In the United States there are approximately 3 million whiplash injuries (auto accidents or car accidents) each year, at a comprehensive cost of about $43 billion. They account for 35% of all auto accident claims paid by auto insurers. In low speed rear impact car accident collisions, with little to no damage to the vehicle the risk for injury is about 30%-60%. About one third of individuals injured in low speed rear impact auto accident collisions are injured. Of those people injured about 35-50% will develop long-term pain varying from minor to severe and never fully recover. True compassion, professional expertise and evidence-based patient care are the focus of the Provo chiropractors at McClean Chiropractic Injury & Rehabilitation in treating Whiplash or auto accident/car accident and other types of personal injury patients.
WHIPLASH/AUTO INJURY
DEFINITION: Injuries to the neck caused by a sudden movement of the head, backward, forward, or sideways, are referred to as “Whiplash.” Whether from a car accident, sport, or an accident at work, whiplash or other neck injuries warrant a thorough chiropractic check-up. The biggest danger with whiplash injuries is that the symptoms persist for years particularly if not treated appropriately. Even after whiplash victims settle their insurance claims, some 45% report they still suffer with symptoms two years later due to the fact that “fully remodeled scar tissue” remains grossly, microscopically, and functionally different from normal tissues.” Journal Science Medicine in Sport 1999 Optimization of the Biology of Soft Tissue Repair.
DISCUSSION: In the past a typical whiplash injury, where no bones were broken, was hard to document clinically. Soft tissue injuries did not show up on normal x-rays/radiographs and insurance companies would deny coverage. New imaging technologies (CT Scans, Magnetic Imaging, and Ultra Sound) now show soft tissue injury and insurance companies now cover most whiplash injuries. When no bones are broken and the head doesn’t strike the windshield, typical symptoms are as follows: 62% to 98% complain of neck pain, which typically starts two hours up to two days after the accident: This is often the result of tightened muscles that react to either muscle tears or excessive movement of joints from ligament damage (sprain). The muscles tighten in an effort to splint and support the head, limiting the excessive movement. Sixty-six to 70% of those suffering from whiplash complain of headache. The pain may be on one side or both, intermittent or constant, in one spot or more generalized. These headaches, like the neck pain are often the result of tightened, tensed muscles trying to keep the head stable and, like tension headaches, they are often felt behind the eyes. Shoulder pain often described as pain radiating down the back of the neck into the shoulder blade area, may also be the result of tensed muscles. Muscle tears are often described as burning pain, prickling or tingling. More severe disc damage may cause sharp pain with certain movements, with or without pain radiation into the arms, hand and fingers. Patients may also a experience Mild Traumatic Brain Injury (MTBI) with cognitive, emotional or behavioral symptoms.
COMMON WHIPLASH SYMPTOMS:
Neck pain and/or stiffness – 92%
Impaired Concentration – 26%
Headaches – 57 %
Blurred Vision – 21 %
Fatigue – 56%
Irritability – 21%
Shoulder Pain – 49 %
Difficultly Swallowing – 16%
Anxiety – 44%
Dizziness – 15%
Pain between Shoulder Blades – 42%
Forgetfulness – 15%
Low Back Pain – 39%
Upper Limb Pain – 12%
Sleep Disturbance – 39%
Upper Limb Weakness – 6%
Upper Arm Numbness/Tingling – 30%
Ringing in Ears – 4%
Sensitivity to Noise – 29%
Jaw/Facial Pain – 4%
HOW DOES WHIPLASH HAPPEN?
Whiplash is most commonly received from riding in a car that is struck from behind, or collides with another vehicle. Whiplash acceleration/deceleration injury can also occur in other types of trauma. Muscles and ligaments supporting the spine can be overstretched or torn. In a rear end collision for example, the victim’s car is first pushed or accelerated forward and then, because their foot is on the brake, or their car hits the vehicle in front, their car is rapidly slowed down, or decelerated. As the vehicle accelerates forward, it pushes the body forward too, but the head remains behind momentarily, rocking up and back, until some of the muscles and ligaments are stretched or torn. Too often, the injury occurs before the head rebounds off the headrest. If there is no headrest, the injuries sustained are much worse as there is no method to prevent hyperextension from occurring. The neck muscles, in a reflex action, contract to bring the occupant’s head forward again, and to prevent excessive injury. This overcompensates because at this point the head is already traveling in a forward direction as the car decelerates. This violently rocks the head forward, stretching and tearing more muscles and ligaments resulting in a sprain to the ligaments of the neck where the joint can become “jammed” and swollen. The soft pulpy discs between the vertebrae can bulge, tear, or rupture. Vertebrae can be forced out of their normal position, reducing range of motion. The spinal cord and nerve roots are stretched, irritated, and choked. If the victim is not properly restrained the occupants head may strike the steering wheel or windshield, possibly causing a concussion.
