The term “Whiplash” originated in 1928 to describe the result of a sudden hyperextension injury of the neck immediately followed by hyperflexion injury and the resulting damage to the surrounding muscles, ligaments and tendons. Today we remove the “hyper” part referring to extension and flexion beyond the normal physical limits and define whiplash as an extremely rapid extension and flexion that causes injury as it is the suddenness of movement and not necessarily movement beyond what we can normally manage that causes the damage. Whiplash injuries are far from straightforward as they involve an unpredictable combination of injuries to the nervous system, muscles, joints, and connective tissues, which makes fully diagnosing whiplash difficult and treatment even more challenging. However, the longer term effects of an untreated or under treated whiplash can be even more distressing. To better understand why whiplash is so problematic, let’s look at the mechanics of how the injury occurs.
The Four Phases of the Whiplash Injury
Whiplash injuries are not confined to auto accidents and often occur during a slip, fall or while playing sport. However, we’ll look at what typically occurs in an auto accident, which is the most common and most severe cause of whiplash.
As a vehicle hits the rear of your car, your body goes through an extremely quick and violent acceleration and deceleration, and all four of the phases described below happen in less than half a second. Each phase involves a different force acting upon your body, which contributes to the overall injury, bringing vertebrae, nerves, discs, muscles, and ligaments into the fold.
- Phase 1: Your car is shunted at great speed from underneath you. Your mid-back is flattened against the back of the seat, creating an upward force in your neck, which compresses your discs and joints. As your momentum continues forward with the car, your head flies backward, and this whips violently at your neck. Only a well-adjusted head rest can help minimize the damage this causes, lessening the backward travel of your head. However, the majority of damage to the spine will already have occurred before your head hits the head rest, as studies show that head rests only reduce injury by 11% to 20%.
- Phase 2: Your torso reaches its peak forward acceleration at twice the speed of the impacting vehicle, while your head continues moving backwards. Your neck goes through an abnormal S-curve as your seat back springs your torso forward. This moment causes extreme compressive forces on the neck and significant damage to bone, joint, nerve, and discs.
- Phase 3: Your torso is now settling back down in your seat, and your head and neck are both accelerating forward at their peak speed. This happens as the car is slowing anyway, but this deceleration is aided by your foot planting itself firmly on the brake pedal after possibly lifting off at the moment of impact. This sudden braking severely increases the flexion injury of your neck. Assuming a seat belt is being worn, it now takes the strain of your forward movement.
- Phase 4: The most damaging part of the whiplash sequence now occurs. The seat belt stops your torso but your head continues forward. The neck bends violently forward, straining muscles and ligaments, tearing fibers in the spinal discs, and forcing vertebrae beyond their normal movement. Your spinal cord and nerve roots are stretched and damaged, and your brain hits your skull, potentially causing mild to moderate brain injury. Where a seat belt has not been used, your head is free to move forward and strike the steering wheel, dash or windshield, causing even more severe brain injuries.
Injuries from Whiplash Trauma
There are so many variables involved in how an accident occurs, as there are with the individual victim, so it is impossible to predict them all. Injuries are sometimes felt immediately or within an hour of the accident but more often due to the immediate shock, which causes the body to release endorphins and adrenaline, the true symptoms surface weeks or even months later. Generally, though, there is an array of conditions that are often seen following a whiplash:
- Neck Pain: the single most common complaint as reported by over 90% of people. Pain often radiates into the shoulders, between the shoulder blades, and into the head. All the tissues in the neck tend to be affected by whiplash, including the muscles, ligaments and nerves, and the facet joints and discs between the vertebrae.
- Headaches: following neck pain this is the second most common complaint, affecting over 80% of sufferers. Although headaches occasionally result from direct brain injury, most are triggered by injured muscles, ligaments and facet joints in the cervical spine, referring pain into the head. It is therefore vital to treat the supporting structures of your neck in order to combat headaches.
