The Four Phases of the Whiplash Injury

Whiplash injuries are not confined to auto accidents and often occur during a slip, fall or while playing sport. However, we’ll look at what typically occurs in an auto accident, which is the most common and most severe cause of whiplash.

As a vehicle hits the rear of your car, your body goes through an extremely quick and violent acceleration and deceleration, and all four of the phases described below happen in less than half a second. Each phase involves a different force acting upon your body, which contributes to the overall injury, bringing vertebrae, nerves, discs, muscles, and ligaments into the fold.

• Phase 1: Your car is shunted at great speed from underneath you. Your mid-back is flattened against the back of the seat, creating an upward force in your neck, which compresses your discs and joints. As your momentum continues forward with the car, your head flies backward, and this whips violently at your neck. Only a well-adjusted head rest can help minimize the damage this causes, lessening the backward travel of your head. However, the majority of damage to the spine will already have occurred before your head hits the head rest, as studies show that head rests only reduce injury by 11% to 20%.
• Phase 2: Your torso reaches its peak forward acceleration at twice the speed of the impacting vehicle, while your head continues moving backwards. Your neck goes through an abnormal S-curve as your seat back springs your torso forward. This moment causes extreme compressive forces on the neck and significant damage to bone, joint, nerve, and discs.
• Phase 3: Your torso is now settling back down in your seat, and your head and neck are both accelerating forward at their peak speed. This happens as the car is slowing anyway, but this deceleration is aided by your foot planting itself firmly on the brake pedal after possibly lifting off at the moment of impact. This sudden braking severely increases the flexion injury of your neck. Assuming a seat belt is being worn, it now takes the strain of your forward movement.
• Phase 4: The most damaging part of the whiplash sequence now occurs. The seat belt stops your torso but your head continues forward. The neck bends violently forward, straining muscles and ligaments, tearing fibers in the spinal discs, and forcing vertebrae beyond their normal movement. Your spinal cord and nerve roots are stretched and damaged, and your brain hits your skull, potentially causing mild to moderate brain injury. Where a seat belt has not been used, your head is free to move forward and strike the steering wheel, dash or windshield, causing even more severe brain injuries.

Injuries from Whiplash Trauma

There are so many variables involved in how an accident occurs, as there are with the individual victim, so it is impossible to predict them all. Injuries are sometimes felt immediately or within an hour of the accident but more often due to the immediate shock, which causes the body to release endorphins and adrenaline, the true symptoms surface weeks or even months later. Generally, though, there is an array of conditions that are often seen following a whiplash:

• Neck Pain: the single most common complaint as reported by over 90% of people. Pain often radiates into the shoulders, between the shoulder blades, and into the head. All the tissues in the neck tend to be affected by whiplash, including the muscles, ligaments and nerves, and the facet joints and discs between the vertebrae.
• Headaches: following neck pain this is the second most common complaint, affecting over 80% of sufferers. Although headaches occasionally result from direct brain injury, most are triggered by injured muscles, ligaments and facet joints in the cervical spine, referring pain into the head. It is therefore vital to treat the supporting structures of your neck in order to combat headaches.
• TMJ: Temporomandibular Joint Dysfunction (TMJ) is a less common disorder that follows whiplash, but can be debilitating if it occurs. TMJ manifests as pain, clicking and popping noises in the jaw when moved. Untreated, TMJ can worsen and cause headaches, facial pain, ear pain and difficulty eating. This is a condition for which chiropractors are specially trained, or you may be referred to a TMJ specialist depending on the severity.
• Brain Injury: Mild to moderate brain injury is fairly common after whiplash, due to the movements as described in the four phases. The brain is very soft and suspended in cerebrospinal fluid, so that when the brain is jolted within the skull, it can be bruised or bleed. Whiplash victims may temporarily lose consciousness or have mild concussion, but more common is a feeling of mild confusion or disorientation following the crash. Long term effects include mild confusion, difficulty concentrating, sleep disturbances, irritability, forgetfulness, loss of sex drive, emotional upset and depression. In certain cases, the nerves that feed your senses of smell, taste and even sight may be affected.
• Dizziness: following a whiplash this is usually temporary and can improve with chiropractic care. It is the result of injury to the facet joints of the cervical spine, but in some cases it may be due to damage to the brain or brain stem.
• Low back Pain: Despite the neck bearing the brunt of the damage, your low back can also be easily injured by whiplash, and this is reported by over 50% of those involved in rear impact collisions, and in nearly 75% of those in side impact accidents. Although the low back does not suffer the same extent of flexion-extension injury as the neck, it still experiences a great compression during the first two phases of the whiplash process.