LIGAMENT INJURY AND HEALING
A REVIEW OF CURRENT CLINICAL DIAGNOSTICS AND THERAPEUTICS
“Ligament injuries create disruptions in the balance between joint mobility and joint stability, causing abnormal force transmission through the joint, which results in damage to other structure in and around the joint, alterations in the biology and biomechanics of the injured ligament, leading to inadequate healing and tissue formation that is inferior to the tissue it has replaced.
The incomplete healing and lower integrity of the new ligament tissue results in ligament laxity, predisposing the joint to further injury, leading to chronic pain, diminished function and ultimately to osteoarthritis of the affected joint.”
“Histological studies demonstrate that ligaments contain mechanoreceptors endowed with nerve endings call Pacinian corpuscles, Golgi Tendon organs and Ruffini endings. The mechanoreceptors in ligaments of the spine and extremities respond to stimuli that provide proprioception and kinesthesia causing activation or inhibition of muscular activities”
As Frank et al notes, “Abnormalities present in the remodeled ligament matrix can have profound implications on joint biomechanics, depending upon the functional demands placed on the tissue.”
“The abnormal cross-linking of collagen and the smaller diameters in collagen fibrils in repaired ligament tissue, often cause weakness in both tissue strength and tissue stiffness, often remaining for several months or years after the initial injury.(46,49,50,52,56,62)”
“Animal studies have also shown that combined ligament injuries heal at a slower rate than isolated injuries and produce tissue of lower quality”.( 37,68,69,74-78)
The results of spinal ligament injury show that over time the inability of the ligaments to heal causes an increase in the degeneration of the disc and facet joints, which eventually leads to osteochondral degeneration. (23,90)
It appears that carefully controlled exercise plans promote healing of injured ligaments. Motion itself causes an increase in blood flow to the affected joint, providing the damaged tissue of the ligament with nutrients and metabolites necessary for its repair and healing.. Mobilization for the treatment of soft tissue damage has also been found to decrease muscle atrophy, osteoporosis, adhesions, and joint stiffness following injury. ” The Open Rehabilitation Journal 2013 R.A. Hauser, E.E. Doan, H.J. Phillips, A.C. Newlin, R.E. Moore, and B. A. Woldin
STAGES OF HEALING & TREATMENT
“The body responds by attempting to heal the injury through a sequence of overlapping cellular events. These events are part of the body’s response to insult and occur with any soft tissue injury. They can be categorized by three consecutive phases that occur over time: the acute inflammatory phase 48-72 hours, the proliferative or regenerative/repair phase 72 hrs-6 weeks, and the tissue-remodeling phase many 14 weeks to 12 months or more.
ACUTE INFLAMMATORY PHASE
The first stage involves simply the immediate effects of injury, including bleeding, blood -clotting, and cellular breakdown. The inflammatory response is the primary means that the body uses to respond to-the injury. The purpose of the inflammatory stage is to surround the area of injury in an attempt to protect it. The effect of this response is usually proportional to the amount of injury sustained. This phase can last up to 3 days. It is characterized by four cardinal signs: redness, swelling, heat, pain. Soon after a soft tissue injury takes place the cell walls begin to leak plasma and leukocytes resulting in phagocytosis with the release of fibronecton which attracts fibroblasts finally creating scar tissue. At this time the doctor may discuss with you the importance of utilizing ice packs, as this is important to reduce sweI1ing and control pain and to avoid applications of heat. Other therapies that will aid in the healing process include electrical stimulation & ultrasound.
REPAIR PHASE
The repair stage is the process following and is dictated by the severity of the injury. The injury will heal by regeneration, which is essentially the replacement of the surrounding tissues by fibrous tissue (fibroblasts), resulting in scarring or adhesions. This phase can last from 2 days to 6weeks. Intermolecular cross-links form between collagen filaments thereby increasing the tissue’s strength. But even at three weeks post injury this tissue has only 15% of its normal strength. In this phase of healing, the doctor may recommend such things as alternating heat and ice to create a “flushing effect” in the blood supply and surrounding tissues. He may begin you on a stretching and/or strengthening exercise program, or recommend that you get a soft tissue massage for tightened muscles. Adjustments may be performed on, above, or below the site of injury. The goals of your adjustments are to improve spinal biomechanics and relieve nerve irritation and pressure, relieve pain and spasm, restore the normal motion of your neck, and increase its strength and stability.
