Whiplash
Whiplash is a type of injury caused by hyperflexion and hyperextension in the spine. Whiplash is the most common injury associated with motor vehicle accidents and a major cause of disability and litigation. It is commonly exhibited in car accidents, where the head, neck, and lower back jolt forward and then backward. Whiplash most commonly occurs during “rear-end” style car accidents; however we see a variety of other types of collisions where this can occur as well. It can also occur during other types of trauma, such as falls. Patients can also experience whiplash in contact sports, such as football. Whiplash can cause a variety of injuries-including fracture in severe cases, but we most often see them causing sprain and strain to muscles and ligaments surrounding the spine.
What is strain and sprain, and what is the difference? Although similar, they involve different structures. Strains occur in muscles and tendons, whereas sprains occur in ligaments. Tendons connect muscle to bone, and ligaments connect bone to bone. Both involve the stretching of tissue potentially to the point that it can cause tearing on a microscopic level. When this occurs, the tissues become inflamed, and the patient can experience moderate to severe discomfort. Patients can often expect pain, tenderness, bruising, swelling, spasm and limited range of motion in the surrounding joint when experiencing this type of injury. This can cause difficulty in activities of daily living, and drastically decrease a patient’s quality of life.
We monitor a variety of symptoms in patients who have whiplash. Some common symptoms that we usually see are: neck and low back pain/stiffness, reduced range of motion, headaches (commonly occurring in the back of the skull), tenderness (in the neck, arms, shoulders, or back), tingling or numbness in the arms or legs, fatigue, or dizziness. Patients also have expressed having blurred vision, difficulty with memory, tinnitus (ears ringing), and issues with sleep. We take a comprehensive history and conduct a full physical examination to determine if the patient has whiplash. This can include orthopedic as well as neurological tests to help confirm your condition.After studying our findings, we may also determine if additional imaging is needed to further confirm diagnosis, and to rule out any complications or red flags.
The table above is from the Quebec Task force regarding Whiplash Associated Disorders (WAD). It classifies people due to their severity of symptoms from both a musculoskeletal and neurological aspects. We typically see grade 1-3 in our office. Grade IV is typically an emergency situation, and usually requires more comprehensive medical attention. See below for reference.
While some patients only have symptoms that last for a few weeks, other patients in more severe cases may not fully resolve for over a year, if at all. Around 40% of patients suffer from WAD beyond 3 months, and 2-4.5% are permanently disabled2,3. It is important to understand that everybody heals differently, so it is usually hard to accurately give a prognosis when this type of thing occurs. Usually, the speed at which the accident occurs usually correlates with the severity of the injury. There are also some other factors that can dictate how long the healing process takes. Typically, patients in younger populations heal much faster than older populations. Also, patients with pre-existing conditions might take longer to heal than others.
Like most conditions, our major goals with care during whiplash are to moderate your pain levels, restore range of motion, and to get your back to your normal activities. Typically, in your initial phase of care, it is our focus to decrease your pain as well as restore your ranges of motion. We understand that the initial phase of care can be both traumatic as well as painful, so we start care accordingly to the severity of your case. As you progress in your treatment, we usually give our patients stretches, as well as rehabilitation exercises so that they can manage the symptoms on their and achieve maximal medical improvement.
How We Can Help
Heat therapy- heat dilates blood vessels, which can promote blood flow to tissues. In bringing blood flow to tissues, it helps muscles to relax and can also support healing.
Electric stimulation therapy- this technique involves low frequency electrical current to help stimulate muscles, which can help reduce inflammation.
Manual stretching- this can help to lengthen muscles that have locked up as a result of your accident, which can improve your range of motion.
Instrument-assisted soft tissue mobilization- this involves using steel tools to work out muscles. This can help break up scar tissue, trigger points, and lay a better foundation for your tissues to heal.
Cupping- cupping techniques help draw blood to the muscles, which can help facilitate and expedite healing in areas. Cupping also allows for decompression of tissues, which can help manage inflammation.
Taping- special taping techniques can help further decompress areas that are irritated, which can help with inflammation and swelling/edema.
Dry needling- can help break down tough trigger points which can reduce discomfort and restore range of motion.
Spinal manipulation- we assess joints of the spine for reduced mobility and then apply gentle force adjustments so that the joint functions properly from a biomechanical standpoint.
Car accidents are very serious, and in some cases can be life-changing. The symptoms of whiplash can range from mild, with minimal complications to very severe and causing extreme neurological deficits. Utilization of chiropractic care in patients who have undergone whiplash can be beneficial. Not only can it reduce initial pain and discomfort, but it can accelerate the healing process and allow you to get back to a normal lifestyle. If you have been in an accident and have questions, we would be happy to help answer them and get you back on track.
References
1. https://academic.oup.com/bjaed/article/14/4/167/293699
2. Bannister, G., Amirfeyz, R., Kelley, S., & Gargan, M. (2009). Whiplash injury. The Journal of bone and joint surgery. British volume, 91(7), 845-850.
3. Rodriquez, A. A., Barr, K. P., & Burns, S. P. (2004). Whiplash: pathophysiology, diagnosis, treatment, and prognosis. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine, 29(6), 768-781.
4. https://www.bcmj.org/icbc/tips-performing-physical-examination-neck-whiplash-associated-disorders