The term “whiplash” refers to an injury to the neck muscles, the muscle attachments (tendons), ligaments, and sometimes the disks that lie between the vertebral bodies of the spine.  In a rear-end collision, the cause of whiplash occurs from a sudden, rapid acceleration of the body and neck as the car is pushed forwards.  In these first 50-75 milliseconds following impact, the head remains in the same place while the body is propelled forward.  This is followed by a “crack-the-whip” movement of the head and neck when the muscles in the front of the neck stretch like rubber bands and suddenly spring the head forwards, all occurring in less than 300 msec.  The force on the head and neck is further intensified if the seat back is too springy, or angled back too far.  Also, if the headrest is too low, the head may ride over the top and more injury can result.

Here’s a break-down of what occurs in the first 200 msec of a 5 mph rear-end collision:

0 msec: At the moment of impact, the car seat just begins to move and the occupant has not yet been accelerated forward.

50 msec: As the back of the car seat pushes the torso forward, the spine moves forward, resulting in a straightening of the thoracic and cervical spine.  This rapid bending in just a few joints can result in ligament damage in the lower spine.

75 msec: This difference in motion between the neck and torso results in an S-shaped curve, where nearly all of the bending in the cervical spine takes place in the lower cervical spine.  Such rapid bending in just a few joints can result in ligament damage in the lower spine.

150 msec: At this point, the torso has been pulled so far forward on the lower neck that the head is forced backwards, often over the headrestraint.  Depending on the position of the headrest, the angle of the seat back, and the “spring” effect of the seatback, the ligaments in the front portion of the spine are often injured during this phase of the collision.  About 3-4 G’s are exerted on the shoulders.

200 msec: Finally, the force of the car seat throws the head and torso forward.  Here, 5 G’s are exerted on the head and neck as it whips forward.

Symptoms occurring from such a seemingly mild accident can have catastrophic consequences.  The primary symptom is neck or upper back pain that may develop immediately or be delayed days, weeks, and sometimes months.  A partial list of possible symptoms (each injured person’s symptoms are different and differ in intensity) include:  muscles spasms, loss of movement, headache, dizziness, concentration &/or memory loss, difficulty swallowing, chewing &/or hoarseness, burning or tingling, shoulder/arm/hand radiating pain, and more.  After an accident, no matter how mild, you should be seen by a qualified health professional to determine the extent of injury.

The treatment of whiplash varies from “watchful waiting” to a multidisciplinary team approach that includes neurology, physical therapy, chiropractic, non-surgical spinal decompression, psychology, and possibly surgery (rare).  In a recent article published in the American Journal of Physical Medicine and Rehabilitation (2009, March Vol. 88, No. 3, pp 231-8), the relationship between clinical, psychological and functional health status factors was investigated in a group of patients with chronic whiplash-associated disorder (WAD).  A total of 86 patients with chronic WAD participated in the study and outcomes were tracked using questionnaires that measure pain, disability and psychological issues including depression, anxiety and catastrophizing.  Physical examination factors included measuring the cervical range of motion.  An analysis of the degree of neck disability and the relative contribution of physical vs. psychological factors revealed catastrophizing and depression played greater roles than did cervical range of motion.  This suggests psychological factors play an important role in the outcome of whiplash.

More than just the physical factors like range of motion should be focused on when treating chronic whiplash patients.  Answering the patient’s questions, explaining the mechanism of injury and how that relates to their specific condition, and addressing depression, anxiety, coping, and other psychological issues is very important. Discussing treatment goals with patients is also very important.  For example, making light of the injury by stating something like, “…you’ll be fine after the treatments,” may harm the patient as anything short of “fine” may be interpreted as failed treatment by the patient.  It is also important not to paint too dismal of a picture as that can have negative psychological effects as well, as this may suggest that they will never improve.

Explaining the difference between “hurt” and “harm” is of great value to the chronic whiplash patient as she is often told, “if it hurts, don’t do it.”  This sends an unfortunate message to the patient that any activity where an increase in pain occurs is “bad” when in fact, that activity may help the patient get better in the long run.  This can make or break an acceptable outcome as many may feel like they shouldn’t do anything and this can lead to unemployment, boredom, and the many psychological issues previously described.

The best advice is to remain active and try to ignore discomfort by staying within “reasonable activity boundaries.” Reasonable activity tolerance is learned as time passes and trying different activities for different lengths of time.  This type of coaching should be at the center of chronic whiplash management rather than over focusing on physical factors such as range of motion.

If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional chiropractic assessment and therapeutic approach at this office. We sincerely appreciate your confidence in choosing our office for your health care needs.  Call 519-988-0220 right now to book an appointment and end your suffering!