Whiplash injury occurs when the body reacts to a deceleration or acceleration force by hyperflexion or hyperextension of the neck.

Whiplash injuries are very common in car accidents. The whiplash injury is in part due to the fact that the muscles do not have enough time to brace. Whiplash, or “Cervical Acceleration/Deceleration” (CAD) accidents most often occur when a patient is stopped at a light or a stop sign and is rear-ended. Often is the case where a car skids and slams into another car or pole and still another common scenario is when a person is driving and gets “T-Boned” by another moving vehicle in the side. *MVC=motor vehicle crash.

Uncomplicated cases of whiplash are the result of sprained ligaments in the neck. The muscles naturally spasm as a protective mechanism. Pain from the whiplash may be a stiff neck and may go down one or both arms. The sudden jerking motion of the head either front to back or side-side forces muscles and ligaments supporting the spine and head to move past their normal physiological limit and can thus be overstretched or torn. Additionally, vertebrae can be forced out of their normal alignment thus reducing range of motion (ROM).

Interestingly, in some extreme cases, the neck muscles and ligaments are so damaged and stretched that a patient’s ROM actually exceeds all normal ranges. Additionally, the actual spinal cord and/or nerve roots in the neck can get stretched and irritated causing even more pain that we call “radiculopathy.” All of this damage and instability can result in pain in the entire neck (cervical spine), mid-back (thoracic spine) and even the low back (lumbar spine). Patients will often complain of headaches, dizziness, blurred vision, face pain, nausea, shoulder pain, knee pain and a other seemingly unrelated health issues. Be advised that all these symptoms are normal after a MVC (motor vehicle crash).

Timing:

Often is the case where a patient will feel a bit of pain at the time of the accident or no pain at all. Later, various pain issues will occur several hours, days, a week or even months AFTER the initial impact. Delayed reactions are the norm, not the exception in whiplash injuries according to the literature. In fact, there are no published reports I am aware of that say otherwise. (Foreman & Croft, ibid). There has been some research to show that after this, or any kind of serious trauma, the body’s natural opiate system kicks into gear. The pituitary gland and hypothalamus both initiate the release of “endorphins.” These are natural pain killing opiates that your own body generates and releases after trauma. The initial release of these endorphins would explain why people don’t seem to have pain until after several days

Symptoms and/or Injuries resulting from a MVC:

The health issues and problems that arise after a MVC, particularly from Whiplash, are legion. We’ll list the more common and prominent pain and injury scenarios here; be advised, some may surprise you.

1) Brain Injury: Yes, brain injury. Believe it or not, brain injury occurs relatively commonly as a result of the physical movement of the brain inside the skull after impact. It is roughly similar to being struck in the head several times during a boxing match. Biochemical reactions also occur for up to 96 hours AFTER the the initial trauma. This involves the formation of free radicals and other toxic bio-chemical reactions that occur at the cellular level. The resultant symptoms usually manifest as confusion, difficulty in concentration, sleep disturbances, irritability, forgetfulness, excess anger, decrease in libido, altered moods, etc. In fact, some studies have shown a permanent loss of IQ.

2) Cranial Nerve Injury: These are the nerves that exit the brain directly. These nerves are a combination of sensory, motor or both. They control such things as smell, sight, taste, facial function, tongue movement, shoulder movement, scalp and internal organ function. Blurred vision is a common complaint after an accident. Uncontrollable tearing, smell dysfunction as in either a lack of the ability to smell and/or the sensation of smelling something that isn’t in the area, blushing, irregular heart beat, upset stomach. These are a few of the functions that are mediated by the cranial nerves and can be adversely affected by a Whiplash accident.

3) Dizziness: A very common complaint after a MVC. This most often results from injury to the joints of the cervical spine. Chiropractic care is especially beneficial in relieving this problem. This due to the fact that the vast majority of balance information sent to the brain comes from the neck. Restoring the neck to proper position via chiropractic adjustments is what chiropractors excel at. More serious complications may arise causing dizziness through injury to the brain stem or the brain itself. However, commonly, it is the so-called mechanoreceptors of the cervical spine that detect our place in time and space. This information is relayed to the central vestibular and reticular systems in the brain for integration and balance coordination. If the neck has been traumatized, the messages going to the vestibular system from the neck will be aberrant and thus lead to dizziness. (see Guyton A, Hall J, “Textbook of Medical Physiology,” 10th Ed., 2000, pg. 645, W. B Saunders Co.)

4) Headaches: After basic neck pain, headaches are the next biggest complaint patients speak of after a Whiplash. Most are related to neck injury and the subsequent muscle spasm that occurs in the neck that then affects the skull. Chiropractic excels in treatment of headaches of all varieties as a result of Whiplash.

5) Neck Pain: By far, the single most prevalent complaint in a MVC is that of neck pain. Over 90% of the patients studies reported neck pain after a Whiplash. This often leads to shoulder, arm and upper mid-back pain. Again, this condition, barring the unusual, is remedied nicely via chiropractic care.

