Whiplash injuries are commonly misunderstood. Many insurance companies would like you to believe that whiplash injuries don’t even exist. Of course, that perspective is complete nonsense! Whiplash injuries are well-documented and have considerable scientific support. There is a mountain of research about the biomechanics of whiplash injuries (whether insurance companies like it or not). Unfortunately, most physicians are not familiar with this data, and many insurance companies would prefer this information be kept hidden.
When we think of a whiplash injury, we normally visualize a person’s head being thrown back-and-forth or side-to-side. In reality, there’s much more to this injury than initially meets the eye. The biomechanics of whiplash injuries are quite unique, with injury often occurring at very low speeds and with almost a little or no damage to both vehicles.
Whiplash injuries are complex, involving much more than just one set of structures. This type of injury often involves; joints, muscles, ligaments, tendons, connective tissue, and a wide array of neurological structures. Besides the immediate pain and suffering felt from the initial incident, this type of injury can often lead to degenerative osteoarthritis ten or twenty years later.
Unfortunately, whiplash injuries do not always manifest immediately after an accident. In some cases, it takes several years to manifest, often long after insurance claims are settled.
Without a complete understanding of these unique circumstances, and the supporting body of evidence, physicians often make mistakes that prevent a complete resolution of this injury.
The first factor to consider is that hyper-extension, hyper-flexion injuries occur in an extremely short period of time. Most of these injuries occur in about one-quarter of a second. This means that the occupants of a vehicle which is struck from behind do not have time to react to the accident. Keep this time-frame in mind as we cover some of the actions that occur.
Vehicle Impact Phase
On initial impact where the vehicle in the rear hits the car in front; The force of impact begins to move the front vehicle forward. Since the seat of the car is attached to its frame, the driver’s seat moves forward with the car. But the driver is not attached to the frame of the car, and he/she continues to remain in a fixed position; this is due to inertia. Physics defines inertia as “the tendency of a body to resist acceleration.” Keep in mind, all of this is occurring within milliseconds.
Then, within a faction of a second, the car seat is pushed into the driver’s lower and mid back. This rapid forward acceleration also pushes the lower part of the drivers neck forward (lower cervical spine). This has the effect of straightening out the normal curve in the driver’s neck (the lordotic curve) and the curve in the driver’s mid back (the kyphotic curve). This creates an abnormal S shaped curve in their cervical spine (neck).
A considerable amount of damage can be done during this phase.
When the neck is in this abnormal S-shaped position, the joints of the neck (facet joints) are forced past what is consider their normal physiological range-of-motion limit. This excessive motion causes damage to the area around the spinal joints (facet joints). This damage can include: facet capsule ligament tearing, bony impingements, and intra-articular (within the joint) hemorrhages. The degree of joint damage depends on the severity of collision.
This next, high-speed, forward motion, jerks the driver’s head back. In many cases the head moves right back over the headrest. This often occurs since most people keep their headrest too low to be effective, or it can occur due to poor head rest design. If the impact of the accident is severe enough, a considerable amount of soft-tissue and joint damage can occur in the front of the neck as the head is thrown back.
Symptoms of Whiplash Injuries
The most predominant symptoms after a whiplash accident are:
Arm pain – This can be due to nerve compression or referred pain from the facet joint or disc
Facial pain (either direct or referred pain)
Headaches – The second most common symptom, headache is usually on one side of the head and begins at the base of the skull (occiput). This pain often radiates to the top of the head and frontal regions.
Jaw Pain – TMJ problems are common
Neck pain – The most common symptom
Nerve entrapment syndromes
Shoulder blade pain (interscapular pain)
Shoulder pain (rotator cuff)
Whiplash injuries also cause:
Balance problems (often upper cervical related)
Dizziness (often upper cervical related)
Fatigue (this can be severe)
Low back pain
Poor concentration, loss of memory
Psychological changes, such as depression
Tinnitus (ringing, buzzing, whistling, or other noises heard in one or both ears)
Visual disturbances (sensitivity to light – this can be stress induced, adrenal stress)
Treatment of Whiplash Injuries with Manual Therapy
After major injuries such as fractures have been ruled out, treatment can begin. For the first 72 hours ice should be used to reduce pain, inflammation, and swelling.
Early implementation of treatment procedures can prevent acute injuries from becoming chronic problems. In the case of whiplash injuries research has show that 15 to 40% of individuals who have had these injuries develop chronic neck pain. Early intervention can help you avoid becoming one of these statistics.
Chronic whiplash and whiplash-associated disorders: An evidence-based approach Journal of the American Academy of Orthopedic Surgeons October 2007;15(10):596-606 Schofferman J, Bogduk N, Slosar P.
Scar Tissue Forms Fast
Also considering how quickly fibrotic tissue (scar tissue) forms in damaged tissue (7 days), early intervention becomes essential. For example, research has shown that after a hyper-extension hyper-flexion injury a muscle called the anterior scalene often becomes fibrotic.
When this muscle becomes fibrotic it can cause compression on a network of nerves called the brachial plexus. This can create a syndrome called neurogenic thoracic outlet syndrome (NTOS) which creates neck pain, headaches, altered sensation (paresthesias), and weakness in the shoulders, arms, wrists, and hands.
Take Care of the Entire Kinetic Chain
Although early intervention is important, it is equally important to have the practitioner consider all the areas that could be, or are, damaged in a hyper-extension, hyper-flexion injury. The practitioner must look for damage in more than just the neck, and review possible injuries to the patient’s jaw, shoulders, arms, wrists, upper-back, lower-back, hips, and sometimes even the lower extremities. Areas that have been injured often do not show symptoms for several weeks.
This is often the case with jaw problems caused by whiplash injuries. With whiplash injuries, one in three people who have been in a hyper-extension hyper-flexion accident will develop delayed TMJ problems.
Delayed temporomandibular joint pain and dysfunction induced by whiplash trauma: a controlled prospective study Journal of the American Dental Association August 2007;138(8):pp. 1084-91 Salé H, Isberg A.