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Reducing the Risk for Chronic Whiplash-Related Pain

27 Jul

A study published in 2019 found that nearly half of whiplash associated disorders (WAD) sufferers are still symptomatic one year after their injury. Why is that, and what can one do to reduce their risk for chronic WAD symptoms?

The most common source of pain from WAD injuries arises from joint capsules and ligaments, which are tough, tight bands of tissue that hold joints together and help stabilize the cervical spine. When these soft tissues are damaged, the body will take measures to restrict movement so that the injury doesn’t become more severe. This is one reason why cervical range of motion is reduced when the neck is injured.

You may recall that a patient with whiplash used to be fitted with a cervical collar to protect the neck and limit movement. However, researchers have since discovered that, in many cases, restricting all cervical movement for a prolonged period of time can lead to a weakening of the deep neck muscles—which are important for maintaining cervical posture—and the buildup of potentially troublesome scar tissue. These days, patients are encouraged to remain active provided their movements do not generate acute pain. Not only does staying active reduce the risk of deep neck muscle atrophy, but movement is necessary to produce the compressive forces that help maintain the flow of nutrients to the cartilaginous tissues in the neck.

The back-and-forth whiplash process can also result in trauma to the brain, also known as a concussion. The brain is suspended in the skull by ligaments and is cushioned by fluid. In a rear-end collision, the oblique angle of the chest restraint results in a twisting of the torso upon impact as the body accelerates forward. The brain slams into the front inside of the skull and then rebounds and hits the back inside of the skull as the trunk is forced backward during the deceleration phase of the injury. Depending on the degree of force, concussion can involve the front, back, or both parts of the brain resulting in memory problems, confusion, fatigue/drowsiness, dizziness, vision problems, headache, nausea/vomiting, light/noise sensitivity, and more. The good news is that chiropractic care applied to the cervical spine has been demonstrated to benefit patients with these post-concussive symptoms that often accompany WAD, which may reduce the chances that such symptoms become chronic in nature. The current research suggests that patients who seek treatment soon after a whiplash event— like a car accident, slip and fall, or sports collision—are not only more likely to experience a faster recovery but they are also less likely to develop a chronic condition. Chiropractic care offers a safe and conservative form of treatment for WAD that is often recommend by treatment guidelines.

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.

Chiropractic Care for Whiplash Injuries

24 Feb

Whiplash associated disorders (WAD) describes a constellation of symptoms that can arise following a motor vehicle collision (MVC), sports collision, or slip and fall. The typical initial treatment approach for WAD is non-surgical care, but what does the research say is the best non-surgical approach?

To start, most (if not all) studies on WAD center around the concept of preventing chronicity of WAD. In other words, the GOAL of care is to restore function and get the patient back to their normal lifestyle (work and play), which has been emphasized as being most important, even more so than pain resolution, though the two often go hand-in-hand. What are the best treatments in the initial stages—acute (less than two weeks) and sub-acute (two to twelve weeks)—of healing that can best reduce the risk of a patient developing chronic WAD (over twelve weeks)?

To answer the question, researchers reviewed studies from a 30-year time frame (1980-2009) and published their findings in a five-part series.

The first article in the series offered an overview and summary of the entire work. The second focused on the acute stage which included 23 studies that met the inclusion criteria. The researchers concluded that EXERCISE and MOBILIZATION treatment approaches had the strongest research support—two services STRONGLY EMBRACED by chiropractic.

The third article in the series focused on the subacute stage (2-12 weeks), which included 13 studies. The authors described research support for “the use of interdisciplinary interventions and chiropractic manipulation” but stated that the level of evidence was not strong for ANY treatment approach in the sub-acute stage. Investigators concluded that more research was needed with respect to this stage of care.

The fourth article in the series centered on the chronic stage (more than three months), of which 22 studies were included. Here, EXERCISE programs were reported to offer relief, at least over the short-term, while nine studies supported effectiveness for an interdisciplinary approach. Manual joint manipulation and myofeedback training were also reported as useful for pain relief.

The authors also stated that there was strong evidence to suggest that immobilization with a soft collar was not only ineffective but may impede recovery.

Do you see the “theme” of this research series? Services offered by chiropractic (exercise training, manipulation, and mobilization) are recommended at each stage of WAD recovery!

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.

