Tag Archives: whiplash

Picturing Chronic Whiplash

20 May

Whiplash-associated disorder (WAD) is a condition characterized by a collection of symptoms that can arise after the sudden back-and-forth movement of the head and neck—most commonly from motor vehicle collisions. It’s estimated that 2-3 million Americans experience whiplash each year and the current data suggests as many as half may continue to experience ongoing, chronic WAD symptoms lasting longer than a year. Unfortunately, there’s no clear way to identify which patient may be at elevated risk for chronicity but a 2022 study suggests it part of the answer may have to do with drawing a picture.

In the study, researchers provided 205 chronic WAD patients with electronic diagrams of the human body and asked them to draw or fill in where they feel pain on their body. The patients also completed a Neck Disability Index questionnaire. They repeated the process a year later. The research team identified an association between perceived pain and disability (from the questionnaire responses) and the degree to which the patient’s pain was widespread (from their drawings). 

This widespread pain is indicative of central sensitization, which is described as greater sensitivity to pain, even stimuli that isn’t normally painful. The system in the body that relays pain signals to the brain is the nervous system, and these signals must pass through the neck. This suggests that a nerve injury or an injury that interferes with the nervous system’s function may be a driving risk factor for chronic WAD. Interestingly, a systematic review that looked at health data from more than 390,000 WAD patients found evidence that a third of grade II WAD patients show signs of nerve injury, which would classify them as grade III WAD and necessitate a more comprehensive treatment approach. Other risk factors for chronic WAD include high initial pain and disability, current low back pain at time of whiplash event, history of neck pain, new onset headaches, post-injury anxiety, and cold hyperalgesia (high sensitivity to cold). 

Doctors of chiropractic are trained to assess patients with whiplash injuries and to provide a conservative treatment approach that not only addresses the patient’s pain and disability, but also to educate them on the importance of maintaining their usual activity as best they can and to reassure them that they can get better—both of which are important for reducing the risk for persistent, ongoing symptoms. If necessary, they will team up with allied healthcare providers to provide the patient with the best possible chance for a satisfactory outcome.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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Nerve Injury Often Missed in Whiplash Patients  

25 Apr

While the literature published on the topic of whiplash-associated disorders (WAD) is voluminous, it’s still somewhat of a mystery why some individuals can walk away from a motor vehicle collision without injury and others can experience chronic, persistent, and disabling symptoms. One area in which researchers have focused their efforts in recent years is on the extent that nerve injury occurs during a whiplash event, and when it occurs, whether it’s being detected early in the course of treatment.

Traditionally, WAD patients are classified the following way: WAD I—pain, stiffness, or tenderness of the neck as the only complaint with no physical exam findings (full range of motion and no muscle guarding or tenderness on examination); WAD II—pain, stiffness, or tenderness of the neck with soft tissue injury signs, loss of range of motion (ROM), and/or point tenderness of the neck (e.g., a sprain/strain neck injury); WAD III—pain, stiffness, or tenderness of the neck along with neurological signs sensory deficits, motor weakness, and/or decreased or absent deep tendon reflexes; WAD IV—pain, stiffness, or tenderness of the neck along with dislocation or fracture with or without spinal cord injury.

As you can expect, treatment guidelines can vary based on how WAD is graded. A systematic review of 54 studies that included more than 390,000 WAD patients and 900 individuals without a history of WAD (who served as controls) concluded that this classification system may need updating. The researchers found that about a third of WAD II patients—the most common WAD level—showed signs of neuropathic pain, though they had not been diagnosed as such. 

The authors stress the importance of a careful INITIAL clinical examination as the presence of nerve injury/pathology may alter the treatment recommendations given to the acute WAD patient such as a wait-and-watch method that is commonly recommended after the initial examination. Researchers point out that compared to other chronic pain conditions, people with neuropathic pain experience greater interference with function and activity tolerance as well as worse quality of life and emotional wellbeing assessments—each of which is associated with an increased risk for chronicity.  

Doctors of chiropractic are trained in the diagnosis and management of WAD using a multimodal approach that embraces spinal and extremity manipulation, mobilization, and other manual therapies; exercise training tailored to the individual patient; nutritional counseling for reducing inflammation and promoting healing; various PT modalities including ultrasound, electrical stimulation, laser, and pulsed magnetic field; acupuncture and/or dry needling; and more. In more severe cases, doctors of chiropractic can also co-manage treatment with the patient’s medical physician, specialist, or other healthcare providers.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org

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A Different Perspective on Chronic Whiplash

30 Mar

It’s estimated that up to 50% of whiplash associated disorders (WAD) patients will continue to experience long-term symptoms that interfere with their ability to carry out activities of daily living. According to experts, the economic burden associated with chronic WAD may exceed $42 billion each year. As such, many studies have sought to better understand whiplash, both from the mechanisms of injury to why some patients recover and some don’t. 