- TMJ: Temporomandibular Joint Dysfunction (TMJ) is a less common disorder that follows whiplash, but can be debilitating if it occurs. TMJ manifests as pain, clicking and popping noises in the jaw when moved. Untreated, TMJ can worsen and cause headaches, facial pain, ear pain and difficulty eating. This is a condition for which chiropractors are specially trained, or you may be referred to a TMJ specialist depending on the severity.
- Brain Injury: Mild to moderate brain injury is fairly common after whiplash, due to the movements as described in the four phases. The brain is very soft and suspended in cerebrospinal fluid, so that when the brain is jolted within the skull, it can be bruised or bleed. Whiplash victims may temporarily lose consciousness or have mild concussion, but more common is a feeling of mild confusion or disorientation following the crash. Long term effects include mild confusion, difficulty concentrating, sleep disturbances, irritability, forgetfulness, loss of sex drive, emotional upset and depression. In certain cases, the nerves that feed your senses of smell, taste and even sight may be affected.
- Dizziness: following a whiplash this is usually temporary and can improve with chiropractic care. It is the result of injury to the facet joints of the cervical spine, but in some cases it may be due to damage to the brain or brain stem.
- Low back Pain: Despite the neck bearing the brunt of the damage, your low back can also be easily injured by whiplash, and this is reported by over 50% of those involved in rear impact collisions, and in nearly 75% of those in side impact accidents. Although the low back does not suffer the same extent of flexion-extension injury as the neck, it still experiences a great compression during the first two phases of the whiplash process.
Recovery from Whiplash
Mild whiplash injuries treated correctly usually heal within six to nine months. However, 20% of victims will still be suffering pain, weakness or restricted movement two years after their accident, and it is likely that some degree of disability or pain will afflict theses people for many years more, if not for life.
Whiplash injuries need to be treated by specially trained professionals who know and understand the condition. The most effective treatment combines chiropractic care with rehabilitation of the soft tissues, and a self-care routine.
Chiropractic care involves the manual manipulation of the spine to restore normal movement and position to the vertebrae. This is the most important and effective treatment to ensure that whiplash damage is minimized. Your chiropractor may also use trigger point therapy, massage therapy, exercise rehabilitation, and other soft tissue rehabilitation treatments.
Soft Tissue Rehabilitation
‘Soft tissue’ refers to anything in the body that’s not bone, so that includes muscles, ligaments, tendons, nervous system, spinal discs and internal organs. It is these soft tissues that are damaged most by whiplash, with the muscles, ligaments and discs taking the majority of the impact. Unless the correct therapies are used to stimulate healing, the result may be permanent impairment and disability. Treatments include trigger point therapy, massage therapy, electro-stimulation, stretching, and specific exercises to boost strength and range-of-motion.
How you behave outside the chiropractor’s office will significantly enhance or detract from the treatment given inside it. Your daily home and work routines must be guided by your recovery plan, so that the treatment sessions have maximum benefit. You should: apply ice packs, carefully limit daily activities, stretch, exercise, supplement nutritionally, and get plenty of rest.
Severe whiplash may require the input of a physician to complement your overall treatment. This may mean anti-inflammatory medications, muscle relaxants, trigger point injections, or even epidural spinal injections. The point of these is short-term pain relief; they are not intended as curative or long-term options. No drug will restore normal joint movement or stimulate muscle repair. Surgery may be necessary for a badly herniated discs, when a disc is impinging on the spinal cord, and in some cases with spinal fractures.
Are You Suffering from a Whiplash Injury?
Whether you have recently been involved in an auto accident, or if you had one several months or years ago and whether or not the symptoms are now starting to show up or not, in any case the sooner that you have your spine fully evaluated and begin a course of treatment the better your chances are for a maximum recovery. Be sure to provide as much detail about your injuries as possible to help your Chiropractor fully understand your condition.
For Your Health,
Dr. Mark Wolff