Management Strategies for Whiplash and Dizziness

20 Jan

Of all the symptoms associated with whiplash associated disorders (WAD), dizziness may be one of the most concerning to patients because of how it can limit their ability to get up and move around. What can be done to treat dizziness following a WAD injury?

Two studies published in 2019 suggest that manual therapies and therapeutic exercises may be an effective option for such patients.

The first study included 40 WAD patients randomly assigned to either a treatment group or control group. The treatment group engaged in twelve 50-minute exercises sessions spread out over a six-week time frame. The exercises included standing on a foam surface and turning the head side-to-side; walking on an inclined plane and turning the head side-to-side; standing on a trampoline and moving the eyes side-to-side; heel-to-toe walking on a line for up to 5 meters (16.4 feet), and standing on one leg. If able, the treatment group repeated the same exercises with their eyes closed. Assessments completed at the end of the experiment revealed substantial improvements in both dizziness and quality of life among participants in the exercise group that were not experienced by those in the control group.

In the other study, researchers assigned 86 patients with chronic cervicogenic dizziness to one of three groups: SNAG (Sustained Natural Apophyseal Glide) exercise for six weeks; passive joint mobilization with range of motion (ROM) exercises for six weeks; or a control group that received no treatment. The SNAG exercises involved two movements (repeated ten times each): 1) Sit/Stand. Place a towel across the upper neck; as you pull forward with the towel, chin-tuck while pushing back into the towel. 2) Hold one end of the towel against the chest; rotate the head/neck toward the same side as far as possible; with the towel wrapped across the top of the neck, gently push the head further into rotation.

The research team reported that participants in both treatment groups experienced improvements with respect to dizziness, balance, cervical range of motion, and head repositioning accuracy. The authors of the study concluded that both treatment approaches are effective for cervicogenic dizziness (dizziness caused by cervical dysfunction).

The good news is that both spinal mobilization and active exercise are utilized by doctors of chiropractic!

 

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.

The Role of Neck-Specific Exercises for Whiplash Recovery

21 Nov

The cervical spine relies heavily on muscular support, particularly from the deep muscles in the front and back of the neck. Some experts estimate that up to 70% of the stability of the cervical spine arises from these deep neck muscles, particularly those in front of the spine. Studies have demonstrated that the rapid acceleration-deceleration forces that are placed on the neck during a motor vehicle collision can injure these deep neck muscles. Indeed, electromyographic (EMG) testing conducted on WAD patients has shown that those with higher pain intensity also had reduced deep muscle function in both the front and back of the spine. Treatment guidelines for non-specific neck pain recommend incorporating neck-specific exercises into the treatment process. But what about for WAD patients with neck pain?

A 2018 study that involved 26 patients with chronic WAD (symptoms lasting longer than three months) evaluated the role of neck-specific exercises (such as cranio-cervical flexion—tucking in the chin and approximating the chin toward the chest while looking straight ahead without bending the head forward) had in  improving muscle performance, disability, and pain intensity over the course of a three-month time frame.

After three months, the researchers used a special type of diagnostic ultrasound to measure function in one large superficial muscle and two deep muscles that all reside in the front of the neck. Investigators observed that the participants in the neck-specific exercises (NSE) group experienced significant improvements with respect to muscle function, disability, and pain intensity that were not observed among those in a “wait list” group who served as controls.

Here’s where it gets more interesting… At the three-month point, the members of the control group were added to the NSE group, and three months later, the researchers observed that these participants experienced the same improvements that they previously noted in the first NSE group!  This study supports the need for specific neck exercises to reduce pain and disability and improve function.

When the deep muscles are injured, it’s common for the body to recruit superficial muscles to help stabilize the body and maintain posture. While this can protect the deep muscles from further injury in the short term, it can decondition these muscles over time and allow fatty deposits to infiltrate its tissue. This helps to explain why exercises are so important in the recovery process from musculoskeletal injuries, especially since there’s research that says that up to half of WAD patients will still experience pain and disability a year after their accident. This underscores the importance of seeking treatment for WAD as soon as possible in order to reduce the risk for chronicity and while the chances for full recovery are greatest.

 

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.

