Dr. Anderson's Guide to Treating Whiplash
Introduction to Whiplash
Whiplash occurs when the neck and head are suddenly forced backward and then forward, putting the cervical spine through lightning-quick motions and extreme stresses. Most cases of whiplash are caused by car accidents where the person has been rear-ended. Other potential whiplash causes, while comparatively rare, can include assault, bungee jumping, rollercoaster, football, falls while skiing or during equestrian events, and other high-impact activities where extreme acceleration-deceleration forces might be applied to the cervical spine.
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Whiplash is medically known as cervical acceleration-deceleration (CAD) syndrome. For some people, whiplash symptoms can be so minor that they go away within a couple days. For others, the symptoms can become varied and chronic, ranging from severe pain to cognitive and emotional problems.
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Whiplash symptoms might manifest immediately following the acceleration-deceleration accident, or they can take a few hours or days to appear. Oftentimes the exact underlying cause remains unknown for some whiplash symptoms despite today’s best diagnostic techniques. Due to the potentially high number and varied complexity of whiplash symptoms, they are sometimes collectively referred to as whiplash-associated disorders.
The Size and Scope of the Problem
These statistics represent how many auto injuries, chronic injuries, and permanent disabilities occur from car crashes in America each year:
The population of South Carolina (2,800,000) = number of injured each year.
The population of Nebraska (1,560,000) = number who develop chronic pain each year.
The population of Wyoming (332,000) = number who become disabled each year.
Whiplash Statistics and Risk Factors
Whiplash Statistics:
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More than three million Americans are injured with a whiplash injury each year.
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The reported risk of injury in a low-speed rear impact collision (LOSRIC) is 35-68%
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About 10% of those injured become permanently disabled.
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Nearly half of all chronic neck pain in America is due to car crashes-mostly LOSRIC.
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Kids are at 2/3 the risk of adults.
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Whiplash Risk Factors:
Risk factors for injury and/or poor outcomes:
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Rear direct impact.
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Limited range of motion and neurological symptoms after the crash.
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Ligamentous instability after the crash.
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Degenerative disease, headaches, or neck injury or pain prior to the crash.
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Head turned at impact or occupant in a poor position at impact.
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Non-awareness of impact.
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Failure of seatback during impact.
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The lack of use of seat belt or shoulder harness.
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No head restraint or poor head restraint position.
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Female gender or advanced age.
Common Whiplash Symptoms
Some of the most common symptoms of whiplash include:
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Neck pain. The pain could range anywhere from mild to severe. It might be located in one spot or general area, or it could also radiate down the shoulder into the arm and/or hand. Typically, neck pain from whiplash is caused by ligament sprains or muscle strains, but it can also be caused by injuries to discs, nerves, joints, and/or bones.
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Neck stiffness or reduced range of motion. Reduced neck mobility could be from pain, tightening of a muscle, or a mechanical problem, such as with a joint.
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Headache. A neck muscle tightening, or a nerve or joint of the cervical spine becoming irritated could cause headaches.
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Neck instability. This whiplash symptom commonly results from stretched or torn soft tissues, such as ligaments. Although, it could also be caused by a fracture.
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Shoulder and/or upper back pain. If the neck’s soft tissues, such as muscles or ligaments, are torn or strained during whiplash, then sometimes that pain can also be referred to other soft tissues in the upper back and shoulders.
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Radiating tingling, weakness, or numbness. Sometimes whiplash can cause one of the neck’s spinal nerve roots to become compressed or inflamed, which can lead to cervical radiculopathy symptoms of tingling, weakness, and/or numbness radiating down the shoulder, arm, hand, and/or fingers. Typically, cervical radiculopathy is only felt on one side of the body, but in rare cases it can be felt on both sides if more than one nerve root is affected.
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Other Symptoms Following Whiplash.
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Fatigue 56%
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Impaired Concentration 26%
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Anxiety 57%
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Blurred Vision 21%
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Mid back pain 42%
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Irritability 21%
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Low Back Pain 39%
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Dizziness 19%
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Sleep Disturbance 39%
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Forgetfulness 15%
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Sensitivity to Noise 39%
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Jaw/facial pain (TMJ) 4%
Common Myths and the Facts About Whiplash Injuries
Common Myths About Whiplash Injuries:
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Low speed rear impact crashes (LOSRIC) do not cause injuries.
