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1st Apr

2009

Whiplash Injuries

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Here in southern California, we spend a great deal of time in our cars, often traveling more than 15,000 miles per year. Unfortunately, this is not without risk, as car accidents are common, especially on freeways, where the distance between cars is usually insufficient for safe driving. Accidents frequently lead to whiplash injuries, in particular if caused by rear- end impact.

FEMALES MORE SUSCEPTIBLE THAN MALES

Studies have shown that females are more likely than males to sustain whiplash injuries (references can be provided). Some researchers have shown that females as a whole have greater axial motion and shear between neck vertebrae than males. It has been theorized that the cause for women’s greater susceptibility is multifactorial, including genetic, hormonal and structural contributions.

Animal studies reportedly have shown that estrogen, or estrogen combined with progesterone decreases the tensile strength (ability to withstand stretch) of ligaments and joint capsules supporting the joints. Furthermore, less muscle strength may decrease females’ ability to quickly prevent excessive neck bending forward and backwards following impact.

MECHANICS OF WHIPLASH

In a rear-end car accident, as the vehicle is hit from behind, the car is suddenly pushed forward, whereas the head remains stationary, thereby pushing it backwards and forcing the neck into backward bending. A properly placed head rest can minimize this backward motion. The muscles in the front of the neck then react as a reflex, by forcefully pulling the head forward, thus bending the neck forward and down. This in turn often leads to the stretched muscles in the back of the neck quickly pulling the head back again, thereby creating a back-forward-back again movement of the head. If the torso has moved forward in a similar whipping motion, the amplitude of the neck movements may be greater, and there could even be trauma to the mid and lower back.

COMBINED STRETCH AND COMPRESSION TRAUMA

Studies have shown that the whiplash mechanism often causes stretch injury to the supporting ligaments and capsule in the front and back of neck joints, called facet joints, quite similar to what happens when you severely sprain an ankle.

There is often also compression trauma or irritation of the facet joint surfaces, which affects the bone underlying the joint cartilage, potentially bruising the bone, similar to what happens with serious knee sprains, such as ACL tears.

Any pre-existing degeneration or weakness of facet joints and discs between vertebrae, with their supporting ligaments, may cause additional trauma to these vulnerable regions.

As a result of the injury, there is typically acute local inflammation, reflex muscle contraction (guarding) around the spine and extending into the shoulders and upper back, resulting pain, and loss of neck range of motion. Because of the violent muscle contraction during the whiplash motion, there may also be some muscle strain injuries in the neck.

PHYSICAL THERAPY TREATMENT AND GOALS

The first step in physical therapy rehabilitation is to reduce tissue irritation and muscle guarding. Physicians would often prescribe anti-inflammatory medications and muscle relaxants, to help in this process as well.

The orthopedic manual therapist would typically start with postural education, emphasize optimal ergonomics while at work or at the computer, perhaps prescribe an appropriate orthopedic cervical pillow, recommend use of ice packs for 5-10 minutes off and on during the day, apply gentle soft tissue mobilization, and within the first 7-10 days start gentle active neck and shoulder girdle movements, often performed lying down.

Stretching to the traumatized area is to be avoided for at least 8-10 weeks following the injury, or further trauma and inflammation may result.

We may also discuss diet, and recommend increased intake of protein and vitamin C (at least 2000-3000mg/day) and additional supplementation of e.g. glucosamine sulfate, to enhance tissue healing.

In addition to modifying daily activities, stress control and proper sleep are also important in the person’s recovery.

The next step in rehabilitation is to add precisely dosed pain free light resistive exercises to the neck, upper back and shoulders. This helps to supply oxygen and nutrients to the tissues, reduces muscle guarding and helps to remove waste products from the injured tissues and guarded muscles. Gentle joint mobilization may be added, to inhibit muscle guarding, and improve joint mobility if found lacking.

As the condition improves, the exercises can be gradually progressed, to help in the process of building tissue strength and stability in the spine. Perfect coordination during exercise is stressed, to fully activate the deep stabilizing muscles, and to prevent strain on injured tissues.

Finally, we may provide the individual with a simple home pulley apparatus, with which she can perform exactly the same type of exercises at home over the course of many months to a year, in order to maximize long-term progress and prevent or minimize future pain.

Best wishes,

Gunnar

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