With respect to chronic WAD resulting from a motor vehicle collision (the most common cause of whiplash), factors associated with the crash itself like speed, impact direction, awareness of collision, and airbag deployment do not appear to be significantly linked to an elevated risk for chronicity. On the other hand, researchers have found that higher self-rated pain and disability, fear of movement, catastrophizing, passing coping, and low expectations of recovery are indicative of failure to fully recover. 

In a 2017 study, researchers reframed the trauma of a motor vehicle collision as an event that is both potentially injurious and distressing. When an acute injury occurs (in this case whiplash), there is often damage to various anatomical structures in the head, neck, and/or upper-mid back. Additionally, there is also a stress response associated with the overall incident (including subsequent events like a trip to the hospital and dealing with the insurance company and legal system) that can interfere with the healing process. When the combination of psychological vulnerabilities and neurobiological processes exceeds a person’s given threshold, their risk for chronic WAD rises.

This finding highlights the importance of treating the whole patient when it comes to WAD as it can affect both the body and mind. In addition to therapies delivered in the office to help the soft tissues in and around the neck to heal, doctors of chiropractic and other healthcare providers need to educate the patient and assure them that they will recover and encourage them to carry on their normal activities within pain tolerance. If necessary, the patient may need a referral to a mental healthcare professional to address psychological factors that can impede recovery. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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Whiplash “Anatomy.”

20 Dec

To better understand Whiplash, let’s take a look at the anatomy and what is actually injured in a whiplash injury.  Our spine is basically a long chain made up of blocks that are larger at the bottom and smaller at the top. This means the low back vertebra are huge compared to the neck vertebrae. The vertebrae fit together in a way that “locks” them together by the small joints in the back called “facets” and in the front by the disks. These joints function as shock absorbers between the blocks or “vertebral bodies.” Also in the front, there is a tough piece of tissue called the “anterior longitudinal ligament” that provides a barrier so that when the neck is bent backwards (into “extension”), it becomes tight and stops that movement so it doesn’t over-extend, which could fracture the small facet joints in the back.

There are ligaments, or tissues that hold bone to bone, in the back of the spine that connect between the “spinous processes,” or bony “bumps” in the middle of the back. These ligaments check or stop excessive forward motion of the neck during whiplash. Joint capsules surround joints, which we all have seen when we separate a chicken leg from the thigh. Remember how smooth and shiny the end of the chicken leg is? That smooth surface at the end of long bones is call “hyaline cartilage”, and it allows for slippery gliding between the ends of our bones when we move any joint, including our fingers, wrists, shoulders, hip as well as the facet joints of the spine. Joint movement is facilitated by the presence of an oily substance called “synovial fluid” which acts like a lubricant for the joint allowing for pain-free movement.

A “sprain” occurs when we damage a joint capsule or a ligament, or when the muscle or its attachment (tendon) is injured. These are graded as mild, moderate or severe, or grades 1, 2,or 3, with grade 3 being the worst at 75% or greater tearing, and healing takes progressively longer with each grade.

During a whiplash injury, the classic rear-end collision results in over stretching of the ligaments in the neck, and tearing can occur (sprain, grades 1, 2 or 3). If one of the nerves gets pinched, then numbness, pain, and/or weakness can occur, radiating down the arm to a specific location. When this occurs, the long-term prognosis is worse. Concussion can also occur if the brain is slammed against the inside of the skull. Chiropractic adjustments, when administered early, yield the best results for treating whiplash, according to many studies.

We realize you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

 

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Whiplash “101.”

14 Dec

Whiplash diagnosis: The diagnosis of whiplash first and foremost requires a thorough history. Here, we discuss the factors leading up to the MVC (motor vehicle collision), the angle or direction of impact (front end, angular, side or T-bone, rear end), whether the head was pointed straight or rotated, whether the head hit anything inside the car, airbag deployment and any related injury, seat belt location and effectiveness, the conditions of the day (weather, road, lighting, etc.), the onset of each injured area including neck, upper/lower back, headache, memory loss, and radiating symptoms (time lapse to symptom onset), ER/ambulance involvement, the initial 24-48 hours, the point of maximum pain intensity, job and non-vocational capabilities, prior test results (x-ray, CT, MRI, lab, etc.), prior treatment effectiveness, and more! The physical examination centers on observation (posture, patient distress, mood); palpation or touching the injured areas; orthopedic tests (looking for positions that either relieve or increase symptoms); range of motion (how far forward, back, sideways, and in rotation can the head be voluntarily moved and its related level of comfort, speed/quality of motion); neurological exam (sensory, motor, cranial nerves, etc.); and special tests (x-ray, CT, MRI, lab, etc.) if not previously done.

