Whiplash
Whiplash is defined as a sudden extension of the cervical spine (backward movement of the neck) and flexion (forward movement of the neck). This type of trauma is also referred to as a cervical acceleration deceleration (CAD) injury. Rear-end or side-impact motor vehicle collisions are the number one cause of whiplash with an injury to the muscles, ligaments, tendons, joints, and discs of the cervical spine.
This guide to Whiplash will help you understand
• what parts make up the spine and neck
• what causes this condition
• how doctors diagnose this condition
• what treatment options are available
Anatomy
What parts make up the spine and neck? The human spine is made up of 24 spinal bones, called vertebrae. Vertebrae are stacked on top of one another to form the spinal column.
The spinal column is the body’s main upright support. The cervical spine is formed by the first seven vertebrae referred to as C1 to C7. The cervical spine starts where the top vertebra (C1) connects to the bottom edge of the skull.
The cervical spine curves slightly inward and ends where C7 joins the top of the thoracic spine. This is where the chest begins.
A bony ring attaches to the back of the vertebral body. When the vertebrae are stacked on top of each other, the rings form a hollow tube.
This bony tube surrounds the spinal cord as it passes through the spine.
Just as the skull protects the brain, the bones of the spinal column protect the spinal cord. As the spinal cord travels from the brain down through the spine, it sends out nerve branches between each vertebra called nerve roots. The nerve roots that come out of the cervical spine form the nerves that go to the arms and hands. Two spinal nerves exit the sides of each spinal segment, one on the left and one on the right.
As the nerves leave the spinal cord, they pass through a small bony tunnel on each side of the vertebra, called a neural foramen. (The term used to describe more than one opening is neural foramina.)
Each spinal segment includes two vertebrae separated by an intervertebral disc, the nerves that leave the spinal cord at that level, and the small facet joints that link each level of the spinal column.
An intervertebral disc is made of connective tissue. Connective tissue is the material that holds the living cells of the body together. The disc is a specialized connective tissue structure that separates the two vertebral bodies of the spinal segment.
The disc normally works like a shock absorber. It protects the spine against the daily pull of gravity. It also protects the spine during activities that put strong force on the spine, such as jumping, running, and lifting. An intervertebral disc is made up of two parts.
The center, called the nucleus, is spongy. It provides most of the ability to absorb shock. The nucleus is held in place by the annulus, a series of strong ligament rings surrounding it. Ligaments are strong connective tissues that attach bones to other bones.
Causes of Whiplash
What causes whiplash? When the head and neck are suddenly and forcefully whipped forward and back, mechanical forces place excessive stress on the cervical spine. Traumatic disc rupture and soft tissue damage can occur. The cartilage between the disc and the vertebral bone is often cracked.
This is known as a rim lesion. Damage to the disc can put pressure on the nerves as they exit the spine. The pressure or irritation can be felt as numbness on the skin, weakness in the muscles, or pain along the path of the nerve. Most people think of these symptoms as indications of a pinched nerve. Health care providers call this condition cervical radiculopathy.
Soft tissue around the facet joint can be injured. Many of the pain-sensing nerves of the spine are in the facet joints. The normally smooth surfaces on which these joints glide can become rough, irritated, and inflamed. Studies show that neck pain often comes from damaged facet joints.
Low back pain is a common feature after a whiplash injury. Studies show that there is significant electrical activity in the muscles of the lumbar spine when the neck is extended. This effect increases when there is neck pain, possibly as a way to help stabilize the spine when neck pain causes weakness. More than anyplace else in the body, the muscles of the neck sense sudden changes in tension and respond quickly.
Tiny spindles in the muscles signal the need for more muscle tension to hold against the sudden shift in position. The result is often muscle spasm as a self-protective measure. The increased muscle tone prevents motion of the inflamed joint. You may experience neck stiffness as a result.
Whiplash Risk Factors
Every year, more and more people experience whiplash injuries to their neck and back. Of these people, only about one half will fully recover. The other individuals will have long-term symptoms, and a certain percentage will actually become disabled as a result of the injury.