Recovery from Whiplash

Mild whiplash injuries treated correctly usually heal within six to nine months. However, 20% of victims will still be suffering pain, weakness or restricted movement two years after their accident, and it is likely that some degree of disability or pain will afflict theses people for many years more, if not for life.

Whiplash injuries need to be treated by specially trained professionals who know and understand the condition. The most effective treatment combines chiropractic care with rehabilitation of the soft tissues, and a self-care routine.

Chiropractic Care

Chiropractic care involves the manual manipulation of the spine to restore normal movement and position to the vertebrae. This is the most important and effective treatment to ensure that whiplash damage is minimized. Your chiropractor may also use trigger point therapy, massage therapy, exercise rehabilitation, and other soft tissue rehabilitation treatments.

Soft Tissue Rehabilitation

‘Soft tissue’ refers to anything in the body that’s not bone, so that includes muscles, ligaments, tendons, nervous system, spinal discs and internal organs. It is these soft tissues that are damaged most by whiplash, with the muscles, ligaments and discs taking the majority of the impact. Unless the correct therapies are used to stimulate healing, the result may be permanent impairment and disability. Treatments include trigger point therapy, massage therapy, electro-stimulation, stretching, and specific exercises to boost strength and range-of-motion.

Home Care

How you behave outside the chiropractor’s office will significantly enhance or detract from the treatment given inside it. Your daily home and work routines must be guided by your recovery plan, so that the treatment sessions have maximum benefit. You should: apply ice packs, carefully limit daily activities, stretch, exercise, supplement nutritionally, and get plenty of rest.

Medical Intervention

Severe whiplash may require the input of a physician to complement your overall treatment. This may mean anti-inflammatory medications, muscle relaxants, trigger point injections, or even epidural spinal injections. The point of these is short-term pain relief; they are not intended as curative or long-term options. No drug will restore normal joint movement or stimulate muscle repair. Surgery may be necessary for a badly herniated discs, when a disc is impinging on the spinal cord, and in some cases with spinal fractures.

Are You Suffering from a Whiplash Injury?

Whether you have recently been involved in an auto accident, or if you had one several months or years ago and whether or not the symptoms are now starting to show up or not, in any case the sooner that you have your spine fully evaluated and begin a course of treatment the better your chances are for a maximum recovery. Be sure to provide as much detail about your injuries as possible to help your Chiropractor fully understand your condition.

Participation in sports or exercise is an important step in maintaining your health. Exercise strengthens your heart, bones, and joints and reduces stress, among many other benefits. Unfortunately, injuries during participation in sports are all too common. Often, these injuries occur in someone who is just taking up sports as a form of activity, doesn’t use proper safety equipment, or becomes overzealous about the exercise regimen.

The more commonly injured areas of the body are the ankles, knees, shoulders, elbows, and spine. Remember that you should discuss any exercise program with your doctor of chiropractic before undertaking such activities.

Strains and Sprains

Although bones can sometimes be fractured with acute sports injuries, the most commonly injured structures are the muscles, tendons, and ligaments. Tendons attach muscles to bones, and ligaments attach one bone to another.

An acute twisting or overextension of a joint can lead to tears of muscles and tendons, called “strains,” and tears of ligaments result in “sprains.” These tears range from mild to severe. In mild injuries, just a few fibers are torn or stretched. Severe injuries, where there is a tear through the full thickness of the structure, are most often considered unstable injuries and frequently require surgical intervention. The intervertebral disc, a ligament between the vertebrae of the spine that works as a shock absorber, can also be torn, resulting in a disc bulge and/or herniation.

Ankle sprains most often involve tears of one or more of the ligaments along the outside of the ankle. Knee ligaments, including the larger external supportive ligaments and the smaller internal stabilizing ligaments, can also be torn. The cartilage on the back of the patella (knee-cap) can also become eroded from overuse, leading to a condition termed chondromalacia patella.