6) Low Back Pain: Another common and yet surprisingly misunderstood issue after a MVC. Various studies have shown that even in cases of primarily Whiplash, the low back is often involved; up to 50% of the time. Seatbelts are often involved in the mechanism of low back pain in a car accident. Why? Because the belt anchors a person to the seat while the upper back and particularly the neck often get “whipped” in the accident which aggravates the low back.

Additionally, there is the phenomena of “ramping” to consider. Ramping is when the human body loads up on the seat back initially. In other words, you, the passenger, tend to climb UP the seat back several inches. The entire spine experiences a straightening of all curves and as a result, there is compression of the spine. Ramping occurs in almost all cars, yet the seat belt is anchored to the seat belt hooks and thus, there is a tremendous amount of pressure put on the waist line and low back as the seat belt attempts to hold the person down while the force of the accident is pushing the person upward. Along with this painful condition is the SI syndrome. This stands for Sacro-Iliac joint. It is the hip joint that connects the upper body to the hips and lower body. This joint is frequently pushed out of its normal alignment. It is a gliding joint with a synovial lower section and a fibrous upper section. Chiropractic manipulation is successful at reducing this problem as well as low back pain.

7) TMJ: This stands for Temporal-Mandibular-Joint. The mandible (lower jaw) inserts itself into your skull via a notch in the temporal bone. This hinge joint is your jaw joint, hence the name TMJ. This joint is frequently injured in a MVC. Clicking and popping noises are often found in the jaw joint after an accident. This condition is not as common as the others mentioned but it is still seen frequently. This condition is easily reduced with chiropractic care. As a matter of fact, TMJ is often nicely reduced by manipulation to the neck WITHOUT having to directly apply manipulative forces to the TMJ itself.

8) Blurry Vision: Still another normal concomitant of Whiplash/CAD accidents is blurry vision. It is often the result of disrupted blood flow to the eyes and/or aggravation to the “Sympathetic Nervous” system. This side effect, thankfully, usually goes away within a day or two but it is very disconcerting to the average accident victim.

Prognosis:

Over the past four decades, numerous studies have been undertaken trying to demonstrate and predict long term prognosis for Cervical Acceleration/Deceleration (CAD) injuries. Foreman & Croft analyzed this vast body of studies and excluded those lacking proper scientific methodology such as blinded studies, accurate descriptions of injury mechanisms and so forth. What remained are 43 scientifically reliable studies published in graph form in Foreman & Croft’s book, 3rd Ed. on page 408.

The literature is clear and consistent; virtually all existing research points to the same conclusion: long term affects can and do appear in CAD. People were shown to be suffering long term affects of CAD for months to YEARS after the fact. This body of literature based evidence cannot be ignored. In the alternative, there is NOT ONE study available that shows patients automatically heal within a few weeks after a CAD experience. Nor is there a single study that shows that people automatically heal after a CAD experience “with or without” treatment as is sometimes alleged by the “insurance consultants” and IE doctors. Another way of putting this is to consider the lingering effects of whiplash. In a great article gaining more and more coverage lately, the authors (listed below) brought to attention the following data:

1. At a mean of 15.5 years post whiplash trauma, 70% of the whiplash injured patients continued to complain of symptoms referable and related to the original accident.
2. Long term symptoms from whiplash injury include neck pain, arm paraesthesia, back pain, headache, dizziness and tinnitus (ringing in the ears).
3. Women and older patients have a WORSE outcome from whiplash injuries.
4. Between 10 and 15 years after the accident, 18% of the patient had improved, whereas 28% had deteriorated.
5. Radiating arm pain is more common in those with severe symptoms.
6. Soft-tissue injuries to the cervical spine may give persisting symptoms.
7. Most whiplash injured patient reach their final state by two years after being injured, but this study showed ongoing symptom fluctuation between 10 and 15 years.
8. At the 15 year follow up, neck pain was present in 65% and low back pain was present in 48% of the subjects investigated.
9. 80% of women and 50% of men continued to have symptoms at 15 years.
10. Back pain and tinnitus (ringing in the ears) actually INCREASED between years 10-15.
11. Degenerative changes are associated with a worse prognosis for recovery.
12. 60% of symptomatic patient had not seen a doctor (MD/DC) in the previous five years because the doctors were unable to help.
13. Whiplash symptoms DO NOT improve after settlement of litigation.
14. Chronic whiplash symptoms will cause an abnormal psychological assessment after 3 months.
15. In this study, 100% of the patient with severe ongoing problems had cervical spine degeneration.  *(Squires, B, Gargan, MF, Bannister, GC, “Soft-tissue Injuries of the Cervical Spine: a 15 year Follow-up,” J of Bone and Joint Surg. (British), Vol. 78B(6), 11/96, p 955-7. From the University of Bristol, England) **See also this companion study: Gargan, MR, Bannister, GC, “The Comparative Effects of Whiplash Injuries, ” J of Ortho. Medicine, 19 (1), 1997.