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Whiplash and Mid-Back Pain

25 May

When it comes to whiplash associated disorders (WAD), injury to the cervical spine is generally the focus, but what about the mid back? Can this area be injured in a whiplash event?

According to the available research, not only can the mid back become injured in an automobile accident, slip and fall, or sports collision, but it’s surprisingly common. A review of data concerning 6,481 patients who had been involved in a motor vehicle collision found that 66% reported mid-back pain (MBP) and 23% still experienced pain in this region a year later.

The mechanism of injury helps us understand how MBP may happen and why it is so common.  The head weighs an average of 12 lbs (or ~5.4 kg)—similar to a bowling ball. The sudden acceleration and deceleration of the neck that occurs during whiplash can place significant strain on the soft tissues that connect the base of the skull with the mid and upper back.

A review of 38 studies that included over 50,000 WAD patients found that not only is MBP common following an automobile collision (over 60% based on the authors’ criteria), but mid-back pain intensity is higher in more severe WAD cases. Additionally, WAD patients experience heightened muscle activity in the neck and mid-back/scapular muscles, have an elevated risk for pinching the nerves that innervate the arm at both the neck and shoulder, are more likely to have myofascial pain and trigger points in the neck and mid-back muscles, and exhibit altered mid-back posture and reduced thoracic spine mobility.

Even if injury is isolated to the cervical spine, the mid back is not out of the woods. The thoracic spine can contribute to up to 33% and 21% of head-neck movement during cervical flexion and rotation, respectively. If mobility is reduced in the neck, then the thoracic spine must take on more of the load, which can increase the risk for overuse and injury.

Proper management of WAD requires treating the whole person and not restricting focus to just one area of the body, such as the neck. Doctors of chiropractic are trained to take this approach when evaluating a patient. Once a thorough examination has been completed, care often involves a multimodal approach that combines spinal manipulation, mobilization, and other manual therapies, along with specific exercises and nutritional recommendations to support the healing process.

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.

Whiplash and Dizziness

15 Apr

Whiplash associated disorders (WAD) is a term used to describe the myriad of symptoms that can occur following the sudden acceleration and deceleration of the head and neck. One of these symptoms is dizziness. How does the whiplash process lead to an impaired sense of balance, and are some individuals at greater risk than others?

It’s important to understand that our sense of balance is the result of input from the inner ear, eyes, and nervous system, which is then processed by the cerebellum located in the rear of the brain, just above the spinal cord. Abnormal function in any of these areas can result in the sensation of dizziness, which can dramatically affect one’s quality of life.

In a 2020 study, researchers enrolled 27 older (over 65) adult WAD patients and 32 young adult WAD patients in a battery of tests to determine which, if any, aspects of the balance system were impaired. Researchers concluded that older participants were at increased risk for vertigo and were also more likely to have abnormal proprioception and lesions near the cerebellum. This suggests that the rapid forward and backward motion associated with whiplash resulted in trauma near the area of the brain that may be most important for maintaining balance and affected the ability of the nervous system to efficiently relay sensory information to and from the rest of the body.

One hypothesis is that age-related declines in muscle strength may have reduced the neck’s ability to resist the back-and-forth whiplash motion. This can lead to increased injury to the tissues in the neck and potential injury to the brain, something that is supported by several recent studies linking whiplash and mild-traumatic brain injury.

Cervicogenic dizziness is a term used to describe dizziness caused by dysfunction in the cervical spine. A 2011 systemic review concluded that manual therapies—especially spinal manipulation and joint mobilization—are effective treatment options for this condition. A follow-up systemic review in 2019 affirmed this finding.

Doctors of chiropractic commonly evaluate and treat patients with whiplash associated disorders, including those experiencing dizziness, with a multimodal approach involving manual therapies and specific exercises. If examination findings suggest injury to areas of the body outside the scope of care, chiropractors can co-manage with the patient’s medical doctor or refer to a specialist.

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.

Screening for Both Concussion and Whiplash

25 Mar

Whiplash injuries are often associated with car accidents and concussions are typically connected with sports collisions, but there’s a growing body of research suggesting that patients should be screened for both conditions following either type of incident.

