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Whiplash and the Four Phases of Injury Potential

19 Jan

Because rear-end motor vehicle collisions are the most common cause of whiplash injury, researchers have continuously sought to better understand this unique injury process, not only to derive more effective treatment strategies, but also to implement safety mechanisms in automobiles to reduce the risk of injury in the event of a car accident. As such, investigators have identified four phases of injury potential during the rapid acceleration and deceleration of the head and neck: retraction, extension, rebound, and protraction.

  • RETRACTION PHASE: Immediately after impact, the upper torso is pushed forward by the seat back while the occupant’s head remains relatively stationary, creating head retraction similar to tucking in the chin. This produces an S-shape of the cervical spine in which the upper cervical segments flex while the lower cervical segments extend. Maximal retraction may occur at or near the point of head restraint contact (depending on headrest position). A primary injury mechanism believed to be associated with this phase is a rapid pressure spike within the spinal canal caused by the sudden differential motion between the upper and lower cervical spine.
  • EXTENSION PHASE: This phase occurs immediately after the head reaches maximum retraction, sometimes even before striking the headrest, causing the occupant’s head to extend rearward as if looking upward. This places the entire cervical spine into extension. Excessive extension can also occur when no headrest is present or when the headrest is positioned too low or too far behind the occupant’s head, contributing to a hyperextension mechanism of injury.
  • REBOUND PHASE: Here, the occupant’s head reverses direction after reaching peak extension and rebounds forward. This rebound action produces some of the highest axial and shear forces measured in whiplash testing, making the cervical spine particularly vulnerable to excessive flexion forces.
  • PROTRACTION PHASE: Injury can occur after rebound when the differential motion between the head and torso is reversed—for example, when the seatbelt and shoulder harness restrain the upper torso while the head continues its forward motion. Similar to the transition from the S-shaped curve into full extension during the retraction-to-extension phase, the cervical spine here rapidly shifts into flexion, producing another pressure spike within the spinal canal like that observed during a front-end impact.

It’s important to note that this entire process occurs within 50–80 milliseconds, roughly three to four times faster than it would take for visual input from the eyes to reach the brain and for the brain to process the information and send signals to the neck muscles to activate in an attempt to brace against injury. As such, strategies employed before a collision can help protect the head and neck from injury. Experts advise positioning the headrest so that its top is at least level with the top of the head and maintaining a distance of less than two inches (five centimeters) between the back of the head and the headrest. Studies also support keeping the seat back at an angle between 100 and 110 degrees to prevent the body from sliding upward during a collision, which can place the head higher than the headrest. Of course, always wear your seatbelt. In the event of a rear-end collision, clinical guidelines consistently identify chiropractic care as an effective conservative treatment option for reducing pain and disability.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

The Neck and Low Back Connection

15 Jan

When a patient seeks chiropractic care for a condition like neck pain or low back pain, it’s natural to assume the underlying cause is located in the region where the patient feels symptoms. But this isn’t always the case. Sometimes, the primary or contributing factor to the patient’s chief complaint can be elsewhere in the body. A July 2024 study involving patients with cervical myelopathy helps illustrate this point.

Cervical myelopathy is a condition in which the spinal canal narrows due to a variety of potential causes—age-related degeneration, cervical spinal stenosis, herniated disks, trauma, rheumatoid arthritis, ossification of the posterior longitudinal ligament, or even tumors, infections, or congenital narrowing—and compresses the spinal cord. While neck pain is common, irritation of the spinal cord can produce downstream effects in the areas those nerve fibers reach. In this study, which involved 786 individuals with cervical myelopathy, two-thirds also reported low back pain.

Following treatment for cervical myelopathy, about half of those with concurrent low back pain experienced meaningful improvement in both lower back pain and function, and some even reported complete resolution. This suggests that for roughly half of these patients, the issue in their neck was a major contributing factor to their low back symptoms.

Beyond cervical myelopathy itself, several soft-tissue systems span the entire spine—including fascia, long spinal muscles, and ligamentous structures—making it possible for restrictions or dysfunction in the upper spine to influence symptoms in the lower spine. The reverse is also true: issues affecting the feet, ankles, knees, hips, or low back can lead to compensatory postural changes that place additional strain on the neck as the body works to keep the eyes level.

