What is whiplash and can chiropractic help?
Understanding whiplash is complex when it comes to research, but the concepts can be made simple. It is important to understand right away that chiropractic can play a role in recovery. Chiropractic adjustments restore range of motion. They relax tight muscles. They help improve nutrition to the discs and joints and help pump out waste products and swelling.
Whiplash is not a medical diagnosis. The word is often used to describe both the symptoms of the injury and the mechanism of the injury. It is also called CAD or “cervical acceleration-deceleration syndrome” and WAD “whiplash associated disorders”.
When did this type of injury first show up?
Whiplash injuries first showed up in the general population after the invention of the train and the establishment of railroad lines in the 1830s. This was at least 70 years before Henry Ford rolled out the first mass-produced automobile.
In the early days, trains were involved in a number of accidents as the bugs were worked out and they began full service. Sometimes it wasn’t even an accident, but an unexpected jolt from the coupling of two train cars together.
At that time patients involved in these accidents began seeking care from doctors for problems that had no real outward appearance of injury. Symptoms like neck pain, headaches, problems with vision, back pain, difficulty concentrating, and radiating pain from the neck and back.
The first doctor to document this type of injury was Dr. John Eric Erichsen. He called it Railway Spine. He wrote a book on the topic called Concussion of the Spine. In it you will find the same mechanism of injury we see in the rear-end collisions of today.
How does the injury happen?
When a car accident occurs, the amount of force transferred from the collision to the occupant is a major factor in how much of an injury they suffer. This is independent of how much damage was done to the vehicle or how fast the vehicles were traveling.
Here is an example of what occurs in a rear-end collision. It can be divided into four phases.
When a stopped car is rear-ended, it moves forward underneath the driver and passengers. That is because the occupants are not glued to their seats, they are sitting on top of them.
When the car moves forward, the seat of the vehicle moves forward, and it strikes the individual in the buttocks and low back. The seat pushes the occupant’s body forward, but the head is moving backward because nothing has struck it to move it forward.
A head restraint in the correct position may stop some of this head movement, but usually, the motion is so fast, the restraint comes too late to the game.
While this is happening, the curves of the spine straighten for a moment and the forces on the neck and pressure on the brain increases.
When your torso is struck by the seat, and the curves of the spine are straightened, the body tends to move upward a few inches. This creates compression of the spine.
The head restraint at this point can contribute to greater bending of the neck and therefore injury risk.
At this point in the accident, the foot can comes off the brake pedal for a moment, allowing the car to move more causing more force. Also at this point, the seat pushed backward by the force of your body, springs forward, usually during the time your head is moving backward, and this spring creates even more force on your neck, but also your torso.
While all this is occurring the car’s acceleration by the impact is slowing down, and the vehicle may stop or continue to roll forward.
But the body is moving forward in the seat at this point until it is thrown against the seatbelts.
If the seatbelts have gone slack or where not tight to begin with, when the body is stopped by them there is even more force involved.
Finally, when the torso contacts the seat belt restraints (across the abdomen and the shoulder), it comes to a stop.
But your head continues to move forward with no restraint. This causes the neck to bend forward with great force.
And as the collision ends, the occupants can experience great tension on their brain stem, the spinal cord, and the nerve roots of the spine.
So during an accident, the neck and back can go through a hyperextension, hyperflexion injury with compressive forces to the spine.
This does not include any further forces from striking another vehicle or object, or striking something inside the vehicle, like a knee against the dashboard, or a shoulder against the door.
And while we are talking about a rear-ended collision, accidents can be from the side or head-on or at an angle.
Risk Factors Count
Following the accident, some risk factors can be applied. These factors can help determine who may be more susceptible to injury.
What was the speed and sizes of the cars involved?
If in a rear-end collision, the vehicle stopped is hit from behind by a larger and heavier vehicle the damage is going to be greater. The higher the speed of the impact, also increased the forces.
So a pick-up truck rear-ending a sports car at 15 mph is going to do more damage than a Sports car rear-ending a dump truck at 5 mph.
What was the condition of the road?
Was it dry, icy, or wet? Was it asphalt or a dirt road? This will determine how much the car will move during impact. The more movement, the more chance of injury.
Was there another impact involved?