In one study, researchers measured the forces applied on the brain both as it impacted the headrest during a rear-end collision and when struck from the rear while wearing a football helmet. They found similar head angular velocities between both crash simulations, suggesting both types of collision can result in brain injury.

On the other hand, a 2015 study reported that athletes with stronger deep neck flexor muscles experienced a faster recovery after a concussion. Past research has also indicated that stronger neck muscles may reduce the severity of whiplash injury to the neck during a motor vehicle collision. This data suggests that reduced injury to the cervical spine and associated tissues during a collision may lessen the severity of an accompanying concussion.

In a 2019 study published in the Journal of Orthopedic Sports & Physical Therapy, researchers reported that the overlap in symptoms between whiplash and concussion are strikingly similar, but the guidelines for diagnosis and treatment for the two are implemented separately, which could potentially lead to misdiagnosis and a delay in appropriate management, along with an increased risk for a poor outcome. The authors concluded that proper assessment and management should incorporate the principles set forth in BOTH whiplash and post-concussive guidelines. Moreover, coordinating other diagnostic principles such as imaging guidelines should also be incorporated to offer these patients optimum quality assessment and management strategies.

These suggestions are backed by a series of case studies of whiplash-injured patients with symptoms that suggested co-existing post-concussion syndrome. The patients reported improvements in function following a course of treatment derived from guidelines for managing both whiplash and post-concussion syndrome.

Likewise, a study published in 2015 by authors affiliated with Canadian Memorial Chiropractic College revealed that the post-concussive syndrome patients experienced favorable outcomes when they received treatment similar to that provided to whiplash associated disorder patients to restore function in the cervical spine.

These findings suggest that whiplash and concussion commonly co-occur, and patients should be screened for both, regardless of how the injury occurred, whether from an automobile crash or a sporting collision. Treatment guidelines show that the non-surgical, conservative treatment provided by doctors of chiropractic is an excellent option for these types of injury.

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.

At-Home Exercise for Whiplash Associated Disorders

15 Feb

There is plenty of research supporting chiropractic care as an excellent approach for managing whiplash associated disorders (WAD). While the in-office treatment aspect of care—spinal manipulation, mobilization, soft tissue therapy, massage, modalities, etc.—is important for restoring motion and reducing pain in the neck and surrounding areas, it’s the at-home exercises that not only maintain those improvements but reduce the risk for developing chronic pain or experiencing re-injury in the future.

When the neck is injured in a whiplash event—like a car accident—the superficial muscles in the neck will spasm to protect the nearby tissues from further injury. In the short term, this is a good thing, but if movement remains restricted, the deep neck muscles that are important for maintaining posture can become deconditioned.

As the deep neck muscles weaken, the superficial muscles that normally control voluntary movements will take on the added work, resulting in further weakening of the deep neck muscles—setting up a vicious cycle that can prolong or even prevent WAD recovery. In fact, a 2018 study followed 141 WAD patients for one year and found that those who were unable to return to their pre-injury work activities had an average of 50% reduction in neck muscle strength.

That’s why it’s important to engage in at-home exercises to strengthen the deep neck flexor muscles and put them back to work (so you can get back to your life).

One exercise can be performed by retracting your chin inward followed by nodding your head (as if you’re agreeing with what someone said). You can apply resistance by placing your fist under your chin and slowly working against both the upward and downward movements. Start at 10% maximum resistance. As you improve and as tolerance allows, add additional resistance (up to 50-75% max) and reps to your sets, enough to feel fatigue. If you apply 100% resistance, no motion will occur, which is called an isometric contraction, which works too but not as well as isotonic strengthening (resistance with movement).

There are several ways to strengthen and recondition the deep neck muscles, and your doctor of chiropractic will show you the ideal exercises for your unique case and provide additional self-care recommendations to optimize the healing process, which can include exercise advice, dietary recommendations, and nutrition supplement guidance.

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.

