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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 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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Recovering from Whiplash

17 Nov

A whiplash neck injury occurs when the head is abruptly thrown backward and then forward. This violent motion, which happens faster than the body can brace against, can damage soft tissues—including ligaments, muscles, nerves, and disks—as well as cause bone injury or fracture with or without dislocation. Symptoms typically develop within days and may include neck pain and stiffness, reduced motion, headaches (often starting at the base of the skull), shoulder or upper back tenderness, dizziness, fatigue, tingling or numbness in the arms, and pain that worsens with movement. Each case is unique, making recovery time highly variable and difficult to predict.

By following clinical guidelines, healthcare providers can give patients the best chance for recovery. In the absence of red flags (such as fracture, dislocation, neurological compromise, or vascular injury), chiropractic care often focuses on reducing muscle spasm, pain, and inflammation; restoring mobility; encouraging activity within tolerance; and reassuring patients about recovery.

While specifics can vary depending on exam findings, patient preferences, and clinical training and experience, a multimodal treatment approach may include manual therapies including spinal manipulation, mobilization, and soft tissue therapies; manual and/or mechanical cervical traction; pain reducing modalities such as electrical stim, laser therapy, pulsed electrical magnetic field, pulsed ultrasound; dry needling or acupuncture; home exercises to increase muscle strength and improve range of motion; patient education; and diet modifications or supplement recommendations.

Although most injured patients improve within several weeks, up to 50% may continue to experience pain and/or other related whiplash associated signs and symptoms at one year post injury. Investigators have initiated a number of studies to identify which patients may be at greatest risk for prolonged recovery, and though no clear rubric has been established, research suggests the following may be risk factors for chronic whiplash symptoms: older age; a history of back or neck problems (including previous whiplash); pre-existing psychological distress; higher initial pain intensity; pre-existing cervical spine osteoarthritis; and current smoking.

If progress is limited or risk factors for chronic recovery are present, a doctor of chiropractic may coordinate with the patient’s medical physician or a specialist to provide additional treatment beyond the chiropractor’s scope of care.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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Whiplash and Temporomandibular Disorders

16 Oct

The sudden acceleration and deceleration of the head and neck during a rear-end collision can stretch the soft tissues surrounding the cervical spine beyond their normal range of motion. This can result in strains, sprains, and tears that trigger the cluster of symptoms collectively known as whiplash-associated disorders. While neck pain is widely recognized, one consequence that often occurs but is less commonly considered is temporomandibular disorders (TMD), or jaw pain and associated disability.

The temporomandibular joint (TMJ) is formed by the socket in the temporal bone of the skull and the condyle of the mandible (jawbone). It is a synovial, condylar, hinge-type joint, with an articular disk that divides the joint into superior and inferior cavities, each lined with its own synovial membrane. A capsule surrounds the joint and attaches to the articular eminence, the articular disk, and the neck of the mandibular condyle. This unique structure allows the jaw to open and close, move side to side, and shift forward and backward, enabling essential functions such as breathing, eating, and speaking.

The rapid forces generated in a whiplash event can directly injure the TMJ as the jaw lags slightly behind the skull, subjecting the joint to excessive forces. Because several muscles and connective tissues link the head, neck, and jaw, injury to these structures can also impair jaw function, leading to both pain and disability. Just as cervicogenic headaches occur when dysfunction in the neck refers pain into the head, similar mechanisms can refer pain to the jaw, creating TMD-like symptoms.

In May 2025, researchers reviewed records from five hospitals covering 2019 to 2023 and found that post-traffic collision jaw muscle tenderness upon palpation ranged from 25% in children and adolescents to 32.56% in older adults. Overall, approximately one in seven patients reported difficulty opening their mouth.

Fortunately, studies have shown that manual therapies combined with therapeutic exercises for both the jaw and neck can effectively manage TMD, whether associated with whiplash or not. A March 2023 case report illustrated this approach in a 39-year-old woman with a six-month history of unexplained jaw pain, disability, co-occurring neck pain, and headaches. She consulted a chiropractor after limited success with conventional treatment. Examination revealed reduced cervical range of motion and tightness in multiple neck muscles. Following a multimodal treatment approach aimed at restoring normal motion to both the cervical spine and TMJ, the patient reported complete resolution of symptoms.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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Cervical Spinal Stenosis and Whiplash Injury

25 Oct

Cervical spinal stenosis (CSS) is a condition characterized by the narrowing of the spaces within the spine through which the spinal cord and the nerves pass. The condition becomes more common with age, affecting 6.8% of adults over age 50 and 9% of those over age 70. While it’s not unusual for a CSS patient to be asymptomatic, a sudden injury to neck tissues can compress, constrict, or injure the spinal cord (or associated nerves) and result in symptoms such as pain, numbness, and/or tingling along the course of that nerve that can affect physical function over time. 

