Whiplash is a generic term applied to
injuries of the neck caused when the neck is suddenly and/or violently
jolted in one direction and then another, creating a whip-like
movement. Whiplash is most commonly seen in people involved in motor
vehicle accidents, but it can also occur from falls, sports injuries,
work injuries, and other incidents.
What structures are injured in a whiplash?
Whiplash injuries most often result in sprain-strain of the neck. The
ligaments that help support, protect, and restrict excessive movement
of the vertebrae are torn, which is called a sprain. The joints in the
back of the spine, called the facet joints, are covered by ligaments
called facet capsules, which seem to be particularly susceptible to
whiplash injury.
In addition, the muscles and tendons are strained—stretched beyond
their normal limits. The discs between the vertebrae, which are
essentially ligaments, can be torn, potentially causing a disc
herniation. The nerve roots between the vertebrae may also be stretched
and become inflamed. Even though it is very rare, vertebrae can be
fractured and/or dislocated in a whiplash injury.
What are the common signs and symptoms of whiplash?
The most common symptoms of whiplash are pain and stiffness in the
neck. These symptoms are generally found in the areas that are
“whiplashed.” For example, during a whiplash, first the head is lifted
up from the upper-cervical spine. This creates a sprain/strain in the
region just below the skull, where symptoms usually occur. Symptoms may
also commonly be seen in the front and back of the neck. Turning the
head often makes the pain and discomfort worse.
Headache, especially at the base of the skull, is also a common
symptom, seen in more than two thirds of patients. These headaches may
be one-sided (unilateral) or experienced on both sides (bilateral). In
addition, the pain and stiffness may extend down into the shoulders and
arms, upper back, and even the upper chest.
In addition to the musculoskeletal symptoms, some patients also
experience dizziness, difficulty swallowing, nausea, and even blurred
vision after a whiplash injury. While these symptoms are disconcerting,
in most cases, they disappear within a relatively short time. If they
persist, it is very important to inform your doctor that they are not
resolving. Vertigo (the sensation of the room spinning) and ringing in
the ears may also be seen. In addition, some patients may feel pain in
the jaw. Others will even complain of irritability, fatigue, and
difficulty concentrating. These symptoms also resolve quickly in most
cases. In rare cases, symptoms can persist for weeks, months, or even
years.
Another important and interesting aspect of whiplash is that the signs
and symptoms often do not develop until 2 to 48 hours after the injury.
This scenario is relatively common but not completely understood. Some
speculate that it may be due to delayed muscle soreness, a condition
seen in other circumstances.
How is whiplash treated?
Staying active
One of the most important aspects of whiplash management is for the
patient to stay active, unless there is some serious injury that
requires immobilization. Patients should not be afraid to move and be
active, within reason. In addition, your doctor will often prescribe an
exercise or stretching program. It is particularly important to follow
this program as prescribed, so that you can achieve the best long-term
benefits.
Chiropractic manipulation and physical therapy
Ice and/or heat are often used to help control pain and reduce the
muscle spasm that results from whiplash injuries. Other physical
therapy modalities, such as electrical stimulation and/or ultrasound,
may provide some short-term relief. They should not, however, replace
an active-care program of exercise and stretching. Spinal manipulation
and/or mobilization provided by a chiropractor can also give relief in
many cases of neck pain.
Can whiplash be prevented?
Generally speaking, whiplash cannot be “prevented,” but there are some
things that you can do while in a motor vehicle that may reduce the
chances of a more severe injury. Always wear restraints (lap or
shoulder belt), and ensure that the headrest in your vehicle is
adjusted to the appropriate height.
Wednesday, April 18, 2012
Migraines and Headaches
Migraines and headaches are NOT the result of an Aspirin shortage. They are NOT normal, and everyone does NOT have them.
A frequent and overlooked cause of Migraines and other headaches is the malfunction of the spinal bones in the neck and upper back.
When the bones of the spine lose their normal position or motion, sensitive nerves and blood vessels to the head can be affected. When spinal nerves and related tissues are stretched or irritated, they can produce Migraines and other types of headaches. Aspirin and other medications may cover up these warning signs, but do not correct the underlying structural CAUSE.
Many people experience correction and long term relief through Chiropractic care, without the short and long term side effects that accompany ALL pain medications.
Call our office to have your type of Migraine or Headache diagnosed and discover the life changing experience many of our Migraine / Headache patients have found.
The Docs at North Dallas Chiropractic
A frequent and overlooked cause of Migraines and other headaches is the malfunction of the spinal bones in the neck and upper back.
