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Whiplash – Who Will Get Better?

19 Feb

Though most patients with a whiplash injury improve within a few months, about 25% have long-term pain and disability that may persist for many months or years.


Now, a team of scientists from Northwestern Medicine Feinberg school of Medicine reports that it may be possible to determine which whiplash patients will develop chronic pain, disability, and/or post-traumatic stress disorder (PTSD) within one to two weeks of their injury—leading to specialized treatment that may reduce their risk for developing a chronic condition.


Using a specialized form of MRI that measures the fat and water ratio in the neck muscles, the researchers found that greater fat infiltration into these muscles indicated rapid muscle atrophy. The presence of fat in the muscle is not related to the person’s weight, size, or shape and is believed to represent an injury that is more severe or serious than what might be expected from a typical low-speed car crash.


However, though the lead investigator notes that the fat infiltration into the muscle appears to be a response to an injury, what has actually been injured—muscle, nerves/spinal cord, and/or more—remains a mystery.

Another study by the same research team found that chronic pain whiplash victims also exhibited a high level of muscle fat in their legs—indicating atrophy. The researchers hypothesize that these patients may have partially damaged their spinal cord, as this group of patients also reported feeling weak and clumsy when walking.

Current research indicates that when managing whiplash cases, early return to activity, movement restoration, and exercises that specifically target the deep neck flexors lead to better outcomes than a “wait and watch” approach.

Doctors of chiropractic also utilize manipulation, mobilization, exercise training, diet, and nutrition, and encourage a return to a normal lifestyle as quickly as possible when treating patients with a whiplash injury.


What You NEED to Know About Whiplash

22 Jan

Whiplash injuries are very common and are primarily associated with car and rear-end collisions in particular. This is what happens when you’re rear ended…

  1. At 0-50 milliseconds (ms): As the car is initially propelled forward, the seatback pushes the torso forward while the head remains in its original position, which straightens or flattens out the cervical curve.
  2. At 50–75 ms: As the torso accelerates forward, the head/neck moves backwards forming an S-shaped curve with flexion of the upper cervical region and extension of the lower cervical region, stressing the ligaments in back (upper) and front (lower) cervical spine regions.
  3. At 150-175 ms: The torso is at its maximum forward position in reference to the neck and the head/neck is forced into peak extension (backward bending). The head may contact the head restraint or ride over it if of the torso slides up the back a reclined seat. This can further damage the ligaments in the front of the cervical spine.
  4. At 200-600 ms: The head and torso are then thrown forward by the rebound off the seatback, hyperflexing the neck (and mid- and/or low-back) and potentially causing further injury to the ligaments in the back of the spine. Depending on whether or not a seatbelt is in use, the head may strike the steering wheel and/or windshield causing further injury.

It may seem logical to think that if we can anticipate an impending MVC, then less injury will occur. Unfortunately, this doesn’t hold true because the total length of time it takes for the sequence described above to occur is about 600 ms and we cannot voluntarily contract our muscles in less than 800-1000 ms. Therefore, you simply won’t have time to brace yourself for impact.

If cervical rotation occurs at the time of impact, such as looking into the rearview mirror, then the risk for injury may increase. There is recent evidence suggesting that it is difficult to avoid rotation of the cervical region during a collision because the diagonal path of the chest restraint promotes trunk rotation in the later stage of whiplash as the torso rebounds forward.  Nonetheless, looking straight ahead at the time of impact may reduce the degree of injury in some collisions.

To achieve the best long-term outcome, treatment should emphasize movement and exercise as soon as possible. In addition to treatments performed in the clinic, doctors of chiropractic commonly recommend whiplash patients to perform home exercises, home cervical traction, and other self-help methods with the objective of returning to a normal lifestyle as quickly as possible.

Whiplash Injury Prevention – Part II

21 Dec

Last month, we discussed whiplash injury prevention by focusing on the physical characteristics of crashes. This included information about head restraints, collision speed, seat back position, body size differences, air bags, and more. This month, we’ll focus on the MOST important aspect of whiplash prevention: driver distraction!