This helps underscore the importance of evaluating the whole patient rather than narrowing attention to the immediate area of complaint—something doctors of chiropractic are trained to do. The good news is that the hands-on care chiropractors provide can often help resolve these contributing issues, and when necessary, your doctor of chiropractic will coordinate with allied healthcare providers to support the best possible outcome.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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The Four Grades of Whiplash Associated Disorders

15 Dec

Whiplash occurs when the head suddenly accelerates and then rapidly decelerates, placing
excessive strain on the soft tissues that support the neck. In addition to neck pain and stiffness, this
motion can produce a variety of symptoms collectively known as whiplash-associated disorders
(WAD). To better define and manage these injuries, the Quebec Task Force on Whiplash-Associated
Disorders (1995) developed a classification system that grades whiplash severity from I to IV.
WAD I is characterized by neck pain and stiffness without any objective findings on physical
examination. In other words, there is no loss of range of motion; no muscle spasm or guarding; no
swelling, bruising, or deformity; no neurological deficit; and no imaging abnormalities.
Approximately 15–25% of whiplash patients fall into this category.
In WAD II, neck symptoms are accompanied by physical examination findings such as
decreased range of motion, localized tenderness in neck muscles, muscle spasm, and sometimes
headache. However, there are no neurological deficits or abnormalities visible on diagnostic imaging.
About two-thirds of whiplash patients are graded WAD II.
At the WAD III level, patients present with both musculoskeletal findings (as seen in WAD
II) and neurological signs, which may include sensory loss (numbness or tingling), motor weakness
(reduced strength in muscles supplied by affected cervical nerves), altered reflexes, or radiating arm
pain. As with WAD I and II, the injury still involves soft tissues that typically do not appear on X-ray
or advanced imaging. Approximately 5–10% of whiplash patients fall into this grade of WAD.
The classification of WAD IV is utilized when there is structural damage to the cervical spine
that is present on diagnostic imaging and is usually associated with severe symptoms. Patients with
WAD IV typically require emergency treatment to stabilize the spine. Fortunately, fewer than 1–2%
of whiplash patients meet this criterion.
The good news is that WAD I, II, and III typically respond well to a multimodal chiropractic
approach aimed at reducing pain and restoring function as quickly as possible. Manual therapies may
include gentle, low-velocity, low-amplitude techniques; thrust manipulation (high-velocity, lowamplitude); facet gliding; long-axis cervical traction; passive range-of-motion exercises; massage;
trigger-point therapy; dry needling; or acupuncture. Adjunctive physical therapy modalities such as
electrical stimulation, therapeutic ultrasound, laser therapy, pulsed electromagnetic field (PEMF)
therapy, in-office or home cervical traction, and others are also frequently utilized. Exercise training
is a crucial component of care, as long-term improvement depends on patient self-management and
reduces provider dependency that can sometimes arise. In the event a patient does not respond to care
or if additional issues are present that fall outside the chiropractic scope, the case may be co-managed
with an allied healthcare provider.
Brent Binder, D.C.

4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

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Chiropractic Approach for Tension-Type Headaches

13 Nov

Almost everyone will experience headaches during their lifetime, with roughly half of adults reporting at least one episode each year. While many may be transitory, some patients develop recurring or persistent headaches. The most common form is the tension-type headache (TTH), accounting for an estimated 60–70% of all chronic headache cases.

Tension-type headaches are characterized by bilateral, non-pulsatile pain of mild to moderate intensity, typically described as a tightening or pressing sensation lasting from 30 minutes to seven days. Many patients liken the pain to a band-like pressure encircling their head. Unlike migraines, TTH is not associated with nausea or vomiting, and patients can usually tolerate routine physical activity. Some may report sensitivity to either light or noise (but not both), and about 20% experience mild loss of appetite.

There is no specific diagnostic test or imaging finding for TTH. Diagnosis is based on its characteristic symptom pattern—bilateral, pressing pain not worsened by activity combined with the absence of migraine features and exclusion of secondary causes through clinical history, physical exam, and neurological assessment. If red flags are present—such as sudden severe onset, progressive worsening, systemic illness, or neurological deficits—urgent referral to an emergency department or specialist is warranted.

A 2023 study in Musculoskeletal Science & Practice found that many TTH patients also experience neck pain, limited range of motion, and impaired motor control. Palpation of trigger points in the neck muscles or upper cervical joints can often reproduce the headache pain pattern. These findings suggest cervical spine examination is an important component of evaluation, and addressing dysfunction through manual therapies—such as spinal manipulation, mobilization, soft tissue work, and neck-specific exercise—may provide benefit.

