Tag Archives: whiplash

Neuroinflammation and Chronic Whiplash Symptoms

25 Jun

It’s estimated that up to 50% of patients with whiplash-associated disorders
(WAD) continue to experience symptoms one year after their injury. Common chronic
WAD symptoms include persistent neck pain and stiffness, headaches, shoulder and
upper back pain, arm pain or numbness and tingling, dizziness or balance issues, fatigue
and sleep disturbance, cognitive difficulties, and increased pain sensitivity.
Because of the significant toll chronic WAD can have on individuals, families, and
society as a whole, there has been substantial research aimed at better understanding
these injuries in hopes of preventing long-term pain and disability. In particular, the view
is beginning to shift from WAD being the result of simple soft tissue injury to a more
complex condition involving the nervous system, where ongoing inflammation in and
around neural tissues may continue to drive pain long after the initial injury.
The sudden acceleration and deceleration of the head and neck that characterizes
whiplash can place rapid strain on cervical tissues, including the joints, muscles,
ligaments, and tendons. In response, the body initiates an inflammatory process, releasing
chemical messengers that help coordinate healing. These inflammatory signals can also
affect nearby nerves, increasing their sensitivity and altering how they transmit signals.
In the short term, this response is normal and part of recovery. However, if the
condition is not effectively managed, this heightened state can persist. Ongoing irritation
of the nervous system may amplify pain signaling and contribute to increased sensitivity
over time, a process known as central sensitization. As a result, stimuli that would not
normally be painful may begin to produce pain, and symptoms can persist even after the
original injury has largely healed.
Patients with signs of sensitization often require a more comprehensive treatment
approach—one that addresses both the physical tissues and the nervous system. Care may
include manual therapies and therapeutic modalities, targeted exercises and a gradual
return to normal activity, and patient education to support positive recovery expectations.
In some cases, additional strategies aimed at reducing inflammation, such as dietary
considerations, may also be included as part of a broader, individualized plan.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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Whiplash Avoidance Strategies

25 May

During a whiplash event, such as a rear-end collision, the head and neck accelerate and decelerate
more rapidly than the nervous system can coordinate a protective muscular response. This can result in
sprains, strains, and microtrauma to the soft tissues of the head, neck, and upper torso, which may
manifest as neck pain, stiffness, headache, brain fog, or dizziness—collectively referred to as whiplashassociated disorders (WAD). Because many patients experience symptoms that persist for months or even
years following injury, WAD can place a significant burden on individuals, families, and society as a
whole—highlighting the importance of strategies and technologies aimed at reducing whiplash risk.
Three key technologies designed to reduce collisions are blind spot monitoring, lane departure
warning, and forward collision warning with automatic emergency braking. Blind spot monitoring
systems detect vehicles alongside the car that may not be visible to the driver and provide visual or
auditory alerts. Lane departure warning systems use cameras to identify lane markings and notify the
driver if the vehicle begins to drift out of its lane; activation of the turn signal typically overrides these
alerts. Forward collision warning systems use cameras and sensors to detect when a vehicle is
approaching another object too quickly and alert the driver. More advanced systems incorporate
automatic emergency braking, which can slow or stop the vehicle to avoid a collision or reduce its
severity.
Proper adjustment of the seat and head restraint is also important in reducing whiplash risk.
Ideally, the head should remain close to the head restraint during a collision to limit excessive backward
motion. Research suggests that a seatback angle of approximately 20–30 degrees, combined with
positioning the head within about 2 inches (5 cm) of the head restraint and ensuring the restraint is aligned
with the top of the head (not below it), may help reduce injury risk. Despite this, observational studies
have shown that a large proportion of drivers do not properly adjust their head restraints. In response,
vehicle manufacturers have introduced seat and head restraint technologies designed to reduce the relative
motion between the head and torso during rear-end impacts.
Perhaps the most important factor in reducing whiplash risk is driver attention. Distracted drivers
are less likely to recognize hazards such as rapidly approaching vehicles, unsafe lane changes by others,
or road conditions that require sudden braking. In situations where a collision appears unavoidable, some
evidence suggests that pre-contraction of the neck muscles may reduce injury severity by limiting head–
neck motion and reducing strain on cervical structures.
If a collision does occur, early management focused on maintaining activity within pain tolerance
and restoring normal movement patterns may help reduce the likelihood of persistent symptoms.
Conservative approaches, including chiropractic care, are commonly used to support recovery in patients
with whiplash-associated disorders.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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Whiplash and Memory Impairment

23 Apr

In addition to neck pain and stiffness, individuals who experience sudden acceleration
and deceleration of the head and neck—such as during a whiplash injury—may also develop
symptoms more commonly associated with brain injury, including memory impairment. These
cognitive symptoms can persist for a year or more in some patients and may significantly affect
daily functioning, including the ability to attend school or pursue a career. Why can memory
impairment occur in patients with whiplash-associated disorders (WAD), and is it possible to
reduce the risk of long-term problems following an automobile collision?
It’s important to understand that the brain does not rest directly against the inside of the
bony skull. Instead, it is supported by protective layers called the meninges and cushioned by
cerebrospinal fluid. This arrangement allows the brain to tolerate normal movement while also
offering limited protection during minor impacts. However, during a whiplash event, the rapid
forces placed on the body can cause the brain to continue moving within the skull as the head
and skull are suddenly pushed in the opposite direction. As a result, the brain may sustain strain
or injury to key structures involved in memory formation and storage, even if the head does not
directly strike an object.
Researchers have also proposed that memory impairment in patients with WAD may not
always stem from structural injury within the brain itself. In some cases, cognitive symptoms
may be influenced by pain-related interference with normal brain function. Persistent pain
signals from injured tissues—often in the cervical spine—can affect attention, concentration, and
memory. Encouragingly, studies have observed that cognitive symptoms in some patients
improve as neck pain and soft-tissue injuries recover.
To facilitate recovery, it’s important for treatment to begin soon after injury—ideally
within a few days, or immediately if symptoms are severe or there is concern for serious injury.
Research suggests that early, active management (preferably within 96 hours) is associated with
better outcomes than delaying care for several weeks. Chiropractic management of whiplashassociated disorders typically focuses on a combination of manual therapies, therapeutic
modalities, targeted exercises, and patient education. The goals are to restore normal motion to
injured tissues, reduce pain, and encourage patients to remain active within comfortable limits
while avoiding excessive fear-based activity restriction, which can increase the risk for chronic
symptoms.
If memory impairment is present and does not improve over time, referral to appropriate
specialists—such as a neuropsychologist or cognitive behavioral therapist—may be
recommended as part of a comprehensive care approach.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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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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