Injuries to the neck caused by a sudden movement of the head, backwards, forward, or sideways, are referred to as “Whiplash” or better acceleration/deceleration injury. Nearly one third of all motor vehicle accidents are rear-end collisions, and it is this type of accident that is responsible for most whiplash injuries. The biggest danger with whiplash injuries is that the symptoms can present themselves immediately after the accident or can take years to develop. Too often people don’t seek treatment until more serious complications develop. Frequently whiplash symptoms take between two and five years to recover, and occationally some victims will sustain permanent damage. A typical whiplash injury does not show any abnormalities on normal X-rays, and creates all kinds of disputes with insurance companies. New imaging devices such as CT (computerized tomography) scan, MRI (magnetic imaging) scan, Ultrasound now show to an extend soft tissue injury, which makes it a little more understandable for insurance companies, the amount of damage a whiplash victim sustains.
How the Cervical spine is Injured
Whiplash is most commonly received from riding in a car that is struck from behind, or collides with another vehicle. Immediately after the impact, the car seat pushes the torso forward while the head remains stationary due to inertia. This results in a straightening of the spine and compresses the facet joints which in turn results in weakening of the joints. After this straightening of the cervical spine the head starts to bend backwards and creats a crushing effect (compression and shear force) on the facet joints (Figure ?). The injury occurs before the head even reaches full extention. Most of the damage will occurs in the region of C4-C6. All this damage occurs within 300 milliseconds.
When no bones are broken and the head doesn’t strike the windshield, typical symptoms are as follows: 62% to 98% complain of neck pain, which typically starts two hours up to two days after the accident. This is often the results of tightened muscles that react to either muscle tears or excessive movement of joints creating ligament damage. The muscle tightness is a normal result in order to splint, and to limit excessive movement of the head and neck. The neck consists out of a large number of small muscles and all have different functions in order to maintain a proper head position. Damage to these will create a incorrect head posture. Ligaments can also be damaged when the spine hyperextends or hyperflexes.
Sixty-six to 70% of whiplash victims complain of headaches. The pain may be at the back of the head, on one side or both, and can be constant or occasional. These headaches are often a result of tight muscle in the neck, or arising from the cervical spine and like tension headaches they are often felt behind the eyes. Occipital neuralgia is a specific type of headache that involves damage or pressure on the occipital nerve. Headache can also arise from the jaw or better know as TMJ(temporomandibular joint). Shoulder pain or pain between the shoulder blades is also a result of whiplash due to tight and tensed muscles.
Disc tissue damage of the spinal column is well documented in the medical literature as result of rear-end accidents. Cervical disc herniation and neurological signs are often present. Due to the herniated disc victims can experience pain, numbness, cramp and tingling sensation down their arms, hands, legs or feet. Tears of the anterior longitudinal ligament, damage to the endplates, and small fractures are also damage that has been reported which can be difficult to diagnose (figure ?)
Facet joint injury:
Over the last few years, researchers have focused a great deal of attention on the role of facet joint injury caused by whiplash accidents. Due to the crushing fenomena during a crash the facet joints can be considerably damaged. Areas of pain caused by facet joints can present themselves at different areas of the neck and back. (Figure ?).
Other common symptoms:
There are many other symptoms that one can suffer from such as: dizziness, blurry vision, difficulty swallowing, lower back pain, ringing of the ears, fatigue, carpel tunnel syndrome, thoracic outlet syndrome and memory loss to name a few.
Factors and Variables:
The potential risk of injury can be effected by different conditions:1. The angle of collition. A straight on impact will generally be less hazardous than a collition from an angle, as the spine may be twisted in an off-center impact.2. The speed and size of the rear car. The faster and heavier the rear car the more damage to the occupant.3. The speed and size of the front car. The larger the car that is being hit the less damage to the occupant.4. Road condition. Was the road wet, dry, or oily. Was the road asphalt or gravel.5. Occupant head position. Was the occupant looking straight forward, or was the head turned. Turned will cause more damage than straight forward.6. Gender. Female in general will suffer more than men due to their body anatomy.7. Occupant awareness. In general it is believed that when the occupant brace themselves during the collition less trauma to the cervical spine can be expected.8. Head restraints. Many adjustable head rests are set too low, so that they act as pivots during hyperextension of the neck and in turn creating more injury. 9. Safety belts. Shoulder belts are very effective at saving lives in auto accidents, but there is some evidence that they can actually cause more damage in a rear car accident, because the body is held in place and the head suffer worse hyperflexion.10. Medical history. Cervical spine arthritis, chronic soft tissue pain, or history of neck problems will complicate the victims condition.
The chiropractic approach to these types of trauma is to use specific, gentle chiropractic adjustments to help restore spinal function. Chiropractic adjustment also called spinal manipulations are one of the only proven remedies for whiplash injuries. Conservative treatment of the neck pain is widely recognized as the best approach. Medical treatment for whiplash symptoms consists of bed rest, analgesics, NSAIDs, muscle relaxants, or sleeping medications. Some practitioners will prescribe a cervical collar but the faster the victim mobilizes the neck the faster the results. Surgery for whiplash neck pain is sometimes performed on patients with chronic pain, but has not been found to be very effective.
Even if you feel normal after an accident, with no symptoms, you should be thoroughly examined. Symptoms can be delayed for days, and some cases may not surface for years. Worse whiplash can still be causing symptoms some five years, and in the long run, can cause secondary problems such osteoarthritis and premature disc degeneration. This is why I highly recommend that everyone that was involved in a car accident to seek chiropractic help.