The Link Between Whiplash and Fibromyalgia

24 Oct

It’s estimated that up to 50% of whiplash associated disorder (WAD) patients will develop chronic symptoms such as neck and upper back pain, headache, dizziness, emotional and cognitive disturbance, referred pain, and physical dysfunctions. Fibromyalgia (FM) is a condition that is also characterized by long-term, persistent symptoms such as chronic widespread musculoskeletal pain, sleep disturbance, cognitive disturbance, fatigue, and physical dysfunctions. Both WAD and FM patients share similar chronic, debilitating signs and symptoms. Why is this so?

In one study, researchers evaluated cognitive loss, central sensitization, and health-related quality of life (QoL) in chronic WAD patients, FM patients, and individuals without any known chronic conditions to serve as a control group. Participants in both the WAD and FM group exhibited significant cognitive impairment, central sensitization, and decreased health-related QoL, suggesting that brain injury plays a significant role in each condition.

In WAD injuries, the mechanism of injury causing cognitive loss (the brain’s inability to process information) appears to arise from the brain slamming into the inside of the skull. In a classic rear-end collision, the brain first hits the back of the brain casing followed by the rebounding into the front of the skull, causing a concussion.

A 2011 study found that among 58 women who had been admitted to the emergency room for a whiplash injury, three met the clinical criteria for FM three years later. Another 2011 study found that among 326 WAD patients with persistent neck pain lasting longer than three months, up to 14% met the criteria for FM. Based on these findings, it’s clear that the whiplash process could be a strong contributing factor for developing FM. Indeed, a 2015 study that looked at the health histories of 939 FM patients identified trauma as a precipitating factor in 27% of cases.

While we typically associated whiplash with motor vehicle collisions, such injuries can also occur in sport collisions, physical assaults, and falling. It’s possible that a greater percentage of FM cases may be due to trauma the participant simply wasn’t able to recall. Emotional trauma and post-traumatic stress disorder have also been associated with an elevated risk for FM. The disease process for FM isn’t entirely understood, and in cases when the cause is not known, it’s possible the condition could be the result of a cumulation of factors, including WAD.

Nonetheless, it’s clear that chronic WAD and FM are potentially debilitating conditions and seeking treatment after a trauma, such as a motor vehicle collision, is important for mitigating the risk for chronic symptoms. The good news is that both FM and WAD patients respond very favorably to chiropractic care!  Doctors of chiropractic are trained to examine, diagnose, and treat those presenting with FM and WAD. Studies have reported that the inclusion of spinal manipulation enhances recovery in acute and chronic WAD, as well as FM.

 

 

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.

The Link Between Whiplash and Jaw Pain

23 Sep

While neck pain is most commonly associated with whiplash associated disorder (WAD), patients often report jaw or temporomandibular joint (TMJ) pain following a car accident, sport injury, or slip and fall.

Common symptoms associated with temporomandibular disorders (TMD) include pain in the jaw joint area (in front of the ear), neck and shoulder pain, ear area pain with chewing or yawning, a “stuck” or locked feeling, and clicking, popping, or grating sounds with jaw movements. Patients with TMD may also feel like their teeth don’t fit well together, or report toothaches, headaches, dizziness, and tinnitus (ringing in the ear).

An MRI (magnetic resonant imaging) study of TMD following a WAD injury revealed joint effusion or swelling and/or disk displacement in more than half of the participants, along with alterations in the thickness of the lateral pterygoid muscle (LPM) that helps open the mouth. Studies have shown that rear-end collisions can result in trauma to the muscles in the area of the TMJ, along with its joint capsule and fibroelastic disk. Post-traumatic muscle imbalance can then perpetuate the problem, leading to chronic TMD.

A 2018 study found that patients with TMD following a whiplash injury (wTMD) had higher pain intensity scores, worse exam findings, worse function, and greater muscle atrophy in the LPM than patients whose TMD resulted from another cause. The patients with wTMD were also more likely to be affected by stress and headaches than the other TMD patients.

The authors concluded that TMD is a common WAD-related injury, and MRI findings of disk displacement and LPM alterations are often found together. They also point out that TMD from whiplash appears to involve a different mechanism than TMD from other types of trauma or no trauma.

Doctors of chiropractic are trained in the assessment and treatment of WAD, including TMD, which often involves a multi-faceted approach that includes manipulation, mobilization, and soft tissue techniques (myofascial release, contract-hold, trigger point therapy, muscle energy, and more).

 

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.