According to a survey of 6,000 drivers conducted by the National Highway Traffic Safety Administration (NHTSA), 20% of those surveyed in the 18-20 years old age group and 30% of those 21-34 years of age claimed texting does not affect their driving.

Of the 6,000 drivers surveyed, 6% reported having been in a crash in the prior year and 7% had been in a near-crash, with men being at a slightly higher risk than women. Young drivers, those 18-20 years old, had the highest incidence of crash or near-crash experiences (23%) compared with all other age groups while interestingly, drivers aged 65 years and older had the lowest (8%). The younger drivers reported almost double the number of crashes (17%) as drivers in their early 20s (9%) and up to four-times more than the other age groups (4-6%).

Of the 718 drivers who were involved in a crash or near-crash in the previous year, 6% reported phone usage at the time (4% talking, 1% sending a text or email, and 1% reading a text or email). The young driver (18-20 years old) group, reported the highest cell phone use (13%) at the time of the crash or near-crash (2% talking, 8% sending a text or email, 3% were reading a text or email). The highest incidence of talking on the phone at the time of crash/near-crash was in the age 25-34 years old group (10%). Not too long ago, we reported statistics comparing texting to drunk driving, and the data was sobering. Researchers from the Monash University Accident Research Centre in Australia found that texting severely impaired driving skills, as participants spent 400% more time with their eyes off the road!

Hands-free devices are NOT without risks either. Put simply, the brain is distracted when talking, as attention is displaced from the road to the conversation—especially if the conversation is heated! Interestingly, the Texas A&M Transportation Institute reported that voice-to-text offers no safety advantage over manual texting while the AAA Foundation for Traffic Safety reported voice-activated in-car technologies “dangerously undermine driver attention.”

To summarize, avoid all distractions while driving and keep your eyes on the road!

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 Injury Prevention

20 Nov

Some studies have suggested that 85% of all whiplash injuries occur from rear-end collisions. So, what are some different ways that we might be able to avoid injury if such an event occurs?

HEADREST: It’s important that your headrest is high enough so that your head and neck doesn’t roll over it in a collision, which can increase the risk of injury to the neck and head. Additionally, be careful to keep your head within eight cm (3.14 in) of the headrest while driving. By reducing the spacing between your head and the headrest, you can lower your risk for sustaining a brain injury in a rear-end collision. Today’s cars may also feature an active head restraint system that adjusts the head rest in an effort to shorten the distance between the head and the headrest when an accident occurs. ADVICE: Check the position and condition of your head restraint!

SEAT BACK POSITION: At least one study has concluded that vehicle occupants may have a higher injury risk if the seat back is fully upright. On the other hand, a seat back that leans too far back may serve as a ramp for the body during an accident, which could slide the head over the headrest. This too can increase the risk of injury. ADVICE: Recline the seat back somewhat while driving, but not too far.

BODY SIZE EFFECTS: A literature search study reviewed the potential injury effects as it relates to differences in anatomical size, head-neck orientation, the facet joints (small gliding joints in the back of the cervical spine), and neck muscles mass. The authors of the study reported that smaller sized necks, head positions outside of neutral (vs. looking straight forwards), and smaller muscle mass increased the potential for neck injury in a rear-end collision. ADVICE: Strengthen/exercise your neck muscles.

AIR BAGS & SEAT BELTS: Though these are not an “option” and have become “standard equipment” in cars, it’s clear that airbags and seat belts have saved far more lives compared with the injuries (including some deaths) that can be attributed to them. According to one source, more than 30,000 lives have been saved by front and side airbags. ADVICE: Make sure you act on any recall involving your airbag (and any recalls involving your car in general) and WEAR your seatbelt!

FACTORS DIFFICULT TO STUDY: Given all the variables involved in “real-world” car crashes, it is very difficult to predict which criteria are most important for injury prevention. For example, vehicular weight/size difference, multiple collisions—from different directions, readiness for impact, etc. The BEST ADVICE  – Stay alert, keep your eyes on the road, and don’t speed.


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 Injuries and Missed Diagnoses of Traumatic Brain Injury

22 Oct

Traumatic brain injury (TBI) is also becoming a “hot topic” as it relates to motor vehicle collisions (MVC). The question is: how often is TBI missed?