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Injuries heal in 6-12 weeks.
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Litigation has an effect on the patient’s recovery.
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The patient’s pre-injury psychological makeup affects recovery.
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Greater vehicle damage = greater occupant injury.
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Accident reconstructionists can predict injury potential.
The Facts About Whiplash Injuries:
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Most auto injuries occur at crash speeds below 12 mph.
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Most cars withstand 8-12 mph impacts without vehicle damage.
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More than half of all LOSRIC injuries occur without vehicle damage.
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There is no correlation between vehicle damage and outcome of a patients’ injuries.
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vehicle.The peak acceleration of the head is much greater than the peak acceleration of the
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A 5 mph change in velocity for an auto crash typically produces about 10-12 Gs of acceleration of the occupant’s head.
Patient History Collected for Whiplash
When a patient visits Dr. Anderson for neck and back pain symptoms potentially related to a whiplash injury, the following steps will occur:
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Complete patient history
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Physical examination
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Diagnostic imaging (only if a fracture or neurological problem is suspected)
For the complete patient history, a full medical background will be gathered first, including family history, any pre-existing conditions, and other health considerations, such as medications or previous injuries, etc. Then questions will be asked regarding the current symptoms and how they started:
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How was the neck injured? Was it a car crash or some other incident?
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When did the pain and/or symptoms start? Were the symptoms present immediately after the accident, or did they take a few hours or days to appear?
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What is the nature of the pain? Where does it hurt, and how much does it hurt? Does the pain come and go, or is it constant? Does the pain radiate down the shoulders and arms? Depending on the answers given, the doctor’s line of questioning can go in various directions to get relevant information regarding a patient’s specific symptoms and situation.
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When a Diagnostic Study May Be Recommended for Back or Neck Pain
Findings from medical history and physical exam typically set up the rationale for ordering diagnostic studies. Diagnostic tests are recommended when:
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Red flag symptoms, including but not limited to fever, chills, night sweats, loss of bowel and/or bladder control, numbness in the arms and/or legs, loss of consciousness, not being able to stay alert, and/or feeling lightheaded and nauseous, are present.
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A few underlying causes may be suspected but confirmation is needed to plan the appropriate treatment.
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A potential cause is presumed but the exact location of the problem needs to be confirmed.
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A systemic (general) disorder, such as infection or malignancy, is suspected.
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Surgery is intended for the treatment of lower back or neck pain.
Imaging tests
Imaging, radiology, or radiographic tests, create standard or detailed images of certain areas inside the body, such as joints, bones, discs, organs, and soft tissues. The images obtained by these tests are used by doctors to analyze the tissues, in order to diagnose the underlying cause of pain, plan the treatment, or monitor the progress of treatment.
Examples of imaging tests include:
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X-rays
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Ultrasonography scans (or ultrasound scans)
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Computed tomography (CT) scans and CT scans with myelography (imaging using a contrast dye)
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Magnetic resonance imaging (MRI) scans
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Positron emission tomography (PET) scans
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Bone scans and bone scan with SPECT
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Imaging tests are generally painless, relatively safe when used with standard precautions, and noninvasive. Selection of the appropriate imaging technique depends on the type of suspected pathology, general condition of the patient, availability, cost of the test, and the presence of certain contraindications, such as pregnancy.
Electrodiagnostic tests
Electrodiagnostic testing is used to analyze electrical activity in the muscles for the diagnosis of neuromuscular diseases. These tests help differentiate between myopathy (a disorder of the muscle) and neuropathy (a nerve disorder that causes muscle weakness and other symptoms) and monitor the response to treatment.
Common electrodiagnostic tests for back or neck pain include:
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Electromyography (EMG) and nerve conduction studies (NCS)
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Somatosensory evoked potential (SSEP)
These electrodiagnostic tests can help provide additional information about spinal cord function. These tests record muscle and nerve activity to detect abnormalities that may not be physically obvious. Usually, these tests are only performed when there is neurological symptoms and signs present for the whiplash injury.