There are many factors that come into play when a person is injured in a rear-end motor vehicle accident. Anyone or more of the following factors can affect recovery:
- Head turned one way or the other at the time of the impact (increases risk of nerve involvement with pain down the arm)
- Getting hit from behind (rear-impact collision)
- Previous neck pain or headaches
- Previous similar injury
- Being unaware of the impending impact
- Poor posture at the time of impact (head, neck, or chest bent forward)
- Poor position of the headrest or no headrest
- Crash speed under 10 mph
- Being in the front seat as opposed to sitting in the back seat of the car
- Collision with a vehicle larger than yours
- Being of slight build
- Wearing a seatbelt (a seat belt should always be worn, but at lower speeds, a lap and shoulder type seat belt will increase the chances of injury)
Symptoms of Whiplash
What are some of the symptoms of whiplash?
- Neck pain or neck pain that travels down the arm (radiculopathy)
- Headaches
- Low back pain (LBP)
- Jaw pain
- Dizziness
Ninety percent of patients involved in whiplash-type accidents complain of neck pain. This is by far the most common symptom. The pain often spreads into the upper back, between the shoulder blades, or down the arm. Neck pain that goes down the arm is called radiculopathy. Low back pain (LBP) can occur as a result of a whiplash injury.
The Insurance Research Council reports that LBP occurs in 39 percent of whiplash patients. Some studies found LBP to be present in 57 percent of rear-impact collisions in which injuries were reported and 71 percent of side-impact collisions.
Jaw pain as a result of temporomandibular joint (TMJ) injury can also cause painful headaches. The TMJ is formed by the bone of the mandible (lower jaw) connecting to the temporal bone at the side of the skull. the TMJ is a hinge joint that allows the jaw to open and closes and to move forward, back, and sideways. Pain in this joint is called temporomandibular joint disorder (TMD).
Dizziness is quite common with a sense of lost balance being reported. It is caused by an injury to the joints of the neck called facet or zygapophyseal joints. When dizziness is reported, it should be distinguished from vertigo (also known as benign paroxysmal positional vertigo (BPPV), which results from an injury to the inner ear.
Other symptoms often reported include, but are not limited to: shoulder pain; numbness or tingling in the arms, hands, legs or feet; facial pain, fatigue, confusion, poor concentration, irritability, difficulty sleeping, forgetfulness, visual problems, and mood disorders.
It is not uncommon to have a delay in your symptoms. It is actually more common to have a 24 to 72-hour delay in the symptoms of whiplash as opposed to immediate symptoms or pain. This is most likely due to the fact that it takes the body 24 to 72 hours to develop inflammation. Disc injuries may take even longer to manifest themselves. It is not uncommon for a disc injury to remain pain-free and unnoticed for weeks to months.
Simply because it is little or no damage to your car does not mean that you were not injured. In fact, more than half of all whiplash injuries occur where there was little or no damage to one or both of the vehicles involved. When we see visible damage to a car, it means that the car has absorbed much of that force and less force is transmitted to the occupant.
On the other hand, if there is little or no damage to the car, the force is not absorbed but transferred to the driver or passengers, potentially resulting in greater injury.
Diagnosis of Whiplash
How will my doctor identify whiplash?
The diagnosis of neck problems begins with a thorough history of your condition and the involved car accident. You might be asked to fill out a questionnaire describing your neck problems. Then your doctor will ask you questions to find out when you first started having problems, what makes your symptoms better or worse, and how the symptoms of whiplash affect your daily activity.
Your answers will help guide the physical examination. Your doctor will then physically examine the muscles and joints of your neck. It is important that your doctor see how your neck is aligned, how it moves, and exactly where it hurts.
Your doctor may do some simple tests to check the function of the nerves. These tests measure your arm and hand strength, check your reflexes, and help determine whether you have numbness in your arms, hands, or fingers. The information from your medical history and physical examination will help your doctor decide which tests to order.
The tests give different types of information.
Radiological Imaging Radiological imaging tests help your doctor see the anatomy of your spine. There are many kinds of imaging tests including X-rays X-rays show problems with bones, such as infection, bone tumors, or fractures.
