Whiplash Injuries? - Visit our Auto/Car Accident Chiropractor in Bozeman, MT.
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Whiplash Injuries? - Visit Dr. Dustin Rising in Bozeman, MT.
The word "whiplash" is used to describe a mechanism of injury characterized by a quick hyperextension immediately followed hyperflexion of the neck and head, resulting in damage to the tendons, ligaments and muscles in the body, and especially the ones surrounding the head. Today, it is believed that whiplash injuries from a car or auto accident are mostly caused by a very rapid extension and flexion of the head and neck, and not the previously thought notion of hyperextension/hyperflexion (movement beyond the normal physiological limits of the body).
Since whiplash injuries are extremely complicated in nature and profoundly impact many of our lives, there are few other topics that are as controversial. When there is a broken bone, a simple x-ray can confirm the presence of the fracture and health care professionals can follow the appropriate standard of care in order to best treat and/or handle the injury. Whiplash injuries are much more complicated and involve a combination of disruptions in the nervous system, connective tissues, muscles and joints and are much more difficult to diagnose and treat. To provide you with more information so that you may better understand whiplash injuries and how they should be treated, we need to discuss in more detail the mechanism of how such injuries occur.
The Four Phases of a Whiplash Injury
When a rear-end collision happens, your body undergoes a very rapid and excessive acceleration and deceleration. All of the four phases of the whiplash injury will occur in less than half of a second! During each phase, there are different forces influencing the body that play a part in the overall injury. The force of the movement is so sudden that the damage to the vertebrae, discs, nerves, ligaments and muscles of your neck and spine can be very serious and substantial.
During the first phase, your car is being pushed out from underneath you, making your mid-back flatten against the seatback. This causes an upward force on your cervical spine, leading to a compression of your joints and discs. As the seat causes your spine to move your torso forward, your head moves in the opposite direction, backwards, creating a type of shearing force in your neck. The distance travelled by your head can be reduced if the head restraint is properly adjusted. Unfortunately, the majority of the damage to the spine will happen before your head is able to reach the restraint. Recent studies have demonstrated that the risk of injury is only reduced by 11-20% when using head restraints.
During the second phase, your body has achieved peak acceleration at 1.5-2 times that of your vehicle, however, your head hasn't started to accelerate forward yet, and is continuing to move rearward. This causes an abnormal S-curve to develop in your neck as the back of your seat recoils forward, like a springboard, adding to the forward motion of your torso. Unfortunately, the recoil of your seat back forward occurs when your head is moving backward, creating one of the most damaging effects of a whiplash injury, a shearing force in the neck. Typically, many of the injuries to the bones, nerves, joints, discs and TMJ happen during this phase.
During phase 3, your body is moving back down into your seat, while your head and neck are at their maximum level of forward acceleration. During this time, your car is beginning to slow down. If pressure on the brake pedal was decreased during the first phases of the incident, it will most likely be reapplied in phase 3. Pressing on the brake will cause your car to slow down more quickly and will increase the severity of the injury to your neck due to flexion. Any slack in the shoulder harness and seat belt will be taken up as your body moves forward in the seat.
The fourth phase is likely the most damaging phase in the development of a whiplash injury. During phase 4, your head and neck are free to move forward without restraints, as your body is restricted by the seat belt and shoulder restraint. This causes an intense forward-bending motion in your neck, putting strain on the ligaments and muscles, damaging fibers in the discs and causing a misalignment in the vertebrae. The impact causes the nerves and spinal cord to become stretched and irritated. Your brain may also strike the inside of your skull, leading to mild to moderate brain injury. Without proper restraints by your seat belt and shoulder harness, you may get a concussion, or severe injury to the brain, by hitting the windshield or steering wheel.
Injuries Resulting from Whiplash Trauma
In the introduction, we discusses how whiplash injuries can present themselves in a multitude of different ways, including headaches, neck pain, upper back and shoulder pain, fatigue, low back pain and cognitive changes. It is virtually impossible to predict a specific pattern of symptoms for each individual due to the variety of factors that play into the whiplash process. Such factors would include the direction of the impact, the speed of the vehicles involved in the collision, the sex, age and physical condition of the individual. In addition, the symptoms of whiplash often have a delayed onset, taking sometimes up to weeks and months to present themselves. However, there are some common conditions that tend to present themselves following whiplash trauma.
Neck pain is the most common symptom and complaint following a whiplash injury, according to over 90% of injured individuals. The pain is usually located across the shoulders, radiates up towards the head, and then back down in between the shoulder blades. In the case of whiplash injuries, usually all of the tissues that are located in the neck become affected, including the spinal discs, the facet joints, ligaments, muscles and nerves.
Neck pain that results from a car accident is most commonly caused by facet joint pain. This pain is located at the back of the neck, either slightly on the right or the left of center, and is tender to touch. The pain in the facet joints cannot be seen and diagnosed on x-ray or MRI. Only physical palpation of the neck can be diagnostic of facet joint injury.
Another common cause of post-traumatic neck pain and chronic pain is disc injury. The anulus, which is the most outer wall of the disc, consists of many bundles of fibers that may be torn or injured during a whiplash injury. The tears that are created can then lead to the degeneration of the discs or a herniation that result in compression or irritations of the nerves that make up that area of the spine. The irritation or compression to the discs may also lead to pain that radiates into the arms, upper back, shoulders and may lead to weakness of the muscles.
