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Automobile Accidents: Whiplash

WHAM! You have just been rear-ended. Except for a minor pain in the neck, you seem to be okay. The next morning, however, you wake up with pain in your head and neck, and when you try to sit up, you feel intense pain and lightheadedness.

What you are experiencing are the symptoms of whiplash- an injury in which the neck is "whipped" in a rapid backward motion as the car lurches ahead, followed by a rapid forward motion as the seatbelt grabs you and the car slows down.

Someone is involved in an automobile collision every five seconds. A person suffering whiplash may not realize the extent of the injury for some time. In fact, research shows that days to weeks to months may elapse before pain presents itself. Common symptoms following whiplash are neck pain and stiffness, upper back pain, headaches, mid-back and lower back pain, pain and weakness of the arms/legs, dizziness, jaw pain (TMJ), hearing or visual changes and difficulty swallowing.

What happens to the neck during a rear end collision

The neck is upright before the collision. Immediately after the impact, the car seat pushes the torso forward while the head remains stationary. At the same time, the torso "ramps" up the seat, compressing the cervical spine. The spine forms an S-shaped curve at about 75 milliseconds into the collision before the musculature of the neck has a chance to react. An S-shaped curve results and causes a sharp bending in just a few spinal segments. After the sharp bending occurs, the spine fully extends (head goes backward). Historically, this is the point where most scientists thought injury occurred. The latest study on this issue shows that the joint capsule of a few segments of the cervical spine undergoes such excessive stress that the joint capsules can be torn or the cartilage in the joint itself can be "pinched," resulting in tissue damage and pain.

The speed of the collision and damage to the vehicles can be very misleading. Federal motor vehicle safety standards mandate that all cars sold in or imported to the U.S. have either a 2.5 or a 5mph bumper. What happens when two cars, each equipped with 5mph bumpers, collide at 9mph? They would very likely be able to absorb the energy without any apparent damage. However, much of this energy has been shown to be transferred directly to the occupant, and this means whiplash.

Forces generated in whiplash injury have been shown to be 2 1/2 times the forces sustained by the vehicle. And, although insurance industry-funded crash testing has shown that 5mph is the real threshold for neck injuries, you'll never hear them admit it publicly.

Another common myth is that all whiplash injuries will heal spontaneously within a few weeks. There has NEVER been any valid research published which supports this claim.

After a whiplash injury, healing of nerves, ligaments, muscles and tendons occurs with scar tissue formation rather than by regeneration of the damaged tissue. Scar tissue is weaker, less elastic, less pliable and more pain sensitive than healthy tissue. This makes prompt and proper treatment essential for healing and rehabilitation.

So, what is the best treatment for whiplash? Chiropractic care! Make an appointment immediately after the accident so we may begin your treatment quickly. Even the prestigious medical journal Spine states that "early manual therapy [manipulation] has been shown to be superior to rest ...in the management of acute whiplash...[and]...only early manual therapy for whiplash has been vindicated in the literature."

The longer you wait to get care, the longer your injury will take to heal. Remember, immediately after an accident, use ice for 20 minutes on the injured areas. Then, call us and start your road to recovery.

WHIPLASH: FACTS AND MYTHS

Myth: Symptoms become maximal within 24-72 hours. There is much research showing that symptoms may be delayed from days to months or years (Gotten 1, Braaf 2).

Myth: Heat and rest at home will relieve the symptoms with resolution occurring in a progressive fashion, leaving no residuals. It is not true in most cases of whiplash that heat and rest at home will relieve symptoms. Waddell (3) states that on considerable clinical and research evidence the main theme of management must change from rest to rehabilitation and the restoration of function. Dr. Bogduk stated in the journal Spine that "early manual therapy has been shown to be superior to rest ...in the management of acute whiplash...of all the various therapies for neck pain only early manual therapy for whiplash has been vindicated in the literature...collars and other passive measures are not justified if manual therapy is available." Several other researcher have shown that early mobilization of the injured muscle tissue provides the most favorable outcome (Lehto 4, McKinney 5 and others).