The Best and the Worst Treatment Choices for Whiplash
While each case is unique and can require a tailored treatment plan to give the patient the best chance at a positive outcome, there is research to support that two choices are among the worst and one choice may be the best for Whiplash Associated Disorder (WAD) treatment.
Worst Choice #1- Doing nothing, especially in the presence of immediate symptoms (including concussive symptoms). Not only can delaying treatment lead to needless suffering, but it may prolong the recovery process and even increase the risk for chronic WAD.
Worst Choice #2- Indiscriminate soft cervical collar use. While the concept of immobilizing the neck for a prolonged time frame to allow the soft tissues to heal makes sense, studies have shown that this practice can be detrimental to the patient. For example, cervical collar overuse can decondition the deep neck muscles that stabilize the cervical spine. When the collar is no longer in use, the deep neck muscles can no longer fulfill their duty and the body will recruit the superficial neck muscles to help maintain cervical posture, causing them to fatigue and increasing the risk for additional problems. One study found that WAD patients sent home from the emergency room (ER) with a cervical collar were about 3.5 times more likely to be back in the ER within three months.
Best Choice #1- Multimodal, conservative care. A systematic review of 1,616 previously published studies looked to find out which interventions or treatments were most cost-effective for managing WAD. The researchers found the favorable approach WAD management includes a combination of manual therapies (such as spinal manipulative therapy and other forms of hands-on treatment provided by doctors of chiropractic), neck-specific exercises, and patient education.
How Dr. Anderson Can Help
Dr. Anderson has advanced training and certification for Whiplash and Brain Traumatology Disorders from Motor Vehicle Crashes.
If you have been in an auto accident and are suffering from pain and are noticing a decrease in your daily function, schedule with Dr. Anderson or walk in to be seen today. The research suggests that between 20-50% of WAD patients will continue to experience some degree of life-interfering pain and disability a year following their initial injury. Chiropractic care is often recommended as the first treatment approach for the WAD patient, and patients are often advised to seek care as soon as possible.
From Crash to Cured
How one commuter found relief when his drive home went wrong
Harry was headed home after a long day at work. Exhausted, he couldn't wait to get home, eat dinner, and get some rest.
Unfortunately, a few blocks from his house, another car ran a read light and t-boned Harry's car on the driver's side.
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Shocked and confused, Harry took a mental note on whether he hurt anything. Although the reckless driver hit him pretty hard, everything seemed clear. He exchanged information with the other driver and went home.
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The next morning, Harry quickly realized the crash affected him more than he realized.
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"The next morning, Harry quickly realized the crash affected him more than he realized."
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While it didn't seem like he was hurt at the time, his neck started to ache. He had to rest most of the day due to dizziness and ringing in his ears.
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Beginning to suspect that the crash left behind neurological symptoms, Harry called his chiropractor. He said it sounded like Harry might have whiplash, and he should come in for an appointment.
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Harry went to his chiropractor the next day with worsening neck pain. He asked Harry a few questions about the crash, his symptoms, and when they started. After that, the chiropractor did an adjustment.
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After the very first pop in his neck from the adjustment Harry felt relief and the ringing stopped. The chiropractor told him to come in if the pain started to worsen again.
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"After the very first pop in his neck from the adjustment Harry felt relief and the ringing stopped."
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Finally relieved of pain and ringing, Harry slept much better that night. It was probably the first good night of sleep he got since the accident.
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The next morning Harry felt much better than he had the past few days. The crash suddenly felt like a small inconvenience rather than a painful experience. Harry got a few more adjustments over the following weeks to maintain his condition.
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Harry was grateful he thought to call his chiropractor that day, he knew he saved a lot of money preventing an urgent care visit and found relief quicker than he expected.
Dr. Anderson is professional, competent, and kind. I go to him on a regular basis, just to keep my body in as healthy a state as possible. In addition, he made my recovery from a serious car accident much easier. I have already recommended him to friends.
Judy M.
