Injuries After Whiplash

Written By Advanced Spine Center on March 21, 2016

Over the last 20 years, a clearer picture has emerged defining the forces generated and the resultant spinal injuries from a whiplash process.

There are two ways to approach the problem of finding out what is wrong with you.

1. The non-technical description;

2. A more involved description which you will only partially understand as you begin to learn the details of what can happen to you as a result of being whiplashed. A classical whiplash process describes what happens to the head and the spine of an individual in a car that gets rear-ended. The studies include detailed analysis of the forces transmitted to the biomechanics of the head movement in relation to the spine. The studies include mechanical models as well as empirical analysis of volunteers who are placed in automobiles and crashed while the occupant’s neck is monitored with accelerometers to record the forces it experiences during the whiplash process.

Here is a little of what we know:

1. Low speed crashes (8-10 mile per hour) generate enough force (8-12Gs) to injure the supporting ligaments of the neck (cervical spine). Reference 1

2. Some of the supporting ligaments that are at risk for injury include:

  • Transverse, alar and accessory ligaments that support the alignment of C1 on C2;
  • The anterior longitudinal ligament (ALL) a support structure that interconnects the vertebrae of the neck supporting the front of the cervical spine;
  • The posterior longitudinal ligament (PLL) that supports the rear of the vertebral column;
  • A combination of both the ALL and PLL support structures that creates maximum ligamentous laxity.
  • The capsular ligaments that support the facet joints located on each side of the neck.

capsular ligaments

The interspinous ligaments that connect and support the spinous processes horizontally

interspinous ligaments

  • The transverse ligament that supports the C1-C2 connection and prevents C1 translation forward on C2.
  • Any of the neck’s cervical disc’s (C2-C7) envelope or outer coating causing herniation of nucleus propulsus (movement of the stuff inside the disc toward the outside).

herniation

Damage to any or all of these ligaments creates abnormal biomechanics usually characterized by loss of normal cervical lordosis (curve). The loss of the curve is not due to spasm although the neck may be in spasm. The abnormal biomechanics causes the neck to slowly degenerate. The patient will feel pain and tightness in an episodic fashion depending on the stress in their lives. The biochemistry for the degenerative process is turned on. Without treatment the effect of degeneration will begin to show in an X-ray after about 7 years.

3. Translation of one vertebrae on another is the basis of whole body impairment. Impairment here refers to loss of function either through pain or reduction in the normal range of motion or both. According to the AMA, translations equal to or greater than 3.5 mm in the cervical spine constitute a range of impairment of 25-28% Reference 1. The movement can be either in one direction or the combination of forward (antero) and backward (retro) movement. Generally, in a whiplash type of injury there is ligamentous damage to cause either forward translation or backward or both.

4. Ligament damage is permanent and considered by the medical and legal communities to be a very significant injury. The damaged ligament never returns to its original uninjured state. Damaged neck ligaments used by the person do not supply the proper support and do not allow normal movement of the neck. Although the damage can become progressive, the result is always the same: function is lost resulting in instability from abnormal biomechanics. A constant palpable pain in or around the joint that is unstable can often determine instability. You might not be aware of the problem unless you palpate the area.

5. Over time, joint instability produces DJD, degenerative joint disease. This always happens because the localized pain stimulates the biochemistry necessary for what we see as degenerative disease. The body is trying to solve a problem by fusing the joint. A musculoskeletal specialist can often determine the approximate age of the injury by the amount of degeneration observed in an X-ray.

6. Joint instability produces a flood of biochemical messages signaling inflammation in the area of injury that leak into the general body. Inflammation has been cited as the leading cause of heart disease.3 (No, it is not high cholesterol!) Reference 3

Injuries and My Accident

So, if you were just in an accident, should you be worried? The answer is Yes, but the only way to find out if you are injured or not is see a specialist who is experienced in looking for these type of injuries.

The doctors at the Advanced Spine Center have over 15 years’ experience in diagnosing and treating these type of injuries. Of all the medical disciplines, a chiropractor is best suited for this determination because of extensive training in musculoskeletal problems and conservative treatment methods that have been shown to help auto accident victims. An orthopedist or neurosurgeon is a good second choice but medical doctors only have pain management drugs and surgery as treatments.

Many of the pain management drugs lead to addiction while others have been shown to inhibit the healing process. Drugs and surgery should be considered but only after all the conservative treatments have been exhausted.

 

References:
1. Arthur Croft, “Man vs Machine I” DVD. Available from Spine Research Institute of San Diego.
2. American Medical Association, “Guides to the Evaluation of Permanent Impairment” Fifth Edition, p 378.
3. Hathaway, Richard; Live Extension Magazine, ”How Aging Humans Can Slow and Reverse Atherosclerosis, March 2010.