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1st Nov

2016

Whiplash Injury following Rear-End Car Accidents

With the Southern California winter approaching, we now hopefully will get some much needed rain. Unfortunately, it also means that rear-end car accidents become more frequent. In today’s newsletter, I will discuss some of the mechanisms and types of injuries that occur, how we can prevent or minimize such injuries, and how and why targeted manual physical therapy including exercise is of great importance, whereas traditional treatment has provided disappointing results. Much of the recent research information shared was presented in the latest issue of the physical therapy journal JOSPT.

Whiplash injury to the neck is a common result of car accidents, especially rear-end collisions, which according to the literature today result in chronic symptoms in approximately 50% of the cases, whereas the remaining 50% of people recover fully within three months. Despite improvements made in car designs, these numbers have not improved over the years.

We know that certain factors make us more susceptible to developing chronic symptoms after an accident, including neck pain prior to the accident, spinal degenerative changes – often producing a flattened or reversed neck curvature pre-trauma, the female gender and slender necks, and older age. The average woman has significantly thinner necks, with less developed musculature, anatomically reduced support areas in the spine – making it less stable, and 31% greater ratio of head mass to neck cross-sectional area, and increased segmental mobility in the neck, compared with males. These factors may all result in increased soft tissue strain during an accident, and elevated injury risk. Furthermore, due to being shorter and lighter, the average female’s neck tends to get pushed upwards towards the head restraint in the car, while not deflecting the seat back backwards as much as the average male, thereby increasing neck loading.

The basic mechanics during a rear-end car accident are divided into three stages: Initially (within 75 milliseconds of impact) the trunk is accelerated forward and pushed into the seat back while the neck assumes an S-curve as seen from the side, as the upper neck bends forward (chin tucks in) while the lower cervical spine bends backwards, placing nonphysiological loads on spinal soft tissues. This is believed to be the phase where most of the whiplash injury occurs.

The second phase throws the neck backwards into extension, resulting in a C-curve of the neck, followed by a rebound of the head from the head restraint.

Commonly injured tissues are the spinal joint ligaments and capsules, and intervertebral discs, and deep stabilizing muscles have in many chronic cases shown fatty infiltration, likely indicating prolonged loss of proper neck stability after the accident. Concussion symptoms or more serious brain injury can also result. People with chronic whiplash symptoms are twice as likely to show fibrosis (thickening/scarring) of synovial folds called meniscoids in the spinal facet joints (they normally have a lubricating function), believed to be caused by adhesions formed with the neck kept immobile during the acute stage. There has also been found to be a correlation in the general population between such fibrous meniscoids, and facet joint arthritis.

To minimize whiplash injury, it has been shown that awareness of the occupant and self-bracing prior to impact, lessens the trauma. Consequently, besides keeping plenty of distance to the car in front and behind you while driving, frequently looking up in the rear view mirror is also a good habit. Proper placement of the head restraint, is furthermore of great importance.

Since increased muscle size and strength can reduce injury risk, it is recommended for everyone, and in particular for women and people with greater than average neck range of motion, to perform regular strengthening exercises for the neck. Military pilots of high performance aircraft perform regular targeted neck strengthening exercises, to reduce their injury risk.

Following injury, it is important to seek treatment as soon as possible. Inflammation can be controlled with medications, but only in the most severe cases, should a neck brace be applied, and if so, only for a short period. As mentioned, adhesions can form quickly in soft tissues around the spinal joints if kept immobile. With orthopedic manual physical therapy, we start early on with gentle small neck movements, performed frequently throughout the day, as well as gentle soft tissue and joint mobilization (no stretches!), to decrease muscle guarding and pain, and promote early healing.

Resisted exercises are at first performed with minimal tension and painfree movements, gradually progressed to eventually restore normal stability in the neck through optimal coordination, endurance and strength, with focus on deep spinal musculature.

I hope that none of my readers will experience this type of injury, but whiplash disorders unfortunately are common, and I would be happy to help you, your family or friends if involved in a car accident.

For those of you who are new readers, I am now in solo practice in Scripps Ranch, where I can provide one-on-one uninterrupted hour long treatment for each person I see. I have found it to be a superior treatment model, to the traditional group practice model where multiple people are seen simultaneously.

With only a few weeks to Thanksgiving, I wish you a wonderful Holiday Season!

All the best,

Gunnar

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