Myth: There will be no residual symptoms after whiplash. This could not be further from the truth. Over the last 36 years, there have been dozens of papers written on the long-term prognosis of whiplash trauma. These studies show that the prognosis for full recovery hovers around only 54-61%. The follow-up periods in these studies ranged from 1 to 10.8 years.(6-20) A 1993 paper based on the long-term outcome of whiplash trauma found that after more than 10 years, 86 percent of the subjects were still symptomatic.(Robinson 20)

One orthopaedic surgeon was so convinced of the trivial nature of whiplash injuries that he volunteered to sit in a car that was struck from the rear by another car at 10 and 20 mph. Six months later he confided to a colleague that his neck still hurt.(Huelke 21)

It is important to understand the commonly accepted classification of the inflammatory response. It is divided into 3 phases. Phase I- acute inflammatory phase- lasts up to 72 hours. Phase II- repair phase- lasts from 48 hours to 6 weeks. Phase III- remodeling phase- lasts from 3 weeks to 12 months or more. (Kellett, Oakes, Van Der Meulin) Thus, symptoms may last for 1 year or more.

Both ligaments and muscles are weaker after healing from a whiplash type strain/sprain. Healing of ligaments, muscles, and other soft tissues occurs with fibrous repair (scar tissue) rather than by regeneration of damaged tissue. Healed ligaments contain immature type III collagen which is deficient in cross-links and the quantity of fibers is less than in normal ligaments which are composed chiefly of type I collagen (Frank 22). Muscle is made weaker, less elastic, less pliable, and often more sensitive by scar formation.

Myth: A low speed collision causes little to no harm to the occupant(s) of the vehicle. The speed of the vehicles involved and the amount of damage to the vehicles is often called to question. Federal motor vehicle safety standards mandate that all cars sold in or imported to the U.S. have either a 2.5 or 5 mph bumper. That means that these cars must withstand a collision at these speeds with a fixed barrier. What happens when two cars, each equipped with 5 mph bumpers, collide at 9 mph? They would very likely be able to absorb the energy without any apparent permanent damage. Much of this energy has been shown to be transferred directly to the occupant, hence the soft tissue injury. Insurance industry funded crash testing has shown that 5 mph is the real threshold for cervical strain. (McConnell 24)

One orthopaedic surgeon was so convinced of the trivial nature of whiplash injuries that he volunteered to sit in a car that was struck from the rear by another car at 10 and 20 mph. Six months later he confided to a colleague that his neck still hurt. (Gotten 1)

Fact: Forces generated in whiplash trauma are surprisingly high. One G is the acceleration due to the earth's gravity. Typically, it is described at 9.81 m/sec2 or 32 ft/sec2. In studies done by Severy et al.(24), forces sustained by both humans and dummies in rear impact collisions were shown to be 2 1/2 times the forces sustained by the vehicle. In other words, the occupant of the vehicle was exposed to greater acceleration and deceleration forces than was the vehicle itself. These findings were confirmed in 1989 by Navin (25).

Ewing (26) measured the maximum peak acceleration to the head of human volunteer exposed to nominal 10 G accelerations to be at 47.8 G. Clemens (27) measured cranial accelerations of 40-50 G and tractional forces at C1 of 1600-2000N in cadavers exposed to an acceleration to 10 mph.

Fact: Patients injured in whiplash accidents develop spondylosis approximately six times more frequently than age and gender-matched controls.(Hohl 28) Other authors have found that patients with pre-existing spondylosis generally fared worse in whiplash injuries. (Watkinson 29)

Fact: The incidence of loss or reversal of the normal lordosis in the asymptomatic, atraumatic population is only 9% (Gore 30).

Fact: While it is true that seatbelts and shoulder harnesses have decreased the number of fatalities and serious facial and chest trauma, they have significantly increased the number of sometimes disabling cervical injuries. (Ommaya 31, Deans 32)

Fact: Chiropractic experts in the field of whiplash recommend early manipulative intervention with treatment daily during the first one to three weeks (Croft, Foreman 33). Treatment may then be performed on an every other day basis. It is not true that chiropractic manipulation performed more than 3 times per week will cause injury. Just the opposite; early, regular care will allow more expedient healing (McKinney 34, Bogduk 35).

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