X-rays of the spine also can give your doctor information about how much degeneration has occurred in the spine, such as the amount of space in the neural foramina and between the discs. X-rays are usually the first test ordered before any of the more specialized tests.
Special x-rays called flexion/extension x-rays may help to determine if there is instability between vertebrae. These x-rays are taken from the side as you bend as far forward and then as far back as you can. Comparing the two x-rays allows the doctor to see how much motion occurs between each spinal segment.
Magnetic Resonance Imaging (MRI) If more information is needed, your doctor may order a magnetic resonance imaging (MRI). The MRI machine uses magnetic waves rather than x-rays to create pictures of the cervical spine in slices. MRIs show the cervical spine vertebrae, as well as the soft tissue structures, such as the discs, joints, and nerves.
Computed Tomography (CT) CT scan is a special type of x-ray that lets doctors see slices of bone tissue. The machine uses a computer and x-rays to create these slices. It is used primarily when problems are suspected in the bones.
Treatment What can be done for the problem? Whenever possible, doctors prefer to use treatments other than surgery. The first goal of these treatments is to ease your pain and other symptoms. Your Osteopath will work with you to improve your neck movement and strength. They will also encourage healthy body alignment and posture. These steps are designed to enable you to get back to your normal activities. Conservative care may include:
Immobilization At first, your doctor may prescribe immobilization of the neck. Keeping the neck still for a short time can calm inflammation and pain. This might include the use of a soft cervical (neck) collar. The collar is a padded ring that wraps around the neck and is held in place by a Velcro strap.
A soft cervical collar may be used for the first 24 to 48 hours to help provide support and reduce pain. There is no need for a hard or rigid cervical collar unless the neck is fractured.
Joint mobilization These are graded pressures and movements that are done by skilled Osteopath. Gently graded pressures help lubricate joint surfaces, easing stiffness and helping you begin moving with less pain.
Spinal manipulation has shown short-term benefits in people with acute neck pain. Commonly thought of as an adjustment, spinal manipulation helps reset the sensitivity of the spinal nerves and muscles, easing pain and improving mobility. It involves a high-impulse stretch of the spinal joints and is often characterized by the sound of popping as the stretch is done.
Electrical stimulation – is a gentle treatment used to stimulate nerves. The current passes through pads applied on the skin. Some people say it feels like a massage on their skin. Electrical stimulation can ease the pain by sending impulses that are felt instead of pain. Once the pain eases, muscles that are in spasm begin to relax, letting you move and exercise with less discomfort.
Platelet Rich Plasma – uses a small amount of plasma from your blood to stimulate an injured area to heal.
Ultrasound – An ultrasound machine produces high-frequency sound waves that are directed toward the sore area. Passing through the body’s tissues, these waves vibrate molecules. This causes friction and warmth as the sound passes through the tissue. The rest of the sound changes to heat in the deeper tissues of the body. This heating effect helps flush the sore area and brings in a new supply of nutrient and oxygen-rich blood. These ultrasonic waves act as an anti-inflammatory to reduce inflammation.
Clinical Pilates to re-educate and strengthen muscles. This is important, However, as a result of pain and inactivity, your muscles may become weak and deconditioned, and your back won’t function optimally.
Soft tissue mobilization/massage: Osteopaths are trained in many different forms of massage and mobilization when treating the neck. Massage has been shown to calm pain and spasm by helping muscles relax, by bringing in a fresh supply of oxygen and nutrient-rich blood, and by flushing the area of chemical irritants that come from inflammation. Soft tissue treatments can help tight muscles relax, getting them back to a normal length. This will help you begin to move with less pain and greater ease.
Medications such as NSAIDS or analgesics
Injections – Spinal injections are used for both treatment and diagnostic purposes. There are several different types of spinal injections that your doctor may suggest. These injections usually use a mixture of an anesthetic and some type of cortisone preparation.
The anesthetic is a medication that numbs the area where it is injected. If the injection takes away your pain immediately, this gives your doctor important information suggesting that the injected area is indeed the source of your pain.
The cortisone decreases inflammation and can reduce the pain from an inflamed nerve or joint for a prolonged period of time.