Tendinosis

In those who are training too much, overuse of a particular joint or joints in the body can result in pain and dysfunction. These injuries are called “overuse syndromes.” A common overuse injury is tendinosis, also called tendinitis. In this condition, the tendon becomes inflamed from repetitive use. In the shoulder, the rotator cuff (a complex of muscles that stabilizes and moves the shoulder) becomes inflamed, resulting in rotator cuff tendinitis. Tennis elbow is another form of tendinitis that occurs along the outside of the elbow, most commonly in tennis players. In golfer’s elbow, the tendons on the inside of the elbow are affected.

Stress Fractures

Some athletes may experience a stress fracture, also called a fatigue fracture. This type of fracture occurs when an abnormal amount of stress is placed on a normal bone. This might occur in a runner who rapidly increases the amount of mileage while training for a race. Stress fractures also occur in people who begin running as a form of exercise but overdo it from the start, rather than gradually progress to longer distances.

One final common injury is worth mentioning, and that is shin splints. This overuse injury is caused by microfractures on the front surface of the tibia (shin bone). This is most often seen in runners, although other athletes can also be affected.

Diagnosis and Treatment

Sports injuries are most often diagnosed from the history of the activity that brought on the pain, along with a physical examination. In some cases, x-rays are necessary to rule out a fracture. Magnetic resonance imaging (MRI) and diagnostic ultrasound are also used in finding soft-tissue injuries, like tendinitis and sprains.

Fractures require the application of some stabilizing device, such as a cast, after the bone is put back into position. Rarely, surgical intervention is required. There is a relatively standard treatment protocol for most of the other overuse types of injuries. This protocol involves the following:

Rest

Generally no more than 48 hours of rest and/or immobilization is needed, depending on the severity of the injury. In most cases, the sooner the person becomes active after an injury, the more rapid is the recovery. In fact, long-term immobilization can sometimes be harmful to recovery. Your doctor of chiropractic will guide this process, as too early a return to activity, choosing the wrong type of activity, or excessive activity can be detrimental.

Ice or heat

Ice or heat can be helpful with pain reduction and tissue healing.

Compression

Compression of the area may reduce the amount of swelling from the injury. Your doctor of chiropractic will determine if this will be beneficial in your case.

Elevation

Elevation of the injured arm or leg above the level of the heart is thought to be helpful in reducing swelling.

Pain relievers

Recent research has demonstrated that some nonsteroidal anti-inflammatory drugs may actually slow the healing process by restricting the body’s natural healing mechanisms, so they should be used sparingly.

Joint manipulation

Recent research has shown us that, in some cases, joint manipulation can be helpful with pain reduction and more rapid recovery. Your doctor of chiropractic will determine if this procedure will be helpful in your case.

A Word about Prevention

In many cases, sports injuries can be prevented. Proper conditioning and warm-up and cool-down procedures, as well as appropriate safety equipment, can substantially reduce injuries. Understanding proper techniques can also go a long way toward preventing injuries. Sufficient water intake is also an important preventive measure.

For decades, osteoarthritis has been considered a part of aging. But not anymore. Recent research points out that older people don’t have to suffer from osteoarthritic pain. And, surprisingly, people much younger than 65 can develop osteoarthritis.

What Is Osteoarthritis?

Osteoarthritis (OA), or degenerative joint disease, affects more than 20 million Americans and is more common in women than in men. The disease affects the cartilage, which is a slippery tissue on the ends of bones that meet in a joint. Normally, cartilage helps bones glide over one another. In an OA patient, however, the cartilage is broken down and eventually wears away.

As a result, instead of gliding, bones rub against each other, causing pain, swelling, and loss of motion.¹ Although the majority of patients with OA are 65 and older, recent research shows that osteoarthritis is not a by-product of aging. Family history of OA, being overweight, lack of exercise, and prior joint injuries are suggested as OA risk factors.

How Is Osteoarthritis Diagnosed?

OA is diagnosed through a combination of clinical history, patient examination, and x-rays. Other tests, such as drawing fluid from the joint, are sometimes used.

