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Motor vehicle accidents can result in a number of very diverse and complex injuries and symptoms. This is due to the diversity of factors involved with the each MVA - i.e. vectors (angles, speed) of the collision, size of the vehicles involved in collision, pre-existing health conditions of victims, age of victims, size and strength of victims, etc.
"Whiplash" is the most common injury sequelae following motor vehicle accidents. Speeds of as little as 5 mph have been documented to result in whiplash injuries. And although whiplash is prevalent in today's society with hundreds of studies on the topic, it is not yet fully understood.
1. What is whiplash?
The term "whiplash" was coined by Dr. Harold Crowe back in 1928. It is used to refer to:
1. the hyperextension (backward)/hyperflexion (forward) injury of the neck, and
2. the resulting bodily symptoms of this injury - sustained from a motor vehicle accident.
This forwards-flexion and/or backwards-extension of the neck essentially results in a soft tissue sprain/strain injury to the structures within the cervical and upper thoracic spinal regions. When the initial impact occurs and the head is forced in either excessive flexion or excessive extension, protective reflexes cause the muscles of the neck to forcefully contract which "whips" the head back in the opposite direction. The resulting injury often leads to numerous symptoms, many of which are confusing and poorly understood.
This loss of normal (C-shaped forward) cervical curvature is the result of the cervical acceleration/deceleration syndrome, and can be responsible for many positive orthopedic and neurological examination findings contributing to the patient’s symptomatology. X-rays cannot demonstrate microscopic tears nor show inflammation in the soft tissue (ligaments, tendons, muscle, cartilage, etc) which is one of the leading causes of the pain and soreness that one experiences following motor vehicular accident trauma. X-rays are the most cost effective study to rule out ligament insufficiency, bone pathology and vertebral misalignment leading to abnormal musculoskeletal mechanics.
2. The specific mechanics of a whiplash injury:
Whiplash is most commonly received from being struck from behind (hyperextension/hyperflexion mechanism), whether from something as light as a fender bender or from something as powerful as a football tackle. When the head is suddenly jerked back and forth beyond its normal limits, the muscles and ligaments supporting the spine can be over-stretched or torn. However, one can be struck from the from (hyperflexion/hyperextention mechanism) or from the side (T-bone mechanism). These mechanisms can also be complicated such as by the position of one's neck during the impact and/or if one was aware of the impending impact (refer to 'Risk Factors' below).
In a rear end collision for example, whiplash can be divided into four basic phases:
3. What symptoms are associated with whiplash?
The following lists the % rate of symptom occurrence. If you experience any of these symptoms, play it safe and get a chiropractic check up:
4. What structures are damaged in whiplash injuries?
Whiplash injuries can damage just a few structures or many, depending on the severity of the accident and direction of the injurious forces, to name a few. Some of the more common pain-sensitive structures that are damaged include:
Damage to any of these structures results in tissue inflammation, tissue edema, microscopic hemorrhage, and the release of noxious chemicals such as histamine, prostaglandins, substance P, and kinins which further hypersensitize already painful and injured tissues.
5. Risk Factors:
The resulting instability of the spine and soft tissues are noteworthy and depend on several important factors:
6. How is whiplash treated?
The most important aspect of a successful treatment program involves active patient participation and patient compliance to the agreed upon program. When treatments focus solely on pain-relief and not tissue rehabilitation or when patients fail to comply with the prescribed treatment plan, the chronicity of problems becomes highly likely.
Early intervention with chiropractic treatment is one of the only proven effective forms of care in the treatment of acute and chronic whiplash related injuries. Through the use of carefully controlled pressures directed at specific spinal segments and various physical therapy modalities, combined with that of exercise and nutrition, whiplash sufferers have a better outcome. This is also known as 'chiropractic rehabilitation', and, is the unique domain of the chiropractic physician.
Studies have demonstrated that without early intervention of promoting proper movement within the fixated spinal joints, osteoarthritis of the spine and nerve root complications may be accelerated.
Whiplash associated disorders do not exclude children. In fact, children involved in automobile accidents are often neglected in these types of injuries when in actuality, they suffer from the same symptoms as adults and are at a greater risk for damages due to their underdeveloped musculo-skeletal structures. Adding fuel to the fire, a number of insurance companies object to paying for the care of children when the literature shows that they are at two-thirds the risk of adults.
