In my experience, I have found that whiplash is a commonly misunderstood diagnosis among the patient population. Many people self-diagnose neck pain after a bad roller coaster 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 often mismanaged by unscrupulous individuals who have a vested interest in the personal injury business.
Whiplash is a common name for a group of neck disorders known as a cervical acceleration-deceleration injury or a cervical sprain / strain injury. It occurs when the head and neck are set in motion and are suddenly forced to stop, causing a hyperflexion or hyperextension movement. This irregular movement of the neck causes the spinal ligaments to sprain and the muscles immobilize the unstable structure. This type of injury is also known to cause the discs in the spine to bulge and herniate, further complicating matters.
It’s easy to see how whiplash can be a real neck pain (pun intended), but most people treat it like a sprained ankle and expect the pain to go away within a few weeks. However, there may be long-term consequences; even for people with no immediate pain symptoms. Research has shown that whiplash-associated disorders are related to inflammatory and endocrine problems such as 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 harm (2). Additionally, people who report whiplash injuries after a rear-end accident are likely to show complaints of headaches, TMJ, back pain, fatigue, and trouble sleeping 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).
Although the focus of my practice has never been on car accident cases, the truth is that most drivers will be involved in a collision no matter how good drivers they are. Most are not likely to feel pain immediately after a collision, especially if you are a teenager or in your early 20s. 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 bends in the neck, anterior ligament instability, displacement of the atlas, and anterior head syndrome. A recent study has found that this type of trauma to the spine can cause parts of the brain and brainstem to slide 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 predispose 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 every day with secondary conditions like headaches and TMJ related to accidents that took place many years before. While some of these patients suffered painful injuries and received treatment after 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-rays and see that the structure of the neck conforms to the familiar S-shape from a previous rear-end collision.
These are his take-home messages:
• First, problems can grow in the body in the absence of symptoms. Just like cancer and heart disease don’t happen overnight, people with chronic pain generally experience slow physiological changes in their brain and hormonal systems for years before having a condition that won’t go away.
• Second, if you have a physical / structural problem, you should go beyond treating pain symptoms to help get a complete resolution of the problem. Whiplash injuries cause various structural problems in the spine. While pain relief is important, making the pain go away and leaving the structure in disrepair is like pulling the battery out of a smoke detector when there is a house fire.
Whiplash-associated disorders can be a complicated problem that requires a comprehensive solution. When selecting a team of doctors, make sure you have someone in your corner who can look at you from a functional point of view rather than pure pathology, who 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 increased sensitivity to negative feedback of the hypothalamic-pituitary-adrenal axis in chronic disorder associated with whiplash. Bread. December 2005. 119 (1). 219-224.
2. Banic B, Peterson-Felix S, Anderson OK et al. Evidence of spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia. Bread. 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 problems. J of Clinical Epidemiology. 2001 Aug (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. July 2001; 21 (4): 272-7
5. Kivioja J, Ozenci V, Rinaldi L. Systemic response in whiplash injuries and ankle sprain: elevated IL06 and IL-10. Clin Immunol. October 2001; 101 (1): 106-12.
6. Freeman MD, Rosa S, Harshfield D et al. A case-control study of cerebellar tonsil ectopy (Chiari) and head / neck trauma (whiplash). Brain Inj. 2010; 24 (7-8): 988-94.