REMODELING PHASE
The third phase is characterized by a process of your body’s response to stress and constitutes scar reorganization. Duration of the remodeling phase last from 14 weeks to 12 months or more. This occurs when the residual scar tissue undergoes reorganization and reorientation along the lines of stress. This phase is significant to the patient. The importance of continuing with the prescribed exercises and continuing to use moist heat on tight and sore muscles will be stressed by the doctor.
RISK FACTORS
The resulting instability of the spine and soft tissues are noteworthy and depend on several risk factors such as Vehicle Size, Headrest Position, Position of Person’s Head, Women, Age, and Pre-Existing Health Problems, (The aforementioned does not exclude children. In fact, children involved in automobile accidents are often neglected in these types of injuries when in actuality; they suffer from the same symptoms and are at a 2/3 risk for damages.)
VEHICLE SIZE
Obviously, the faster and heavier the rear car is moving, the more severe the forces placed on the occupant in the front car. A large truck going 5 mph can do much more damage than a sma1l car going 20 mph.
HEADREST POSITION
This can make an injury much worse if too low, and even at the right height, it must be close enough to catch the head in time (about 2 inches). A seat that is rec1ined to increase this distance, as will poor posture and driving habits if leaning forward.
POSITION OF PERSON’S HEAD
Head position is important. When turned to the side, for instance, it can only move about half as far as a straightforward position. Hence, the mechanism of injury can occur much sooner and substantially increase the severity of injuries.
AGE
Age plays an important role because as the body becomes alder, ligaments become less pliable, muscles weaker and less flexible, and decreases in range of motion.
WOMEN
Women seem to be injured more seriously than men are. This is most notable due to the fact that they tend be shorter, have less muscle mass and less bone structure. Because of this, they are either too close to the steering wheel/airbag and or have improper fitting shoulder harness/ seatbelts.
PRE-EXISTING HEALTH PROBLEMS
Pre-existing health problems such as arthritis, lend to the severity of the injuries.
NUTRITIONAL RECOMMENDATIONS
During the first two weeks after injury it is critical to create an optimal healing environment for the various damaged nerves, ligaments, and muscles. They need adequate minerals, vitamins, water, and amino acids if they are to heal properly. A balanced diet with abstinence from dehydrating substances such as alcohol, caffeine, hot dogs and too much hormone grown red meat can be beneficial. During the first day after trauma, the body is in its injury-shock phase. Nutritional changes are not advised for the first day because of the potential for disturbing the body’s preprogrammed metabolic balance system. Mega doses of synthetic vitamins and minerals are not suggested. A well balanced, digestible whole food concentrated multivitamin supplement will suffice. Supplements to facilitate the growth of ligaments, muscle and cartilage include Vitamin C, ferrous iron, zinc, copper, manganese, magnesium, methionine.
OF SPECIAL NOTE
Cigarette Smoking during the first few weeks following an injury may interfere with the normal healing process. If you smoke during this time you may slow your recovery down or end up with pain that you would not have otherwise. This may result in your requiring more treatment and a worse outcome. Cigarette smoking, which results in oxygen deficiency to already injured tissues, also, it can deplete tile Vitamin C supply in your body and should be increased. Smoking is not recommended for 4-6 weeks after a traumatic injury.
REFERENCES:
Chiropractic Health and Rehabilitation Group. P.C. Copyright @ 1996 Langlitz Krames Communications @ 1989, 1991. Randanov BP, et al. Long-term outcome after whiplash injury: a two-year follow-up considering features of injury mechanism and somatic, radiologic and psychosocial factor. Medicine 74(5):281-297, 1995. Randanov BP, et al. The role of psychological stress in recovery from common whiplash. Lancet 338: 712-715, 1991. Nordhoff, L.S. Motor Vehicle Collision Injured. Mechanism. Diagnosis and Management. @1996, Aspen Publishers, Inc. Melton MR. Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics: The Open Rehabilitation Journal 2013 R.A. Hauser, E.E. Doan, H.J. Phillips, A.C. Newlin, R.E. Moore, and B. A. Woldin Journal Science Medicine in Sport 1999 Optimization of the Biology of Soft Tissue Repair.