Useful Tests for Diagnosing Whiplash

21 Jan

When it comes to whiplash associated disorders (WAD), the process of making an accurate diagnosis and treatment recommendation can vary from healthcare provider to healthcare provider depending on their educational background, ongoing training, and clinical experience. There is also a growing pile of research with respect to WAD that helps refine existing processes and introduce new perspectives to take on the condition and its treatment. Here are developments that can help doctors better evaluate the presence and severity of WAD.

In a 2017 study, researchers evaluated a diagnostic test that utilizes six isometric muscle fatigue tests of the neck and arm muscles in search of an inexpensive and relatively low-tech method for identifying the presence and degree of WAD injury—WAD I (no/minimal complaints/injury), WAD II (soft-tissue injury—muscle/tendon and/or ligament injury), WAD III (nerve injury), WAD IV (fracture). The study included 75 patients who had experienced a whiplash injury in the previous six hours and 75 non-injured subjects with a similar make-up (age, gender, body type, etc.).

            The investigators observed that the participants with WAD injuries fatigued at a much faster rate in each of the six tests, and those with a higher grade of WAD injury experienced fatigue even quicker. Based on the fatigue data alone, evaluators were able to identify the WAD patients with a more than 90% accuracy. While additional studies are underway to confirm these findings with more participants, this may offer healthcare providers an easy, accurate, and safe method to determine the severity of WAD injury and offer more tailored treatment recommendations in the time period immediately following an automobile collision.

A study published in 2020 used video fluoroscopy (VF) to observe both WAD patients with chronic neck pain and non-injured subjects while they performed five movements to a firm end range involving the motion of the cervical spine. Using the VF data, radiologists were able to differentiate members of the two groups with significant accuracy. The use of x-ray taken at a firm end range of each motion can also be used to make these measurements. This is important as most patients and healthcare providers don’t have ready access to VF but many times, X-rays can be done in the office or a short drive away.

The most current treatment guidelines for WAD recommend seeking care as soon as possible versus taking a wait-and-see approach. Chiropractic care is an excellent option that can reduce one’s risk for developing chronic WAD symptoms that may be more difficult to resolve.

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.

Car Crash Characteristics and Whiplash Recovery

17 Dec

While many cases of whiplash that result from a motor vehicle collision (MVC) have a successful outcome, some experts estimate that up to 25% of whiplash patients will experience chronic pain and disability. Several studies have sought to identify characteristics that differentiate these individuals from those who recover so that additional treatment can be offered to reduce the risk for chronicity. Let’s see if the characteristics of a MVC can shed any light on this…

In a 2019 study, researchers assessed 37 acutely injured patients within a week of their MVC, two weeks later, and three months later in order to determine any association between pain and disability with both specific crash measurements (head turned at time of impact, seatbelt use, whether or not airbags deployed, if the vehicle was struck while stopped or while turning, the principle direction of force, damage cost estimates, speed of impact, etc.) and patient characteristics (sex, body mass index, signs of post-traumatic distress, negative affect, etc.).

The research team identified a positive association between the percentage of self-reported neck disability at three months post-MVC and post-traumatic distress, negative affect (such as anger or sadness), and uncontrolled pain. There was no direct effect with crash characteristics such as vehicle damage, principle direction of force, or speed change. Though they recommended a larger study to confirm their findings, researchers were unable to establish a link between chronic whiplash pain and disability and specific crash characteristics. That is, there was no apparent connection between a person’s risk for ongoing whiplash issues and the severity of the collision. This study points out that recovering from a whiplash associated disorder requires a biopsychosocial care approach, not just focusing on the biology or tissue damage/diagnosis, but also the patient’s attitude about the injury and getting better.

This echoes a similar study that linked post-traumatic stress disorder (PTSD) with prolonged whiplash associated disorders recovery. In the study, researchers found that hyperarousal/numbing PTSD symptoms were predictive of long-term neck pain-related disability.

In addition to managing musculoskeletal disorders with manual therapies, nutritional recommendations, modalities, and specific exercise recommendations, doctors of chiropractic may utilize more whole body, health-oriented approaches to help patients learn how to relax and reduce stress and anxiety with techniques such as deep-breathing, visualization, contract-relax or tensing exercises, and more. When needed, your chiropractor can coordinate with primary care and specialty care providers, such as mental health counselors and clinical psychologists.

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.