The topic of whiplash injury is often considered controversial, partly because the diagnosis depends entirely on a patient’s symptoms and a physical assessment. The condition cannot be proven through X-rays or other imaging studies nor by a lab test. However, for those who have suffered this injury, the condition is very real and can be debilitating. Here’s what you need to know about this problem and whiplash treatment, courtesy of Advanced Chiropractic and Wellness Center, your Arizona whiplash chiropractor.
This condition was first described in 1928, as doctors struggled to describe the combination of mechanisms involved. Injury to the spinal column – especially the neck – typically results from a sudden hyperextension and then an immediate hyperflexion. When a joint is extended, it is completely straight; hyperextension occurs when the joint is straightened beyond its normal range. Flexion is the opposite, as it occurs when the joint bends; hyperflexion is a bend beyond the normal range. The combination of the sudden movement plus excessive flexion and extension is what causes damage to the muscles, ligaments and tendons in the neck, which is why treatment requires the service of an Arizona whiplash chiropractor.
The Neck is Vulnerable
Although hyperextension and flexion of any joint is possible, the neck is particularly susceptible because of its anatomical structure and the weight of the head. The adult head weighs about 11 pounds. Unlike other parts of the spine, which are connected to the ribs, pelvis and other parts of the skeleton, the neck is connected only at top and bottom, with no support in the middle. When the body is suddenly thrown forward and back, the heavy head acts like a pendulum, stressing the neck.
Causes of Whiplash
Anything that makes the head suddenly whip back and forth is a potential cause of injury. Car accidents in which the car is rear-ended are the classic cause as this is the perfect set-up to make the head suddenly whip back and forth on the neck. Any abrupt deceleration in a moving vehicle – car, train, plane or even a bicycle – may have a similar effect. Roller coasters and carnival rides are another potential source of injury. In all cases, the mechanism is the same: a sudden back and forth movement of the head that hyperextends and then hyperflexes the neck. It seems to be the suddenness of the neck movements as well as the actual movements themselves that cause the damage.
The Phases of Injury
A neck injury typically occurs in less than a second. Each phase of the injury has specific forces that act on the spine, including the vertebrae (bones), discs (cartilage cushions), nerves, muscles, ligaments and tendons.
Phase 1: The car seat is pushed out from under you, forcing the mid-back against the seat, which results in an upward force on the cervical spine (neck). The head moves backward. Even if your seat has a headrest, by the time the head comes into contact with the headrest, most of the damage has already been done.
Phase 2: Your torso is still moving forward at one to two times the rate of your vehicle speed, but the head is still moving to the rear. An S-curve develops in the cervical spine (which is highly abnormal) and the opposing forces cause a shearing effect in the neck. This is the source of most of the physical damage involved in a whiplash injury.
Phase 3: The torso is now dropping back into the seat, while the head and neck are moving forward. The car is slowing down. Many drivers apply the brake during this phase, which makes the car slow even faster and increases the flexion in the neck. The lap belt and shoulder harness contribute to the sudden deceleration as your body slams against the restraints.
Phase 4: Now your torso has been stopped by the seat belt and shoulder harness, but the head is free to move forward without any kind of restraint or support. The neck bends forward suddenly and violently – probably the most damaging aspect of the four phases of injury.
What Kind of Damage Occurs?
The mechanics of these injuries strain muscles and ligaments, stretching them beyond the normal. This results in micro-tears in the muscle fibers. Fibers in the spinal discs may also tear. The vertebrae can be forced out of their normal alignment. The spinal cord – which runs through the center of the vertebrae – is excessively stretched and becomes irritated. The brain is soft and lies suspended in a cushion of fluid inside the skull. As the head moves forward and back, the brain also moves, hitting first the back and then the front of the skull. The impact from this injury, which is called a contrecoup, can cause damage and even bleeding inside the brain tissue.
Whiplash injuries may present with a wide variety of symptoms. Even with very similar mechanisms of injury patients may have very different symptoms. Many factors play into this, such as the speed of the accident, the direction of the impact, the age, physical condition and even gender of the victim and whether the seat belt and harness are properly fitted or even used. Symptoms often appear weeks or even months later. Certain symptoms are common in those who have suffered this injury.
Neck pain is the most common symptom, and the great majority of patients present with this complaint. The pain may be localized to the neck or radiate across the shoulders, upward to the head or downward between the shoulder blades. Facet joints (the small bony knobs on the back of the spine) are often the source of this pain. Facet joint pain is typically felt on the back of the neck, slightly off-center. The area is usually tender to the touch.
Headaches are the next most common symptom after neck pain. The pain may be from the direct brain injury sustained during the contrecoup movements. What is most likely, however, is that the pain is referred (originates in one area but felt in another) from the muscles, ligaments or facet joints in the neck.
Disc injury often causes chronic pain. Each vertebra is separated from the next by a thick cushion of cartilage called a disc, which prevents the bones from rubbing together. Fibers in the outer wall of the disc (the annulus) can be torn during the accident. The tears may allow the interior contents of the disc to bulge outward, irritating or compressing the nerves in the spine. The pain may radiate into the shoulders, arms or upper back and the patient may have weakness or numbness in one or both arms.
Muscle and ligament damage is most likely to cause the pain that occurs in the first few weeks after a neck injury. Many people report stiffness and limited range of motion in addition to the pain. The muscles are often the first of the damaged body structures to heal and don’t usually cause pain after the first weeks, but they may contribute to abnormal movement if they become tense or weak. Ligament injuries often cause abnormal movement as well and may cause instability in the joints.
