Whiplash Type Injury / Whiplash Associated Disorder.
Chiropractic treatment has been a great source of relief for many people who have suffered from whiplash. What exactly is whiplash and how does chiropractic help?
What is Whiplash?
Whiplash is a description of how the injury has been sustained. It is not a disease and not in itself a diagnosis. Rather it is a descriptive term that describes the mechanism of injury. Anytime the spine is unexpectedly moved in one direction and then it rebounds in the opposite direction there is the possibility of developing a whiplash type injury. It can happen in a backwards and forwards direction or it can be in a side to side motion. Of course whiplash type injuries are not limited to motor vehicle accidents alone; Sports injuries, knocks falls and slips can all produce a whiplash type injury. The term “whiplash type injury” is used to describe any injury mechanism where there is sudden excessive extension followed by an immediate excessive flexion of the neck that results in damage to the muscles, ligaments and tendons. We now know that whiplash type injuries frequently do not result from just excessive extension or excessive flexion (extension and flexion beyond normal limits of motion), but rather an extremely rapid extension and flexion that causes the damage.
What part of the spine is damaged in whiplash?
Most whiplash sufferers have misaligned vertebrae in their spine. Whiplash type injuries usually involve a combination of nervous system, muscles, joints and connective tissue damage. There are different degrees of whiplash type injuries and in order to decide the appropriate treatment, it is important to understand the mechanics of how whiplash type injuries occur.
How does a whiplash injury occur?
There are many different potential causes of whiplash type injury but one of the most common causes is the result of a motor vehicle accident where your body goes through an extremely rapid and intense acceleration and deceleration. In this instance all four phases of a whiplash type injury occur very quickly. During each phase there are different forces acting on the body that can cause injury, and with such a violent and forceful movement, damage to the vertebrae, nerves, discs, muscles, and ligaments of your neck and spine can be significant. The following is a description from Meridel Gatterman in her book “Chiropractic management of spine related disorders pages 230-231).
“In rear end collisions, even with a high seat back or head restraint, the neck is thrown into extension in proportion to the distance between the occupants head and the supporting structure. As the victims torso is forced backwards into the seat back, the head and neck initially remained fixed while the vehicle moves forward.”
“This initial inertia of the head followed by extension of the cervical spine at the end of this rearward translation.” This means that whilst the seat is moving forward whilst the head is still moving backwards. This shearing force in the neck is what causes most of the damage in whiplash type injuries. Many of the bone, joint, nerve, disc and TMJ injuries that we see clinically occur during this phase.
“After deflecting off the seat back or head restraint, the head rebounds forward, forcing the neck into flexion. In cars without head restraints or with head rests in a low position hyperextension occurs. If the headrest is not high enough then it may act as a fulcrum over which the neck pivots. As you move forward in your seat, any slack in your seat belt is removed and the restraint becomes tight.
“As the neck recoils forward hyperflexion is stopped by the chin hitting the chest.” This is where a lot of the injuries that are sustained in an accident can happen.” It causes a severe flexion in the neck putting tremendous strain on muscles, ligaments, and misaligning vertebra. If your head hits the windshield or steering wheel then you may suffer a concussion, or more severe brain injury.
Symptoms of Whiplash
There are a number of common symptoms associated with whiplash. These symptoms include some or all of the following:
Most patients suffering from whiplash complain of some form of neck pain. This is a very common symptom and it may be either localised or it may refer into the head, down the arm or into the mid back region.
It is quite common for patients suffering a whiplash type injury to suffer from headaches. These often originate in the neck and refer into the head and are termed a cervicogenic headache. They are usually of a dull aching nature but can also be sharp. They may be localised in the back of the neck or refer into the front of the head.
Low Back Pain
This is a common complication of a whiplash injury. This can be the result of twisting in the restraint/ seatbelt and from rapid bending or twisting of the spine.
Whiplash type injuries can manifest in a wide variety of ways.
The exact nature of the symptoms will vary depending on the patient’s direction of impact, speed of the vehicles involved, as well as sex, age and physical condition. Each case will be different. It is not uncommon for signs and symptoms to come on after a period of time, sometimes with a delay of days or weeks. This can often be because inflammation can take 24 to 72 hours to develop. It is not uncommon for some injuries to go unnoticed for weeks or months.
People often make the mistake of thinking that because there may be very little damage to the car that they can’t be injured. In fact even small accidents can cause whiplash, especially if you are not aware there is an impending accident about to happen and are unprepared. Often when there is no visible damage to the car it might mean that more of the impact force has been transferred to the occupant of the car. Whatever the situation be sure to be checked by your chiropractor as soon as possible after an accident to assess you for whiplash type injuries.
Diagnosis of whiplash type injuries:
Your Back to Health Chiropractor will conduct a thorough history of what exactly has caused the whiplash type injury. This will include questions on :
- The nature of the accident
- The exact location of the pain
- Exacerbating and relieving factor
- Types of pain
- Referral of pain
- Family history etc
You will then be offered an in depth physical examination which will look at all of the following factors:
- General posture and flexibility
- Palpation may reveal muscle tenderness and tightness in the neck muscles and suboccipital
- There may be reduced active and passive range of motion
- Orthopedic tests may be positive
- Muscle tests to determine the extent of weakness
- Neurological assessment if required
- X-rays of the spine may be conducted depending on the extent of your problems and the examination findings
Your Chiropractor will discuss with you exactly what examinations will be appropriate and will require your consent before undertaking an examination. Once a diagnosis has been confirmed then specific treatment options can be discussed.
Chiropractic Treatment for Wiplash
Chiropractic Management and Treatment Whiplash Type Injuries:
Chiropractic care is a useful way of treating whiplash. There are a number of different treatment modalities that your Back to Health chiropractor might consider.
The main treatment a chiropractor would provide would be gentle spinal adjustments and or manipulation to the spine as required to reduce inflammation and irritation to the nervous system.
Massage, stretching and strengthening exercises for neck muscles are based on the specific muscles that are involved.
Relative rest. It is important in the initial phase of treatment to reduce exercise and movements that aggravate the problem to minimum and reduce inflammation, whilst at the same time continuing with other activities that do not affect the condition such as swimming and other low impact aerobic activities. this is a concept often termed relative rest.
Ice can be applied to the neck to reduce the inflammation. This can be a frozen gel pack or simply a home made ice pack. It is recommended to use the ice for no longer than 10 minutes and to wrap it in a towel so as the ice is not directly in contact with the skin.