The signs of OA include:

• Steady or intermittent joint pain
• Joint stiffness after sitting, sleeping, or otherwise not moving for a long time
• Swelling or tenderness in the joints
• A crunching feeling or the sound of bones rubbing against each other.

If you experience any of these signs, consult your health care provider. While the diagnosis is relatively easy to make, it is often harder to establish whether or not OA causes the patient’s symptoms. That’s why the treating doctor needs to not only make the diagnosis, but also rule out other disorders and conditions that can make the symptoms worse.¹ Timely diagnosis and treatment can help manage pain, improve function, and slow the degeneration.

Should Osteoarthritis Patients Exercise?

Exercise is one of the best forms of OA treatment and prevention. It strengthens the muscular support around the joints and improves and maintains joint mobility and function. In addition, exercise helps control weight and improves the patient’s mood and outlook, which are important factors influencing the severity of the symptoms.

If you suffer from OA, consider the following exercise tips:

• Low impact or non weight bearing activities, such as walking, stationary training, and light weight training work best for OA patients.
• Use strengthening exercises if the key muscle groups that relate to the function of the joints are weakened by the degeneration.
• If you are overweight, start exercising carefully, so as not to put too much stress on the knee and ankle joints.
• Stair climbing, water aerobics, Theraband workouts, and similar exercises will help to keep the joints mobile without straining them.
• Learn to read the body’s signals and know when to stop, slow down, or rest.

How Can Your Chiropractor Help?

Doctors of chiropractic, by the nature of their work, can detect the earliest degenerative changes in the joints. They see the impact of degenerative changes in the spine, as well as in the hips, knees, and other weight bearing joints. Doctors of chiropractic are also trained to relieve the pain and improve joint function through natural therapies, such as chiropractic manipulation, trigger-point therapy, or some massage techniques.

Doctors of chiropractic can provide exercise counseling, helping you choose exercises that are best for you. If a sore or swollen joint prevents you from exercising, talk to your doctor of chiropractic about other drug free pain relief options, such as applying heat or cold to the affected area. In addition, your doctor of chiropractic can help you choose proper supplements that play important roles in OA prevention and treatment.

References

1. Osteoarthritis: Handout on Health. National Institute of Arthritis and Musculoskeletal and Skin Diseases. July 2002.

A healthy spine is an often overlooked and essential part of a healthy lifestyle. People who suffer from back pain, particularly if it is long-term, are generally less healthy than those who do not. In fact, back pain costs are staggering not only financially, but also in terms of lost time from work and because of psychosocial problems that arise during the healing process associated with long-term back pain.

Unfortunately, approximately 80-90% of the population suffers from spinal pain at some point. People who are overweight or obese, and who smoke, lift heavy objects, or had a previous episode of back pain, are more likely to experience back pain.

Because so many people suffer from spine pain, it’s important for you to try to keep your spine as healthy as possible. Following simple posture, lifting, and healthy lifestyle guidelines can help you keep your back in good shape.

The American Chiropractic Association recommends the following spinal health tips:

Standing

• When standing, keep one foot slightly in front of the other, with your knees slightly bent. This position helps to take the pressure off your low back.
• Do not stand bent forward at the waist for prolonged periods of time. The muscles in your low back become deconditioned in this position, which may lead to pain.

Lifting

• At all times, avoid twisting while lifting. Twisting is one of the most dangerous movements for your spine, especially while lifting.
• If the item is too heavy to lift, pushing it is easier on your back than pulling it. Whenever possible, use your legs, not your back or upper body, to push the item.
• If you must lift a heavy item, get someone to help you.

Sitting

• Keep your knees slightly higher than your hips, with your head up and back straight.
• Avoid rolling your shoulders forward (slouching).
• Try to maintain the natural curve in your low back.

Reaching and Bending

• When reaching for something above shoulder level, stand on a stool. Straining to reach such objects may not only hurt your mid-back and neck, but it can also bring on shoulder problems.
• Do NOT bend over at the waist to pick up items from the floor or a table.
• Instead, kneel down on one knee, as close as possible to the item you are lifting, with the other foot flat on the floor and pick the item up.
• Or bend at the knees, keep the item close to your body, and lift with your legs, not your back.

Carrying

• When carrying objects, particularly if they are heavy, keep them as close to your body as possible.
• Carrying two small objects—one in each hand—is often easier to handle than one large one.