The simple answer is: FREQUENTLY! This is due to the fact that attention is often drawn toward other injuries such as a neck injury or a limb injury. One study found that doctors were more likely to miss an mTBI diagnosis in patients who had sustained an arm or leg fracture. Among a total of 251 trauma patients, only 8.8% were diagnosed with mTBI at the time of injury vs. 23.5% who were eventually diagnosed at a later date. The authors of the study note the importance for healthcare providers to not be overly focused on the most obvious injury, as it may result in missing an mTBI diagnosis and the opportunity for early management of the condition—potentially leading to greater pain, suffering, and long-term disability.

But how “good” is our ability to assess mTBI? In a recent study on the ability of sideline assessments to predict subsequent problems after a sport-related concussion, researchers concluded that although sideline measures are useful for diagnosing concussion, they are not suitable for determining the extent of injury one to two weeks post-injury.

Part of the problem associated with concussion, regardless of cause, is an overall lack of knowledge about the condition on the part of athletes, parents, coaches, and medical professionals. In a Canadian survey of members of these groups, “predictors” of better concussion knowledge included prior personal experience or history of concussion. Factors affecting knowledge included language, age, educational level, annual household income, and TBI history.

Yet another issue is the “under reporting” of concussion. Looking at gender differences in a total of 288 athletes across 7 sports (198 males, 90 females), in spite of having similar knowledge about concussion, female athletes were more likely to report their concussive symptoms than males.

Sobering facts: 1) About 1.7 million cases of TBI occur in the US annually, and approximately 5.3 million live with a disability caused by TBI; 2) Annual direct and indirect TBI costs are estimated at $48-56 billion; 3) Among children under fourteen years of age, TBI results in 2,685 deaths and 37,000 hospitalizations; 4) Between 50-70% of TBI accidents are the result of a motor vehicle crash.

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 Injuries and Neck Strain

21 Sep

The terms “whiplash” and “neck strain” are often used interchangeably, though there’s debate about whether this is appropriate. Let’s take a closer look at the differences between these two common descriptions of neck pain…

The term “strain” technically means a stretch injury to a muscle and/or the tendon that attaches muscle to bone. The terms mild, moderate, and severe offer a classification approach commonly used by healthcare providers to describe the degree of injury. As implied, a mild strain is just that—little to no muscle fiber or tendon tearing has occurred and thus, the injury will have a faster recovery time than a moderate strain. Moderate strains include partial tissue tearing and take longer to mend. Severe strains described complete tearing and in certain muscles in our body, surgery may be needed to repair the tear.

There are many muscles and tendons in the neck that overlap each other to allow for various functions or movements to occur. The deep “intrinsic” muscles are described as “fine movers” and allow for the individual cervical vertebra to move in a very specific manner and direction. The superficial muscles are larger, stronger, and utilized in global/large movements and help to protect the neck and the deeper, more delicate structures.

It can take a total of about 600 msec for the head to “whip” forward and backward in a classic rear-end collision, which is faster than we can voluntarily contract a muscle. This explains why an injury is difficult (if not impossible) to avoid in a motor vehicle collision, even if you “see” that an accident is about to happen.

To further differentiate the whiplash injury from a simple muscle strain, the brain is suspended by ligaments and cushioned further by fluid inside the calvarium (or skull) and can easily get bruised by literally slamming into the walls on the inside of the skull in a whiplash injury. This results in “traumatic brain injury” (TBI) or concussion. Interestingly, it’s been reported that one does NOT have to directly hit the head on a hard object to suffer TBI.

The symptoms associated with TBI include mental fog; fatigue/tiredness; slow mental functioning, such as having difficulty formulating thoughts, staying on task, and/or expressing one’s self; visual complaints; memory loss; and/or headache. The term “Whiplash Associated Disorder” or WAD is preferred, as it encompasses the many different symptoms associated with whiplash.

Doctors of chiropractic are trained to evaluate, diagnose, and treat patients who have sustained a whiplash injury. Generally, the sooner treatment commences after the injury, the more favorable the outcome or prognosis. Therefore, don’t delay in obtaining care following a collision!


Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055
Member of

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.