Tag Archives: whiplash

Whiplash-Related Somatosensory Tinnitus

25 Mar

Most people associate tinnitus with excessive noise exposure, such as the ringing that
can follow a rock concert. However, tinnitus can also develop following a whiplash event,
such as the rapid acceleration and deceleration of the head and neck that occurs during a
motor vehicle collision. While a crash may involve loud noises that can temporarily affect
hearing, the persistent nature of tinnitus associated with whiplash-associated disorders
(WAD) suggests a different underlying mechanism.
Research in this area is ongoing, but the leading explanation involves a process
known as somatosensory modulation. The nervous system has sensory receptors throughout
the body that relay information to the brain, where it is interpreted as somatosensory input—
including touch, body position, temperature, and pain. Importantly, the somatosensory
system shares neural connections with other sensory systems, including the auditory system.
When somatosensory input is altered—due to injury, irritation, or persistent pain
signals from tissues of the head and neck—it can interfere with how the brain processes
information from other systems, such as sound. In this way, whiplash does not necessarily
cause direct injury to the auditory system. Instead, injury to cervical muscles, joints, or
related nerves may disrupt normal sensory signaling, leading the brain to misinterpret
auditory information and produce the perception of ringing in the ears.
In June 2025, researchers studied 80 patients experiencing WAD-associated tinnitus
and assigned them to either an intervention group or a control group. The intervention group
received a combination of manual therapy, stretching exercises, and relaxation techniques
aimed at reducing muscle tension and addressing myofascial trigger points in the head and
neck region, while the control group was placed on a waitlist and received no treatment. As
expected, patients in the intervention group demonstrated improvements in pain and cervical
range of motion. Notably, they also reported a reduction in tinnitus symptoms, suggesting
that addressing dysfunction in the head and neck may help normalize somatosensory
modulation contributing to tinnitus.
Doctors of chiropractic commonly incorporate these types of therapies as part of a
multimodal approach to managing patients with whiplash-associated disorders. Restoring
normal motion and function to the cervical spine may help alleviate not only neck pain but
also associated symptoms, such as tinnitus. In cases where symptoms do not improve,
referral to an appropriate medical specialist may be warranted.

Brent Binder M.S.,D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055

(717) 697-1888

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Chronic Whiplash and Neck Muscle Endurance

16 Feb

Whiplash-associated disorders (WAD) is an umbrella term used to characterize the
myriad symptoms that can occur when soft tissues are injured during rapid acceleration and
deceleration of the head and neck in a whiplash event, such as a rear-end automobile collision.
Despite advances in the understanding and treatment of WAD, it is estimated that nearly half of
whiplash patients continue to experience ongoing pain and disability for a year or longer. Recent
studies have identified reduced neck muscle endurance as a risk factor for chronic WAD, but
what happens in a real-world setting when neck muscle strengthening is included as part of
treatment?
To explore this question, a May 2025 study recruited 140 patients with chronic WAD
who completed pre-intervention assessments of neck pain, neck-related disability, neck function,
and psychosocial factors. Participants were then assigned to one of two treatment groups: athome exercises delivered through Internet-based instruction or in-office exercises facilitated by a
physiotherapist. Treatment frequency ranged from two to four sessions per week over a twelveweek period. Participants completed the same assessments three months and fifteen months
following the conclusion of care.
The results demonstrated that both in-person and at-home exercise approaches produced
similar improvements in neck pain, disability, and function, and these improvements were
associated with increased neck muscle endurance. While this finding provides important
confirmation that addressing impaired neck muscle endurance may help reduce persistent WAD
symptoms, the results related to psychosocial factors—how a person perceives, responds to, and
recovers from neck pain and injury—were particularly noteworthy. The data showed significant
post-treatment improvements in self-efficacy, fear-avoidance beliefs, depressive symptoms, and
catastrophizing. This is especially meaningful, as these factors are known to be present early
after injury and are strongly associated with the development of chronic WAD.
While further research is needed to confirm these findings and better understand the
underlying mechanisms involved, the results suggest that assessment of neck muscle endurance
should be included as part of the initial clinical evaluation, with targeted exercises prescribed for
patients to perform between in-person visits with their chiropractor or other healthcare provider,
if needed. Beyond the personal and family-level benefits associated with successful WAD
recovery, any intervention that reduces the risk of chronic WAD may also offer substantial
macroeconomic benefits, including improved productivity and reduced litigation-related costs,
which could ultimately contribute to lower automobile insurance expenses.
Brent Binder, D.C. 4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

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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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