Temporomandibular joint dysfunction or syndrome (usually just called TMJ) is due to a misalignment in the joint, which acts like a sliding hinge and connects the jawbone to the skull. Headaches, facial pain, clicking or popping noises in the jaw, difficulty eating and ear pain may all be signs of TMJ problems.
Brain injury that results from contrecoup can cause a variety of subtle symptoms. Some people may actually lose consciousness briefly and initially have symptoms of a mild concussion, while others have no obvious symptoms. Several weeks or months later, however, patients may complain of confusion, difficulty in concentrating or forgetfulness. Other symptoms of mild brain injury include sleep disturbances, diminished sex drive or emotional issues like instability, irritability or depression. Some patients have less common symptoms, like visual changes or problems with taste and smell.
Dizziness may occur after a brain injury but may also occur with neck injuries alone. This symptom can be caused by injury to the facet joints. It is usually temporary and resolves once the precipitating cause is resolved.
One of the symptoms that doesn’t really seem to be related to the neck injury is lower back pain. This symptom occurs in about half of all rear-impact crashes and about three-quarters of side-impact crashes. The pain is a result of lower spine compression in the first two phases of a neck injury (see above).
Spinal injuries often take months to heal – and that is assuming that patients receive whiplash treatment promptly from experts like those at Advanced Chiropractic, your Arizona whiplash chiropractor. Six to nine months is not unusual for full healing. About one in five people who suffer this injury will still have pain and disability such as weakness or restricted movement up to two years after the accident. The majority of this group will continue to have symptoms for years and sometimes the rest of their lives. However, proper treatment can help decrease pain and promote better function.
Treatment for neck injuries includes four basic categories of care: chiropractic care from experts like those at Advanced Chiropractic, soft tissue rehabilitation, medical care and self care.
Chiropractic care focuses on restoring the proper alignment in the spine. Spinal manipulation helps restore normal movement and position in the spinal vertebrae. A chiropractor may use the traditional methods of manipulation or the newer Activator technique, as well as trigger point therapy and massage. In addition, the chiropractor can advise you on correct posture, exercise and nutrition to support your healing.
Soft tissue rehabilitation targets the supporting structures of the musculoskeletal symptoms that are not bone – tendons, ligaments and muscles. Therapies in this phase help stimulate the soft tissues to heal correctly. They include trigger point therapy, massage, electro-stimulation of muscles, gentle stretching and strengthening exercises, as well as range of motion exercises. One of the most important parts of this treatment is to keep the soft tissues flexible, strong and balanced.
Medical care may be necessary, especially in the acute phase following an injury. Anti-inflammatory medications, pain medications and muscle relaxants may be helpful. Other possible medical care techniques include trigger point injections and epidural spinal injections with cortisone and local anesthetic. These should be used in the acute phase and for the short-term relief of pain. The primary goal of treatment should be to restore normal joint movement and to promote healthy tissue repair rather than just to manage symptoms with medications and injections. In rare cases, surgery may be required for spinal fractures or if a disc is pressing on the spinal cord.
Self care is very important in the rehabilitation process, as patients can easily stress or re-injure themselves. Practicing correct posture and following all exercise recommendations makes a big difference in healing. Other self care modalities include ice packs and/or the application of heat, nutritional supplements and adequate sleep. Many people need to limit certain activities at home or work, especially in the early phases of healing.
Whiplash treatment can be successful, especially if implemented early. At Advanced Chiropractic and Wellness Center, we offer chiropractic care, corrective exercise, lifestyle advice, nutritional counseling, massage and BioFreeze pain relief therapy for relief of soft tissue pain. Think of us as your Arizona whiplash chiropractor; please contact us today for an assessment.
Consult with an Arizona Back Pain Chiropractor Today
Postponing a chiropractic treatment may only worsen the pain. And that would require longer therapy. Aside from basic chiropractic care, patients with severe conditions may also require supplementary services such as extensive corrective exercises, massage therapy, and spinal and postural screening.
Initially, chiropractors will conduct a diagnosis of a patient’s back pain to determine what causes it. Potentially serious back pains may no longer be under the scope of a chiropractor. If the back pain were caused by severe fracture, tumor, infection, neurological problems, open wounds or burns, prolonged bleeding, and joint infection, then the patient would be referred to a medical specialist that can help them best. This is another reason why it is necessary for back pains to be addressed immediately. Once it has worsened, help from a chiropractor alone may no longer be sufficient.
Help from the Experts
Seek help from the Advanced Chiropractic & Wellness Center for all your back pain issues. We take pride in providing the finest chiropractic health care to every patient. We use state-of-the-art chiropractic techniques to offer patients a safe, comfortable, and effective treatment package. Our experts don’t just treat back pain; they also offer preventive care for total health and wellness.
Additionally, our experts are highly knowledgeable in corrective exercises that could help strengthen the body and correct any irregularity. They also provide nutritional counseling to achieve one’s total health and balance. Our massage therapies don’t just make a person feel good. They are specially provided to relieve a wide range of musculoskeletal pains. To further ensure the prevention of injuries and other diseases, we also provide posture and spinal screening, as well as lifestyle advice. It is our goal to make sure that every patient comes out of our facility fully cured, healthy, and balanced.