For example, did the car rear-ended get pushed forward and rear-end another car. This causes a second accident with a second chance of injury.
Was the individual hopefully wearing a safety belt?
One should always wear a seat belt when in a car. They save lives.
But a seatbelt can add to the hyperflexion of the injury and also cause a twisting of the spine because the belt only goes across one shoulder and not both as you see in a race car.
Was the head restraint in the proper position?
The head restraint is actually what most people call the headrest.
The name headrest came from the automobile industry. They did not want people to think automobiles were less safe when they began including head restraints so they called them rests.
The head restraint should be positioned so that the back of the head is touching it. Often the individual posture, leaning forward while driving, their position in the seat, or how the seat is reclined negates this protection.
Did the head or body strike anything in the vehicle causing local injuries?
Obviously the person can also be exposed to local injuries to the head, shoulders, arms, legs, feet, or hands depending on the impact.
Was the head turned at impact or looking forward?
Turning the head increases the risk of injury by introducing more complex stresses to the spine.
Was the accident a surprise?
Being able to brace for the impact, using the arms and legs to push the head and body into the seat, may protect against some of the hyperextension and hyperflexion of the injury.
The tradeoff is the arms and legs may take more strain.
Are you slight of build or are you a female?
The differences in anatomy and size can factor in. An automobile is not a custom fit for the individual.
And wasn’t until 2011 did they build and start using female crash dummies in research. That means that much of the vehicle and its safety is built around the concept of an average size male.
Was there a loss of consciousness?
This could mean a concussion but also that the individual experienced a lot of g forces.
Is there a history of or underlying health conditions?
Poor health might make recovery more difficult or allow the individual to experience more injury.
Some examples are degeneration of the spine, headaches or migraines, prior chronic problems like neck and back pain or fibromyalgia.
Was there immediate pain following the accident or did it come later?
Immediate pain can be an indicator that the individual is at higher risk for long term problems.
The types of injury occur to your spine and head following trauma from a motor vehicle accident
The brain is a soft organ that is encased by a hard skull and is surrounded by a liquid called cerebrospinal fluid. The rapid acceleration and deceleration of whiplash to the head causes rapid pressure changes to various parts of the brain.
This can result in what is known as mild traumatic brain injury.
Sometimes this leads to a mild concussion and loss of consciousness.
But usually, the symptoms of this are feeling dazed and disoriented. Following the injury, the individual may also experience symptoms such as irritability, outbursts of anger, and mood disorders. There can be confusion, lack of concentration, forgetfulness, difficulty sleeping, and loss of sex drive.
Sometimes the hypothalamus and pituitary gland in the brain can be affected by the injury. This can lead to hormonal imbalance and issues with the thyroid.
Cranial nerve injury.
These types of nerves exit from the skull and not the spinal cord.
Cranial nerves can be motor (controlling muscles) or sensory (for example smell) or both.
Cranial nerves are involved with the muscles of the tongue, the jaw, the face, the shoulders, and the neck.
They are involved in taste, hearing, and vision.
When damaged the symptoms from cranial nerves can be symptoms related to those structures like the twitching of the eyes, blurred vision, and jaw pain.
Neck pain is the number one complaint of whiplash, followed by a headache.
Many of the structures of the neck and sometimes the temporomandibular joint (TMJ) can be injured and cause pain.
Because of the various structures involved, the pain can be felt in the neck, up into the head, between the shoulder blades, and into the shoulders.
The nerves of the neck can become inflamed, irritated, or compressed.
This leads to symptoms of numbness, tingling, muscle weakness, headaches, and dizziness. This can extend down the arms to the fingertips.
Low back injury
The low back is more stable during whiplash accidents than the neck but it is still often injured.
Most of the damage occurs due to the pelvis being held by the seat belt while the torso is moving during the impact. This is even more noted if a shoulder belt is not being used.
Also during the impact, the low back can hyperextend, especially if the seat is not hard enough.
Another mechanism of injury could be the occupant bracing for the injury, pushing the legs into the floor. Depending on the speed and forces involved, the soft tissue of the buttocks and legs may be traumatized.
Furthermore, a compressive force on the low back may be created causing injury.
As with the neck, the structures in the back can cause local pain, pain into the buttocks, and pain down the legs along with numbness and tingling or weakness.