Course of care: The type and length of treatment will vary based on the degree of injury (see last month’s “prognosis” discussion), the initial response to care (improvement vs. worsening), the compliance of the patient in modifying their activities, performing home-based care (ice, rest, exercise, etc.), and the patient’s motivation to get better. The latter may be partially dependent on factors like whether there is litigation planned or occurring, their belief that they will “get better,” and how the health care provider manages the care (the use of passive approaches where the patient must go and see the doctor vs. active approaches where the patient is taught how to self-manage through diet, exercise, activity modifications, education, etc.)

Treatment options: The patient has the choice of following a traditional medical model of initial anti-inflammatory medication, patient education, wait and watch, and/or a physical therapy referral. The chiropractic approach includes patient education, anti-inflammatory approaches (ice – NOT HEAT, anti-inflammatory herbs), exercise training and manual therapies including spinal adjustments. The latter, when applied properly, has been found to return patients to work faster than other approaches with a shorter recovery time and is less costly and more satisfying. When comparing treatment options beyond 6 or 12 months, the differences are more subtle. Other treatment options include acupuncture, massage therapy, and various forms of exercise. When necessary, injections, narcotics, and other pharmaceutical options exist but are not recommended as initial care approaches. Behavioral and cognitive therapy can help people cope with chronic, permanent pain related problems. There are many approaches to the management of whiplash and the patient needs a “quarterback” or someone to help them with these decisions. This is perhaps the most important role of the chiropractor!

We realize you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

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Whiplash “Fun Facts.”

14 Dec

Whiplash is a slang term for cervical acceleration, deceleration syndrome, or CAD. There are facts and myths surrounding the subject of whiplash. Let’s look at some of the facts.

The origin of CAD. The history of CAD dates back to a time prior to the invention of the car. The first case of severe neck pain arose from a train collision around the time of 1919 and was originally called “railroad spine.” The number of whiplash injuries sharply rose after the invention of cars due to rear-end crashes.

Whiplash synonyms. As stated previously, the term “cervical acceleration-deceleration disorder, or CAD, is a popular title as it explains the mechanism of injury, where in the classic rear-end collision, the neck is initially extended back as the car is propelled forward, leaving the head hanging in space. Once the tissues stretch enough in the front of the neck, the head and neck flex forward very rapidly, forcing the chin towards the chest. This over stretches the soft tissues in the back of the neck. Another term for whiplash is WAD or, Whiplash Associated Disorders. In 1995, the Quebec Task Force categorized injuries associated with whiplash by the type of tissues that were found to be injured. Here, WAD Type I represents patients with symptoms/pain but normal range of motion and no real objective findings like muscle spasm. Type II includes injuries to the soft tissues that limit neck motion with muscle spasm but no neurological loss (sensation or muscle strength). WAD Type III includes the Type II findings plus neurological loss, and type IV involves fractures of the cervical spine.

Head rest facts: Prior to the invention of head rests, whiplash injuries were much more common and more serious because the head was propelled in a “crack-the-whip” like fashion. However, headrests are frequently not adjusted correctly; they are either too low and/or too far away from the head. If the seat back is reclined, this further separates the head from the headrest. The proper position of the head rest should be near the center of gravity of the head, or about 9 cm (3.5”) below the top of the head, or at minimum, at the top of the ears. Equally important is that it should be as close as possible to the back of the head. When the distance reaches 4” away from the head, there is an increased risk of injury, especially if it’s also set too low. When the headrest is properly positioned, the chances of head injury are decreased by up to 35% during a rear-end collision.

Seat back angle. The degree of incline of the seat back can also contribute to injury of the cervical spine. As stated above, as the seat is reclined, the head to headrest distance increases, furthering the chance for injury. A second negative effect is called “ramping.” Here, the body slides up the seat back resulting in the head being positioned over the top of the head rest. Also, the degree of “spring” of the seatback contributes to the rebound of the torso during the CAD process.

Concussion: The notion that the head has to hit something to develop a concussion is not true. Also, the idea that a loss of consciousness is needed to develop a concussion is also false. Simply, the rapid forward/backward movement of the head is enough force for the brain (which is suspended by ligaments) to literally slam into the inner walls of the skull and can result in concussion. The symptoms associated with concussion are referred to as post-concussive syndrome or, mild traumatic brain injury.

We realize you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

 

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