The chiropractic approach to treating whiplash injuries is highly successful compared with other health care professionals because chiropractors focus on rehabilitating the injured tissues and restoring optimal function. This is reflected in the high patient satisfaction scores that chiropractors have received in "patient satisfaction surveys" performed on MVA patients.
Chiropractic care is a safe, natural, noninvasive, and addresses the cause of the symptoms. Our treatments also include active patient participation, and in some cases, lifestyle modifications. While we do focus on eliminating pain early on, we realize that in addition to pain - optimal tissue healing, restoration of normal function and prevention of future recurrences and re-injuries - are equally important.
Our treatments are highlighted by our use of many gentle and highly effective spinal adjustment techniques. When used properly, these techniques allow us to safely and effectively reduce pain levels, reduce muscles spasms, eliminate inflammation, restore normal joint motion and biomechanics, prevent or minimize degenerative processes, and, minimize the likelihood of future recurrences.
We also incorporate many natural and safe chiropractic spinal/joint adjustment techniques into our treatment plan to further assist in the healing process. Some common adjunctive therapies include physiotherapy such as: low-level laser therapy (LLLT); ice therapy (cryotherapy); heat therapy; therapeutic ultrasound; electronic muscle stimulation; cervical spinal decompression traction; soft tissue mobilization; spinal stretches and strengthening exercises; nutritional supplementation; ergonomic and lifestyle modification counseling.
7. How long do whiplash treatments take?
As with any other injury, there are a number of factors which influence the treatment length of whiplash injuries:
The easiest and most effective way of eliminating pain and preventing residual and chronic problems is to start care immediately following the accident. As you allow time to slip by without seeking appropriate treatment, your injuries become more permanent and far more difficult to manage.
8. Will I have future problems from my whiplash injury?
Numerous studies show that many whiplash victims have a relatively poor outcome without immediate and appropriate treatment. One such study found that 75% of patients with whiplash still suffer from symptoms 6 months after the accident. Experts agree that individuals with any degree of neck complaints following an auto accident dramatically improve their prognosis if they seek immediate evaluation and appropriate treatment within hours of the accident.
9. Interesting whiplash statistics:
Injuries to the neck (soft-tissue and bony) caused by a rapid movement of the head backward, forward, or side to side, is commonly referred to as "Whiplash" or in other words, a whiplash associated disorder (WAD). Whether a result of a car accident, slip/trip and fall, sport or work injury, whiplash or other neck injuries warrant a thorough chiropractic check-up. The biggest danger with these injuries is that the symptoms can ‘silently’ take days, months or years to develop. Too often people don't seek treatment until more serious complications develop. Even after whiplash victims settle their insurance claims, between 39%-56% report they still suffer with symptoms two years later.
In the past, a typical whiplash injury where no bones were broken, was hard to document. Soft tissue injuries do not show up on x-ray and insurance companies would deny coverage. Literally adding insult to injury, the patient suffering all too real pain was considered to be a fraud, a liar, or at best a hypochondriac. New imaging devices (CT Scans, Magnetic Resonance Imaging (MRI), Ultra-Sound) may now show soft tissue injury and now insurance companies cover most whiplash injuries.
When no bones are broken and the head doesn't strike the windshield, typical symptoms are as follows: 92% complain of neck pain, which typically starts two hours up to two days after the accident. This is often the result of tightened muscles that react to either muscle tears or excessive movement of joints from ligament damage. The muscles tighten in an effort to splint and support the head, limiting the excessive movement.
About 57% of those suffering from whiplash complain of headaches. The pain may be on one side or both, on again off again or constant, in one spot or more generalized. These headaches, like the neck pain, are often the result of tightened, tensed muscles trying to keep the head stable and, like tension headaches, they are often felt behind the eyes.
Shoulder pain often described as pain radiating down the back of the neck into the shoulder blade area, may also be the result of tensed muscles, accounting for 49% of injuries caused by whiplash.
Muscle tears are often described as burning pain, prickling or tingling. More severe disc damage may cause sharp pain with certain movements, with or without radiation into the arms, hand and fingers, which are relieved by holding your hand over your head.
11. Crash Facts:
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I have been a patient of Dr. Pisarek for a few years now. Every morning I have to say "thank you Dr. P.!". Your care and your treatment renew my energy... no more pains in my lower back, knee and foot. With your help I lost 20 pounds and I am keeping it off. I am really grateful to you and your wife Hilda for taking care of me. My retirement got a new meaning, thanks to you.