Studies have found that manual therapies applied to the cervical region to address trigger points in the muscles and restore normal movement to joints and other soft tissues can reduce the intensity, duration, and frequency of tension-type headaches. However, a multimodal approach that includes modalities, therapeutic exercises, and diet and lifestyle improvements may be necessary to more effectively manage the condition.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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Multimodal Treatment for Chronic Neck Pain

13 Oct

Chronic neck pain is one of the most common musculoskeletal disorders, with up to half of adults experiencing it in a given year, and it accounts for as much as 4% of all visits to healthcare providers. The most common classification is non-specific neck pain, meaning the condition arises from musculoskeletal strain or dysfunction in the neck region without a clearly identifiable medical pathology such as fracture, infection, tumor, or inflammatory disease. Because the exact pain generator is often difficult to determine, treatment focuses instead on restoring normal motion to the cervical spine using a multimodal approach.

The mainstay of chiropractic treatment for neck pain and other musculoskeletal disorders is manual therapy, delivered either hands-on or with the assistance of instruments. The most common technique is spinal manipulation, also called spinal manipulative therapy, which involves high-velocity, low-amplitude movements applied at the end of a joint’s range of motion to restore mobility, reduce pain through neuromechanical effects, and normalize function of the spine and surrounding tissues. Other forms of manual therapies may also be used, such as mobilization (slower, gentler movements within the range of motion), myofascial therapy (sustained pressure or stretching to release restrictions in connective tissue), and trigger point therapy (direct, focused pressure to relieve taut muscle bands). All share the goal of restoring normal movement and reducing pain.

Exercise is another key component of managing neck pain, both to relieve current symptoms and to reduce the risk of recurrence. Neck pain often relates to poor posture that places excess strain on some muscles while deconditioning others. For instance, forward head posture shifts the head in front of the shoulders, forcing posterior neck muscles to overwork while anterior neck muscles weaken. To address these imbalances and other deficits, patients may be prescribed range-of-motion drills, stretching, strengthening, postural retraining, and proprioceptive exercises.

Additional treatment strategies may be incorporated depending on the patient’s needs and preferences, the provider’s clinical training, and examination findings. These may include ergonomic advice, physiotherapy modalities, ice/heat, dietary modifications, and nutritional supplementation. Multimodal approaches are well supported in the literature, consistently providing better outcomes than any single therapy alone. When needed, chiropractors may co-manage care with other healthcare providers, always with the goal of reducing pain, improving function, and helping patients return to normal activities as quickly as possible.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

Treating the Neck of the Carpal Tunnel Syndrome Patient

6 Mar

Carpal tunnel syndrome (CTS) is the most frequently diagnosed peripheral neuropathy and one of the most common conditions affecting the hand. The disorder typically results from compression of the median nerve on the palm side of the wrist, leading to numbness, tingling, and sometimes weakness in the thumb and fingers—except for the pinky and the pinky-side of the ring finger, which are innervated by the ulnar nerve. To avoid surgery, many CTS patients seek chiropractic care, which often includes manual therapies applied beyond the wrist and even to the neck due to the nature of the median nerve.

The median nerve originates from the C6-T1 spinal nerve roots in the neck and provides sensory and motor functions to the palm-side forearm and hand. It enables gripping, forming a fist, and detecting temperature and texture. If the mobility of the median nerve is restricted along its course, the resulting symptoms may mimic or overlap with traditional CTS. To complicate matters further, compression can occur at multiple sites, all of which need to be addressed for effective treatment.

In an October 2024 study, researchers divided 48 CTS patients into two groups. Both groups received wrist-focused treatment, including ten sessions of wrist mobilization, electrotherapy, and the use of a nocturnal wrist splint to maintain a neutral wrist posture overnight. However, one group also received manual therapies targeting the cervical spine. Patients underwent motor and sensory nerve conduction testing and completed questionnaires on CTS-related disability at baseline, immediately after treatment, and at six-month follow-ups.

Initially, both groups reported similar improvements in all outcome measures. However, at the six-month follow-up, the group that received cervical spine care showed greater improvements, suggesting that long-term benefits favor incorporating cervical spine treatment into CTS care.

Doctors of chiropractic are well-equipped to assess the entire course of the median nerve—from the neck to the hand—and identify all potential areas of restriction. They can provide conservative treatments to restore normal nerve function and help patients return to their daily activities. In more complex cases, chiropractors may coordinate care with specialists or medical physicians as needed.

Pain Relief Chiropractic

4909 Louise Drive, Suite 102

Mechanicsburg, PA 17055

Painreliefcare.net

Member of Chiro-Trust.org

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

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