A “Whiplash” injuries are damage to the soft-tissues of the neck and upper back. The rapid back and forth motion of the head is what causes a whiplash injury. These injuries occur in rear-end collisions, contact sports, and “slip and falls”. The first symptoms of a whiplash injury are usually muscle tightness and pain. But where does the pain come from?
The Evolution of a Whiplash Injury
Whiplash injuries begin within 50 milliseconds of a rear end accident. The body below the neck moves forward in relation to the neck, causing the curve in the neck to straighten. From 100-200 msec, the lower half of the neck extends while the upper half flexes. Next, the head accelerates backwards, and is (hopefully) stopped by the head rest. Lastly, the head and neck accelerate forward, now (hopefully) stopped by the seat belt or air bag. Within 300msec, a whiplash injury has occurred. This is faster than we can brace or guard, even when we see the accident coming.
Whiplash injuries typically involve tendons (“strain”), ligaments and joint capsules (“sprains”), and disk injuries (tears, herniation). Concussions (traumatic brain injuries) can occur even without anything the head.
There are many factors that contribute to whiplash injuries.
Everything from the angle and firmness of the seat, headrest position, and condition of the road surface, can affect injuries.
The symptoms of whiplash can vary but most frequently include neck pain and stiffness, sore muscles and headaches. These types of injuries can result in a condition called myofascial pain.
Other symptoms can include:
- Dizziness (vertigo)
- Muscle weakness.
If a concussion occurs, additional signs can include cognitive problems, memory loss, anxiety, difficulty sleeping, fatigue, and more.
So what is causing your neck or back pain? Is it the muscles, ligaments, joints, tendons? With so many symptoms associated with whiplash, ‘whiplash associated disorders’ (WAD) is used to describe these cases.
The four categories of WAD:
1) few symptoms/no exam findings
2) more symptoms/positive exam findings but no nerve pain
3) nerve pain—numb/tingling and/or muscle weakness
“Cervical sprain/strain” refers to ligament and muscle injuries. Muscles move bones and joints and are very elastic while ligaments firmly hold two bones together at a joint. A strain refers to a muscle and/or tendon injury. Both sprains (ligaments) and strains (muscle/tendon) are graded to describe how serious the injury is. Typically, they’re graded as one, two, and three or, mild, moderate, and severe. How quickly these injuries heal depends on the severity of the injury as well as what type of treatment received. The pain from a whiplash injury can last for weeks, months, or even become a permanent problem.
What makes whiplash injuries unique is the many layers of muscle in the cervical spine.
The different layers of muscle run in different directions performing different jobs. The muscles on the surface tend to be long, large, and strong. Deep cervical muscles are short and small, and involved with fine motor control and coordination.
The prognosis of WAD is generally good. Many patients will recover from their injuries without any residual problems within days to weeks. Most auto accident victims will recover from their injuries in 60 to 90 days after their accident. However, some people aren’t that lucky. For instance, some patients will continue to have neck pain, stiffness, headaches, and even post-concussive syndrome (traumatic brain injury or TBI). TBI’s can affect mental function, memory, vision, and other higher brain functions. Usually, the higher the WAD category, the worse the prognosis.
Medically integrated practices have proven to be the most effective way to treat whiplash injuries.
WAD commonly occurs as a result of a car crash but can also result from many other causes. For instance, These include slip and falls, sports injuries and even assaults. The tissues commonly injured are tendons (“strains”), ligaments and joint capsules (“sprains”), and disk injuries (tears, herniation). Traumatic brain injuries (TBI or concussions) can occur even without hitting the head.
Occasionally, If concussion occurs, additional symptoms include cognitive problems, concentration loss, poor memory, anxiety/depression, nervousness/irritability, sleep disturbance, fatigue, and more!
There are 3 Categories of Whiplash Associated Disorders:
1) WAD I includes symptoms without any significant examination findings
2) WAD II includes loss of cervical range of motion and evidence of soft-tissue damage
3) WAD III includes WAD II elements with neurological loss—altered motor and/or sensory functions.
There is a WAD IV which includes fracture. However, this is not very common and is often excluded from the list.
Effective treatment of WAD should include intensive management from many providers including chiropractors, medical doctors, and physical therapists. In serious instances, clinical psychologists, pain management specialists, and specialty providers (neurologists, orthopods) can also be needed. The goal of treatment is to restore normal function and activity participation, as well as symptom management.
The prognosis of WAD is generally good, with most people recovering with no residual problems in days to weeks. Most people will recover in 3 to 4 months after the injury. Unfortunately, some are not so lucky. Some have continued neck pain, stiffness, and headache. Some patients can develop post-concussive syndrome. This affects cognition, memory, vision, and other brain functions. Typically, the worse the WAD category, the worse the prognosis. Additionally, if the injury includes neurological symptoms (numbness, tingling, burning, pressure), the prognosis is often worse.
Care for the WAD patient can include acupuncture, chiropractic, dry needling, physical therapy, and massage therapy. In addition, home-based exercises and instruction on proper work ergonomics are also very important.