Healthy Diet and Exercise

• While the proverbial jury is still out, we suspect that extra weight puts undue strain on your spine. Keep within 10 lbs. of your ideal weight for a healthier back.
• “Beer belly” is likely the worst culprit, as it puts unwanted pressure on the muscles, ligaments and tendons in your low back.
• The most efficient and effective way to reduce weight is by eating a sensible diet and exercising regularly.
• Consult with your doctor before beginning any exercise program, particularly if you have a health condition.

Sleeping

• Sleeping on your back puts approximately 50 pounds of pressure on your spine. Other positions may be better.
• Placing a pillow under your knees while lying on your back cuts the pressure on your spine roughly in half.
• Lying on your side with a pillow between your knees may also reduce the pressure on your back.
• Never sleep in a position that causes a portion of your spine to hurt. Most often, your body will tell you what position is best.

Quit Smoking

Smokers have more spine pain than nonsmokers, and they also heal more slowly when they have an episode of back pain because the chemicals in tobacco smoke restrict the flow of blood to the tissues in and around your spine.

While following these instructions is no guarantee that you’ll be free from back pain for your entire life, it can certainly reduce your risk of developing it. These simple steps will help you keep your spine in good shape, making you a healthier, happier person.

Stress has been called the spice of life, the common cold of the psyche, and even a socially acceptable form of mental illness. No doubt, stress can be beneficial for example, a deadline can help us focus and become more alert and efficient. Persistent or excessive stress, however, can undermine performance and make us vulnerable to health problems, from cancer and heart disease to substance abuse and obesity.

Stress is a physical and mental response to the difference between our expectations and our personal experience, real or imaginary. While reacting to stress, the body goes through alarm, resistance, and exhaustion. Released hormone epinephrine, or adrenaline, prepares the body for physical action (“fight or flight”) by increasing heart rate, blood pressure, and blood glucose levels. Then, the body releases glucocorticoid cortisol, or hydrocortisone, producing anti-inflammatory and immunosuppressing effects.

Consequences of Chronic Stress

Although occasional stress can be of benefit, too much stress is taxing on the body. Excessive levels of glucocorticoids can hinder growth, delay wound healing, and increase risk of infection. Chronic stressors or their constant anticipation can make us believe that we must always be on guard, leading to anxiety. Feelings of hopelessness or avoiding solving our problems can spark depression.

Past or present psychological distress can also lead to pain, particularly low back pain, which often comes with leg pain, headaches, sleep problems, anxiety, and depression. Stress may even be a more powerful pain generator than strenuous physical activity or repetitive motion. Research shows, for example, that pain in adolescents is associated with depression and stress, but not with computer use or physical activity.

Stress is highly individual and depends on our circumstances. For example, we react to stress better if we can vent our frustrations, feel in control, hope that things will change for the better, and get social support.

Gender also determines how we handle stress. Women are easily stressed by household problems, conflicts with people, or illness in people they know. Men get more significantly affected by job loss, legal problems, and work related issues. Men are also more likely to get depressed over divorce or separation and work problems. Depression in women, however, is more likely to spring from interpersonal conflicts or low social support, particularly from family.

Stress on the Job

The workplace has become a major stressor, contributing to the risk of hypertension and heart disease. Recent studies have shown, however, that what stresses us out is not so much the job demands, but our attitude toward them. For example, people who react with anger to their high job strain or who are worried about their chronic work overload have much higher morning corsisol levels. Lack of a sense of control over a job is also associated with higher blood pressure, especially in women and in people with higher socioeconomic status.

Stress Relief Is Important

No matter what stresses you out, consider taking active steps to change your attitude toward stress and to reduce stress in your life.

*Source: Journal of Manipulative and Physiological Therapeutics Volume18, Number 5, June, 1995. Singer Health Reports: The Truth About Health.*

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Dejan suffered with severe neck pain and headaches following and auto accident. Chiropractic helped to resolve this from the first treatment.

Peggy suffered with severe back pain that was getting worse by the day. Now with the help of Columbus Chiropractic and Acupuncture she is on the road to recovery. For more information on how you can get on the road to recovery visit our website: columbuschiropracticandacupuncture.com or give us a call on 614-864-1611.