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WHIPLASH

Imagine yourself driving when a car behind you rear-ends your vehicle. The impact pushes your car forward. It takes about 100 milliseconds for your body to catch up to the forward movement. Your shoulders travel forward until they are under your head, and your neck extends forward as your head tilts slightly down toward your steering wheel. You step on the brakes, bringing the car to an abrupt halt. The sudden stop throws your head and neck backward, and they bounce against the headrest. In a matter of seconds, you've experienced the classic mechanism of injury for whiplash.

About 20 percent of people involved in rear-end collisions later experience symptoms that center in the neck region. Although most of these people recover quickly, a small number develop chronic conditions that result in severe pain and sometimes disability.

Whiplash is an injury to the soft tissues of the neck. Whiplash injury strains the muscles and ligaments of the neck beyond their normal range of motion. There is often pain and stiffness in the neck for the first few days following a whiplash injury. The pain can also be felt in the surrounding muscle groups in the head, chest, shoulders, and arms.

Definition of Whiplash: Whiplash is when the soft tissues of the neck are injured by a sudden jerking or "whipping" of the head. This type of motion strains the muscles and ligaments of the neck beyond their normal range of motion.

Considerations of Whiplash: When a vehicle stops suddenly in a crash or is struck from behind, a seat belt will keep a person's body from being thrown forward. But the head may snap forward, then backward, causing whiplash.

Causes of Whiplash: In addition to car accidents, whiplash can be caused by roller coasters and other amusement park rides, sports injuries, or being punched or shaken. (Whiplash is one of the hallmarks of shaken baby syndrome.)

Symptoms of Whiplash: You may feel pain and stiffness in your neck for the first few days following a whiplash injury. Then you feel better, but the pain and stiffness may come back several days later.

The discomfort you feel may involve surrounding muscle groups in your head, chest, shoulders, and arms.

People who experience whiplash may develop one or more of the following symptoms, usually within the first two days after the accident:

• Neck pain and stiffness
• Headaches
• Pain in the shoulder or between the shoulder blades
• Low back pain
• Pain or numbness in the arm and/or hand
• Dizziness
• Ringing in the ears or blurred vision
• Difficulty concentrating or remembering
• Irritability, sleep disturbances, fatigue

Diagnosis and Treatment of Whiplash: How whiplash injuries occur is clearly understood, but the extent and type of injuries varies greatly. The diagnosis of whiplash is often one of exclusion. Most injuries are to soft tissues such as the disks, muscles and ligaments, and cannot be seen on standard X-rays. Your doctor may need to request specialized tests, such as computed tomography scans or magnetic resonance imaging (MRI).

In the past, whiplash injuries were often treated with immobilization in a cervical collar. However, the current trend is to encourage early movement, rather than immobilization. The soft collar may be used for a short term and on an intermittent basis.

Ice may be applied for the first 24 hours, followed by gentle active movement. Your doctor may provide you with a series of exercises that you can do at home. An early return to work is encouraged, even if your doctor must prescribe some temporary modifications in your work situation. No single treatment has been scientifically proven as effective, but pain relieving medications, exercises, physical therapy, traction, massage, heat, ice, injections and ultrasound have all been beneficial for some patients.

As soon as possible, you should begin aerobic activities, such as walking. Your doctor may prescribe some isometric exercises as your condition improves. Symptoms resolve within several months for about 75 percent of people who have whiplash. Chronic conditions should be investigated further and might require surgery.

First Aid of Whiplash: Try over-the-counter pain relievers like aspirin, acetaminophen, or ibuprofen.
For at least 2 to 3 weeks, avoid activities that bring on or worsen your pain and stiffness. Don't lift or carry anything heavy or participate in sports.

If you have pain when you move your head or the pain involves your shoulders or arms, your doctor may recommend a soft neck collar or short-term prescription drug to relax the muscles.

Call your doctor if:

• Neck pain and stiffness comes back after it had resolved.
• The pain spreads to your shoulders or arms.
• You have pain when you move your head.
• You have numbness, tingling, or weakness in your arms.

Prevention of Whiplash: Headrests in your car can reduce the severity of neck pain from a car accident. Make sure that the headrest is positioned properly for your height.

If you do get whiplash, learn proper stretching exercises once your neck has healed. This reduces the chance that neck pain or stiffness will come back.

Facts on Whiplash

1. In a series of recent human volunteer crash tests of low speed rear impact collisions, it was reported that the threshold for cervical spine soft tissue injury was 5 mph (delta V).
2. Other reports have shown that crashed cars can often withstand collision speeds of 10 mph or more without sustaining damage. Thus: the concept of "no crush, no cash" is simply not valid.
3. Recent epidemiological studies have shown that most injury rear impact accidents occur at crash speeds of 6 mph to 12 mph --the majority at speeds below the threshold for property damage to the vehicle.
4. A number of risk factors in rear impact accident injury have now been verified including: rear (vs. other vector) impact, loss of cervical lordotic curve, preexisting degenerative changes, the use of seat belts and shoulder harness, poor head restraint geometry, non-awareness of the impending collision, female gender, and head rotation at impact.
5. The notion of litigation neurosis has been rather definitively dispelled.
6. Once thought to suggest minimal injury, a delay in onset of symptoms has been shown to be the norm, rather than the exception.
7. Mild traumatic brain injury can result from whiplash trauma. Often the symptoms are referred as the postconcussion syndrome. This condition, often maligned in the past, has now been well-validated in recent medical literature.
8. A recent outcome study of whiplash patients reported in the European Spine Journal found that between one and two years post injury, 22% of patients' conditions deteriorated. This second wave of symptoms has been observed by others as well.
9. Radanov et al. followed whiplash patients through time and reported that 45% remained symptomatic at 12 weeks, and 25% were symptomatic at 6 months. Other researchers have reported time to recovery in the most minor of cases at 8 weeks; time to stabilization in the more severe cases at 17 weeks; and time to plateau in the most severe categories as 20.5 weeks. Thus, the notion that whiplash injuries heal in 6-12 weeks is challenged. (Incidentally, there never has been any real support for this common myth.)
10. Each year, 1.99 million Americans is injured in whiplash accidents.
11. Of the 31 important whiplash outcome studies published since 1956 (19 published since 1990 pooling patients from all vectors of collision (i. e., rear, frontal, and side impacts), a mean of 40% still symptomatic is found. For rear impact only, a mean of 59% remain symptomatic at long- follow-up.
12. Although estimates vary, about 10% of all whiplash victims becomes disabled.
13. The Quebec Task Force on Whiplash-Associated Disorders has been criticized on the basis of potential bias, study design, the use of ambiguous and misleading terminology, and for developing conclusions that are not supported by the literature.
14. The chiropractic profession has developed its own guidelines for management of whiplash patients.

If believe you have whiplash as a result of a traffic accident, it is important to visit a qualified doctor to evaluate your injuries. Trying to "heal yourself" could cause your body more harm.

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