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Cervical Whiplash Injury

Why is it Important?

Problems associated with whiplash affect 20 million people in the United States. Since whiplash is commonly associated with motor vehicle accidents and with more and more congestion on our roads and highways, the number of whiplash accidents is increasing. Whiplash seems to be poorly understood by the public. The term has emerged in the public mind as a phenomenon whose very existence has been questioned. It is significant that over 90% of auto accidents are nonfatal, minor collisions but it is this group that accounts for over 50% of the economic costs associated with auto accidents. 

Part of the problem is that historically whiplash diagnosis and management has been elusive to an orthodox medical approach because of the inadequacy of diagnostic tests in documenting spinal soft tissue injury. It has only been in recent years that research has focused on the low to medium impact collisions as representing a genuine clinical entity with symptoms based on actual injury.  

What is Whiplash?

Whiplash is sometimes called hyperextension-hyperflexion injury to the cervical spine or cervical acceleration-deceleration (CAD) injury; names which are descriptive of the mechanism of injury. In the typical whiplash injury, the victim is struck from behind. The head and neck are vulnerable to injury because of their position at the end of the spine which functions as a long lever. As the auto is impacted the head is thrown into extension with the acceleration forces rapidly increasing as they move up the spine into the head. The head then rebounds into hyperflexion.

The sudden acceleration forcing the head into hyperextension stretches and damages the muscles and supporting structures at the front of the neck. The deceleration movement has a similar effect on the structures at the back of the neck including the spinal cord.  

What are the Symptoms Associated with Whiplash? 

Whiplash injury frequently represents a complex clinical picture and is complicated by the fact that initially there may be an absence of positive diagnostic signs, a delay in the onset of symptoms and a long-term persistence of complaints and dysfunction. 

In addition to the pain and stiffness arising from involvement of the spinal joints, their associated connective tissues and muscles of the neck, the nervous system may become injured due to the close proximity of the cervical spinal cord to the brainstem and brain. The result may be a myriad of secondary complaints such as headaches, disorientation and the inability to concentrate, vertigo, insomnia, tingling and numbness into hands and fingers or even the lower extremities. 

How is Whiplash Injury Prevented and Treated? 

Although seat belts tend to increase acceleration forces to the cervical spine they do restrain the occupant in the seat preventing severe injury to the head and chest. Features such as hydraulic bumper systems tend to dissipate impact forces before they are transferred to the occupant. Headrests should be adjustable but secured into position so as to prevent the head from ramping over the top. Ideally they should come into contact with the back of the head and neck. Seatbacks should provide support for the entire spine.  

Approaches to treatment require active manual intervention to begin as early as is clinically possible in order to avoid long-term problems affecting the cervical intervertebral joints and supporting muscles. The goals of treatment should be to control inflammation and pain, normalize joint movement and the function of supporting soft tissue structures. Prolonged immobilization should be avoided if possible. Use of a soft collar is appropriate with certain clinical findings. Even while immobilized ice massage and isometric exercises may be indicated. When there is no contraindication to manual care, various mobilization techniques can be employed to prevent muscle contractures and to bring about the restoration of joint mobility. 

Sources:
1) Brier, Steven R. Primary Care Orthopedics. St. Louis: Mosby, Inc., 1999
2) Nordhoff, Jr., Lawrence S. Motor Vehicle Collision Injuries. Gaithersburg: Aspen
    Publishers, Inc., 1996

 

 

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