- Radanov BP, Distefano GD, Schnidrig A, et al.: Cognitive functioning after common whiplash: a controlled follow-up study. Arch Neurol 50:87-91, 1993.
- Radanov BP, Di Stefano G, Schnidrig A, Sturzenegger M: Psychosocial stress, cognitive performance and disability after common whiplash. J Psychosom Res 37(1):1-10, 1993.
- Hohl M. Soft-tissue injuries of the neck in automobile accidents. J Bone Joint Surgery 1974; 56A:1675-1682.
- Hijioka A, narusawa K, Nakamura T. Risk factors for long-term treatment of whiplash injury in Japan: analysis of 400 cases Arch Orthop Trauma Surg 2001;121:490-493.
- Radanov BP, Sturzenegger M, Di Stefano G, Schnidrig A. Relationship between early somatic, radiological, cognitive and psychosocial findings and outcome during a one-year follow-up in 117 patients suffering from common whiplash. Br J Rheumatol 1994;33:442-448.
- Radanov BP, Sturznegger M, Stefano GD. Long-term outcome after whiplash-injury: a two year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial factors. Medicine 1995;74:281-287.
- Quinlan KP, Annest JL, Myers B et al. Neck strains and sprains among motor vehicle occupants-United States, 2000. Accid.Anal.Prev. 2004;36:21-7.
- Moore TJ, Cohen MR, Furberg CD. Serious adverse drug events reported to the food and drug administration; 1998-2005. Archives Internal Med 2007;167(16):1752-1759.
- Woodward, et al., Injury, 1996, 643–645.
- Ferrantelli J, Harrison DE, Harrison DD, Steward D. Conservative management of previously unresponsive whiplash associated disorders with CBP methods: A Case Report. J Manipulative Physiol Ther 2005;28:205e1-205e8.
- Harrison DE. Structural Rehabilitation Procedures for Cervical Spine and Postural Abnormalities in Post-Traumatic Cervico-genic and Tension Type Headache Sufferers. Proceedings of the International Whiplash Trauma Congress 2007; Miami, FL., October.
- Underhill M, Harrison DE. Rehabilitation of Cervical Kyphosis in a Previously Unresponsive Adolescent with Chronic Cervico-genic Symptoms from a Motor Vehicle Collision: A Case Report. Proceedings of the International Whiplash Trauma Congress 2007; Miami, FL., October.
- Alpass L. Chiropractic management of intractable chronic whiplash syndrome. Clinical Chiropractic 2004;7:16-23.
- Collins ME, Misukanis TM. Chiropractic management of a patient with post traumatic vertigo of complex origin. J Chiropractic Medicine 2005;4:32-38.
- Davis CG. Chronic cervical spine pain treated with manipulation under anesthesia. J Neuromusculoskeletal System 1996;4:102-119.
- Filipkowski DE. Upper quarter kinetic chain response to cervical manipulation: A case report. J Chiropractic Medicine 2006;69-71.
- Fitz-Ritson D. Phasic exercises for cervical rehabilitation after whiplash trauma. J Manipulative Physiol Therapeutics 1995;18:21-24.
- Grosnold JM. The impact of rehabilitation on chronic whiplash. Clinical Chiropractic 2003;6:129-136.
- Kessinger RC, Boneva DC Case study: acceleration deceleration injury with angular kyphosis. J Manipulative Physiological Ther 2000; 23:279-287.
- McCoy HG, McCoy M. A multiple parameter assessment of whiplash injury undergoing subluxation based chiropractic care: A retrospective study. J Vertebral Subluxation Research 1997;1:1-11.
- Provinciali L, et al. Multimodal treatment to prevent the late whiplash syndrome. Scandanavian J of Rehabilitative Medicine. 1996;105-111.
- Suter E, Harris S, Rosen M, Peterson D. Cervical spine adjustment improves muscle strength of the upper extremities in patients with subacute whiplash. European J of Chiropractic 2002;49:107-108.
- Suter E, McMorland G. Decrease in elbow flexor inhibition after cervical spine adjustment in patients with chronic whiplash. European J of Chiropractic 2002;49:117-118.