During the weeks that follow a whiplash injury, the major cause of the pain that is experienced is damage to the ligaments and muscles of the upper back and neck. It is the main reason patients notice limited range of motion and tightness in their spine. As the muscles are able to heal, the amount of pain decreases but the abnormal movement remains uncorrected without proper treatment from a chiropractor. Instability and abnormal motion will result from the damage to the ligaments.
Next to neck pain, headaches are the most common complaint of whiplash injury and affects more than 80% of individuals involved in an auto accident. The headaches are usually due to injury to the muscles, facet joints and ligaments of the cervical spine, that refer pain to the head. Less commonly, headaches can be the result of direct brain injury. To help reduce the pain and discomfort associated with your headache, it is important to treat the support structures in your neck with chiropractic care.
Another less common, but very painful disorder that can be associated with whiplash is temporomandibular joint dysfunction (TMJ). This condition usually begins as pain, popping and clicking noises in the jaw with movement. When it is not evaluated and treated properly, issues with the TMJ can worsen and lead to other symptoms such as face and ear pain, headaches and difficulty eating. Many chiropractors have special training in TMJ problems, or they can refer you to someone specializing in TMJ issues.
To many people, it may be surprising that mild to moderate brain injury can occur after a whiplash injury, mostly due to the increased force on the brain during the four phases that we discussed earlier. Our brain is very soft and is suspended in a liquid called cerebrospinal fluid. When the brain moves back and forth in the skull, the brain will bounce inside the skull and may lead to bruising or bleeding inside the brain. Patients of a car accident may sometimes also lose consciousness and suffer symptoms of a minor concussion. Most commonly, there isn't a loss of consciousness, but mild confusion or disorientation are often reported after the crash. Minor brain injury can have many long-term consequences including mild confusion, inability to concentrate, irritability, loss of sex drive, disturbances in sleep patterns, emotional instability and depression. In lesser instances, the nerves that are responsible for our sense of smell, vision and taste may become injured which results in loss of taste, visual disturbances and changes in our sense of smell.
Injury to the facet joints of the vertebrae in the neck due to a whiplash injury will result in dizziness. In some cases, another factor may be injury to the brain stem or brain. Usually, the dizziness is temporary and will improve drastically with chiropractic adjustments.
Low back pain
The majority of people assume that whiplash only results in injuries to the neck. However, the low back is often injured as well. Low back pain is present in over half of all rear-impact car accidents where an injury was reported, and up to three quarters of crashes resulting from side-impact. This can be attributed to the significant amount of compression that the low back experiences during the first two phases of the whiplash injury, even though the amount of flexion-extension that it undergoes is not as significant as that in the neck.
Recovery from Whiplash
If proper treatment is sought, most minor car accident whiplash injuries will heal in about six to nine months. Unfortunately, over 20% of individuals suffering from whiplash injury will continue to have pain, abnormal motion and weakness up to two years after their accident. Most of these individuals will suffer for a number of years after the first two, and may even have a disability for the rest of their lives.
Whiplash injury is a very unique condition that needs to be treated by a skilled health professional that has specialty training with these types of injuries. To obtain the best results possible following your accident, it is important to undergo chiropractic care accompanied by rehabilitation and a regimen at home.
Chiropractic adjustments consist of manual manipulation of the spine in order to restore proper motion and alignment of the spinal vertebrae. Chiropractic is definitely the most effective type of treatment for reducing the long-term consequences of whiplash injuries, and is more effective if it is accompanied by massage therapy, rehabilitative exercises, trigger point therapy and other soft tissue modalities. Here at Gallatin Valley Chiropractic, in Bozeman, we will submit to the insurance companies for you at no cost!
Soft Tissue Rehabilitation
Anything in your body that is not made of bone, like ligaments, nervous system, muscles, tendons, internal organs and spinal discs are referred to as "soft tissue". The muscles, discs, ligaments and soft tissues are the tissues that are affected the most during a whiplash injury. To decrease the severity of a disability or permanent impairment, it is very important to incorporate therapies and modalities in addition to chiropractic adjustments that will stimulate the tissues, helping them heal correctly. These modalities include, electro-stimulation (EMS), massage therapy, stretching, trigger point therapy and exercises that target range of motion and promote strength.
The benefits of the best chiropractic care as well as rehabilitation of the soft tissues are limited by your at-home activities and stresses that you encounter at work that may re-injure your spine. Therefore, it is very important that your treatment plan encompass daily home and work activities during the days that you are not visiting the clinic in order to speed up the healing process. Some widely used home care therapies include ice packs, area specific stretches and exercises, nutritional supplements, limiting your work and daily activities and making sure you get plenty of rest.
When treating some of the more severe cases of whiplash injury, it is sometimes necessary to seek out medical care in addition to your chiropractic treatment plan. Some of these treatments include muscle relaxants, anti-inflammatory medication, spinal injections and trigger point injections. These modalities should only be used for short-term relief of the pain, if needed, and should not be the primary method of treatment since drugs cannot restore proper joint motion or stimulate the healthy repair of muscle. Thankfully, surgery is only an option in the case of herniated discs, when the spinal cord is being pushed on by the disc material and in some instances of fractures to the spine.