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The Chiropractic Treatment Approach for Whiplash

22 Jul

Whiplash associated disorders (WAD) describes a constellation of symptoms (neck pain, headache, mental fog, radiating arm pain, mid- and/or lower-back pain, neck and upper back stiffness, muscle spasms, fatigue, anxiety, memory loss, etc.) that can result from the sudden forward and backward whipping motion of the head and neck. While motor vehicle collisions are most often associated with WAD, such an injury can also stem from a sports collision, fall, and physical abuse/trauma. Since the condition is a common reason individuals are referred for chiropractic care, let’s take a look at how WAD is diagnosed and managed.

Your doctor of chiropractic will ask you to complete initial paperwork that includes the usual biographical data as well as questionnaires specific to the event that caused the WAD injury. The physical examination will include various movement tests to help them determine the pain generator(s) and whether or not there is neurological injury. X-rays taken from the front, side, and at the end range of motion may be used to assess ligament integrity. If necessary, advanced imaging—a CT scan or MRI, for example—may be ordered to provide a clearer picture about damage to the soft tissues (such as the disks).

The current treatment guidelines for WAD recommend therapies that promote restoration of motion and for patients to continue activity as much as “normal” since immobilizing the neck (by wearing a cervical collar, for example) can actually delay recovery and prolong a return to normal activity. Doctors of chiropractic are trained to employ a number of manual therapy options for reducing pain and disability to facilitate the healing process. In-office treatment may also include massage and physical therapy modalities like electric stim, ultrasound, laser, magnetic field, and more.

A chiropractor may also prescribe specific exercises for the patient to perform at home to strengthen the deep cervical muscles and to improve the patient’s range of motion. To manage pain and inflammation, the patient may also receive instruction on the application of heat and/or ice, as well as recommendations for natural anti-inflammatory agents like ginger, turmeric, bioflavonoids, or to reduce their intake of processed foods, which can promote inflammation in the body. If brain injury is present, chiropractors frequently partner with other healthcare professionals who specialize in such matters. Often, a team approach will offer the best outcomes in more complicated cases.

Since studies have demonstrated that WAD patients who delay care are more likely to develop chronic symptoms, it’s important to receive a thorough examination of the neck and associated soft tissues sooner rather than later.

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.

Initial Treatment Approach for Whiplash-Associated Neck Pain

24 Jun

While neck pain is one of the most common reasons patients seek chiropractic care, the underlying cause of neck pain can vary. In some patients, the cause may be unknown or it may be the accumulation of years of poor posture, bad ergonomics, and an unhealthy lifestyle. In other patients, such as those who experienced a whiplash event in a rear-end automobile collision, the cause is well known and better understood. Is neck pain related to whiplash associated disorders (WAD) different than other types of neck pain, and what’s the best initial approach for those with traumatic vs. non-traumatic neck pain?

In a 2020 study, researchers compared the initial presentation of 22 patients with mechanical neck pain (non-traumatic) and 28 patients with grade I or II WAD-related neck pain with or without loss of range of motion but no neurological sensory deficits, motor weakness, and/or decreased or absent deep tendon reflexes.  

A review of participant-provided assessment data as well as examination findings revealed the WAD patients exhibited higher neck-related disability, felt pain over a larger area, and had a lower pressure pain threshold over the tibialis anterior (the muscle next to the shin bone).

In the next phase of the study, each patient received two treatments a week for three weeks that included soft tissue techniques targeting trigger points in the cervical region, spinal mobilization, muscle energy techniques, manual traction, and specific cervical spine exercises. This is the type of multimodal approach a patient may receive from their doctor of chiropractic to restore normal motion to the cervical joints as well as to strengthen the deep cervical muscles that often become deconditioned following an injury to the cervical spine and associated tissues.

The researchers hypothesized that due to greater symptom severity and sensitivity to pain, the WAD patients would not respond as well to care. However, patients in both groups reported similar overall improvements in pain and disability following just six treatments. The findings suggest that a multimodal approach can benefit both types of neck pain patients. However, those with WAD may require more office visits to reach maximum improvement. Treatment guidelines encourage patients to utilize conservative options first, of which chiropractic care is an excellent choice. In the event an individual develops neck pain, either from whiplash or non-traumatic origin, it’s important to seek care sooner rather than later, as delaying care can increase the risk the condition becomes chronic and more difficult to manage.

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 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.