It’s estimated that more than two million Americans sustain a whiplash injury each year, with automobile collisions being the primary cause. In a June 2023 study, researchers used a previously validated three-dimensional model of the human head-neck complex to assess the risk for spinal cord injury with CSS of varying sizes (from 14 mm to 6 mm—a lower number is worse) with rear-impact acceleration of both 1.8 m/s and 2.6 m/s. At the C5-6 level of the cervical spine, which sits toward the bottom of the neck, the stress on the spinal cord was enough to cause injury at both accelerations with a stenosis of 6 mm. However, for the less severe 8 mm stenosis, only 2.6 m/s acceleration applied sufficient forces to injure the spinal cord.  In general, the authors surmised that the narrower the opening for the nerve/spinal cord to pass through, the less force needed to reach the threshold for spinal cord injury. 

Aside from genetics, the risk factors for CSS include cumulative trauma, osteoporosis, cigarette smoking, and degenerative joint disease/osteoarthritis—all of which can affect the ability of the tissues of the neck to absorb the forces stemming from the sudden acceleration and deceleration during a rear-end collision, leading to a potentially more severe injury, which may require a more comprehensive treatment approach to reduce the risk for ongoing, chronic symptoms. The good news is that doctors of chiropractic offer an excellent conservative treatment option for managing both cervical spinal stenosis and whiplash injuries.

While it may not be possible to fully prevent CSS, there are measures one can take to reduce their risk for developing the condition. This includes eating a healthy diet, getting regular weight-bearing exercise, getting good sleep, not smoking, avoiding excessive alcohol intake, and avoiding the risk factors for metabolic syndrome including obesity, hypertension, diabetes, and dyslipidemia. A 2018 study found a link between worse spinal posture and spinal stenosis, so maintaining good posture and getting regular chiropractic care to keep the spine aligned may also lower the risk for CSS!

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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Post-Whiplash Headache Risk Factors and Treatment

25 Sep

The International Headache Society lists “headache attributed to whiplash” as a headache that appears or existing headaches that worsen within seven days after a whiplash event (i.e., automobile collision, sports collision, slip and fall, etc.). It’s estimated that up to 60% of whiplash associated disorders (WAD) patients experience such headaches and nearly 40% will continue to do so a year after their initial injury. Thus, studies that focus on what factors are linked to post-whiplash headaches, especially those that persist in the long term, are important.

In a 2022 study, researchers monitored 47 recent WAD grade II patients (pain, stiffness, or tenderness of the neck with soft tissue injury signs, loss of range of motion, and/or point tenderness of the neck) without a previous history of headache or musculoskeletal disorders associated with headache. All participants completed self–reported questionnaires including Visual Analogue Scale for neck pain intensity, the Neck Disability Index, Pain Catastrophizing Scale, and the Tampa Scale Kinesiophobia–11. Of the 47 patients in the study, 28 developed headaches within a week of the whiplash event, which correlates to findings from previous studies. 

Analysis of questionnaire data revealed that neck pain intensity, neck disability, pain catastrophizing, kinesiophobia, and anxiety were ALL higher in those with post-whiplash headaches. Previous research has also linked central sensitization (experiencing painful sensations to non-painful stimuli) to post-whiplash headaches. This suggests that worse injury to the musculoskeletal system, particularly in the vicinity of the cervical spine may contribute to post-whiplash headaches and the neck should be evaluated in WAD patients, especially those with new-onset or worsening headaches.

The 2016 update to the 2000-2010 Bone and Joint Decade Task Force on That Pain and its Associated Disorders concluded that episodic tension-type headaches, chronic tension-type headaches and cervicogenic headaches are effectively managed with low load endurance craniocervical and cervical scapular exercises, relaxation training with stress coping therapy, and/or multimodal care that includes spinal manipulation, mobilization, and postural correction.  Both cervical and thoracic spine manipulation with or without mobilization was found effective for cervicogenic headaches.  Doctors of chiropractic frequently employ these and other treatment options as part of a multimodal approach for the management of WAD patients, including those with post-whiplash headaches.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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