In my experience, I’ve found that whiplash is a commonly misunderstood diagnosis among the patient population. Many people self-diagnose the pain in the neck following a bad roller coaster ride or car accident as a whiplash injury. While they may or may not be correct, the truth is that whiplash is a type of injury with serious implications, and is frequently mismanaged by unscrupulous folks with a big stake in the business of personal injury.
Whiplash is a common name for a group of neck disorders known as cervical acceleration-deceleration injury or cervical sprain/strain injury. It occurs when the head and neck are placed in motion and suddenly forced to a stop causing a hyperflexion or hyperextension motion. This irregular movement of the neck causes the ligaments of the spine to sprain and the muscles to splint the unstable structure. This type of injury is also known to cause the discs of the spine to bulge and herniate, thus complicating matters even further.
It’s easy to see how whiplash can be a real pain in the neck (pun intended), but most people treat it like a sprained ankle and hope that the pain goes away in a few weeks. However, there can be long term consequences; even for people who don’t have pain symptoms immediately. Research has shown that whiplash associated disorders are related to inflammatory and endocrine problems like those seen in chronic fatigue syndrome or fibromyalgia (1). Whiplash is also associated with chronic pain by making your brain more sensitive to pain signals, which explains why so many people can suffer without any evidence of physical damage (2). Additionally, people who report whiplash injuries after a rear-end accident are likely to show complaints of headaches, TMJ, back pain, fatigue, and sleep problems even 7 years later (3)! Whiplash has even been associated with chronic inflammation by making the body’s own immune system overly responsive to normal stimuli (4, 5).
Though the focus of my practice has never been on auto-accidents cases, the truth is that most drivers will be involved in a collision no matter how good a driver they may be. Most will probably not experience pain immediately after a collision, especially if you’re in your teens or early 20’s. However, the impact of a vehicle traveling at speeds as low as 15 mph can show visible signs of structural damage to the neck. These include s-shaped curves in the neck, anterior ligament instability, Atlas Displacement, and Anterior Head Syndrome. A recent study has found that this type of trauma to the spine can cause parts of the brain and brain stem to slip further into the neck creating a condition called Chiari Malformation (6). While they may not be painful in their early stages, these structural changes can pre-dispose the spine to early degeneration and arthritis if left uncorrected over the course of several years.
As a chiropractor focused on structural correction, I see patients everyday with Secondary Conditions like headaches and TMJ related to accidents that took place many years earlier. While some of these patients suffered painful injuries and received treatment following an accident, most people will walk in and say they didn’t have any symptoms until years later. When someone asks why their pain seemed to come out of nowhere, I can usually look at their x-ray and see that the structure of the neck fits the familiar S-shape of a previous rear end collision.
Here are your take home messages:
• First, problems can grow in the body in the absence of symptoms. Much like cancer and heart disease don’t happen overnight, people with chronic pain usually under go slow physiologic changes in their brain and hormonal systems for years before they have a condition that won’t go away.
• Second, if you have a physical/structural problem, then you must go beyond treating the pain symptoms to help get full resolution of the problem. Whiplash injuries cause distinct structural problems in the spine. While pain relief is important, making the pain go away while leaving the structure in bad shape is like taking the battery out of a smoke detector when a fire is burning in the house.
Whiplash associated disorders can be a complicated problem that requires a comprehensive solution. When selecting a team of doctors, make sure that you have someone in your corner that can look at you from a functional standpoint rather than sheer pathology, that addresses the structure of your spine in 3-dimensions, and understands the nature of traumatic injuries.
References:
1. Gaab J, Baumann S, Budnoik A et al. Reduced reactivity and enhanced negative feedback sensitivity of the hypothalamus-pituitary-adrenal axis in chronic whiplash associated disorder. Pain. December 2005. 119(1). 219-224.
2. Banic B, Peterson-Felix S, Anderson OK et al. Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia. Pain. January 2004. 7-15.
3. Berglund A, Afredsson L, Jensen I, Cassidy JD, Nygren Ake. The association between exposure to a rear-end collision and future health complaints. J of Clinical Epidemiology. Aug 2001 (54): 851-856.
4. Kivioja J, Rinaldi L, Ozenci V et al. Chemokines and their receptors in whiplash injury: elevated RANTES and CCR-5. J Clin Immunol. Jul 2001; 21(4): 272-7
5. Kivioja J, Ozenci V, Rinaldi L. Systemic response in whiplash injury and ankle sprain: elevated IL06 and IL-10. Clin Immunol. Oct 2001; 101(1): 106-12.
6. Freeman MD, Rosa S, Harshfield D et al. A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash). Brain Inj. 2010; 24(7-8): 988-94.