When the bones of the spine lose their normal position or motion, sensitive nerves and blood vessels to the head can be affected. When spinal nerves and related tissues are stretched or irritated, they can produce Migraines and other types of headaches. Aspirin and other medications may cover up these warning signs, but do not correct the underlying structural CAUSE.
Many people experience correction and long term relief through Chiropractic care, without the short and long term side effects that accompany ALL pain medications.
Call our office to have your type of Migraine or Headache diagnosed and discover the life changing experience many of our Migraine / Headache patients have found.
The Docs at North Dallas Chiropractic
Low Back Pain
Low back pain is the cause of many
patients who limp, hobble or even crawl in to our office. Its not
surprising to learn that Low back pain results in millions of dollars
of lost work and untold suffering every day.
Low back pain usually falls in to one of the following categories:
1. Patients have experienced chronic long term pain or discomfort with multiple episodes of increased pain which come and go.
Many of these people either cover the pain with OTC or prescription medications, or decide to just live with it. The problem is that all medications have both short and long term side effects. Only in rare cases should this be considered as a long term treatment option to this typically correctable problem.
As far as just living with the pain, two areas must be considered.
First, pain is NOT normal, so there IS something wrong. Ignoring it, or just dealing with it allows the condition to progress undiagnosed and untreated. Lastly, why live with it and the effects it can have on your QUALITY of life, if you don't have to.
2. These patients are the limpers, hobblers and crawlers. Their pain started all at once and hit hard and fast. We typically hear something like "I just reached down to pick up a book and my back went out." Another common statement goes something like "I have never had low back pain before."
This type of condition can stop even the most determined and tough individual in their tracks and literally bring them to their knees. This can be a very scary time for those who have never experienced this before.
Typically our spinal examination reveals long time trauma or misalaignment of the Lumbar vertebrae, the sacrum or the hips. The body has gotten to a point where it is overcome by these conditions and literally stops functioning properly.
NOTE: There are a number of causes of low back pain. Most who seek out our office fall into the category of Chiropractic care to fix the CAUSE of the problem. We have great success with these patients. Occasionally, we find that the problem is not musculo-skeletal related and in these cases, they are referred to to another type of Doctor who specializes in their particular condition.
Dr Ewing - Dr. Soto - North Dallas Chiropractic
Low back pain usually falls in to one of the following categories:
1. Patients have experienced chronic long term pain or discomfort with multiple episodes of increased pain which come and go.
Many of these people either cover the pain with OTC or prescription medications, or decide to just live with it. The problem is that all medications have both short and long term side effects. Only in rare cases should this be considered as a long term treatment option to this typically correctable problem.
As far as just living with the pain, two areas must be considered.
First, pain is NOT normal, so there IS something wrong. Ignoring it, or just dealing with it allows the condition to progress undiagnosed and untreated. Lastly, why live with it and the effects it can have on your QUALITY of life, if you don't have to.
2. These patients are the limpers, hobblers and crawlers. Their pain started all at once and hit hard and fast. We typically hear something like "I just reached down to pick up a book and my back went out." Another common statement goes something like "I have never had low back pain before."
This type of condition can stop even the most determined and tough individual in their tracks and literally bring them to their knees. This can be a very scary time for those who have never experienced this before.
Typically our spinal examination reveals long time trauma or misalaignment of the Lumbar vertebrae, the sacrum or the hips. The body has gotten to a point where it is overcome by these conditions and literally stops functioning properly.
NOTE: There are a number of causes of low back pain. Most who seek out our office fall into the category of Chiropractic care to fix the CAUSE of the problem. We have great success with these patients. Occasionally, we find that the problem is not musculo-skeletal related and in these cases, they are referred to to another type of Doctor who specializes in their particular condition.
Dr Ewing - Dr. Soto - North Dallas Chiropractic
What to Do If Injured in an Accident and Suffer From Whiplash
The term "whiplash" was first used in
1928 to define an injury mechanism of sudden hyperextension followed by
an immediate hyperflexion of the neck that results in damage to the
muscles, ligaments and tendons – especially those that support the
head. Today, we know that whiplash injuries frequently do not result
from hyperextension or hyperflexion (extension and flexion beyond
normal physiological limits), but rather an extremely rapid extension
and flexion that causes injuries.
Due to their complicated nature and profound impact on peoples lives, few topics in health care generate as much controversy as whiplash injuries. Unlike a broken bone where a simple x-ray can validate the presence of the fracture and standards of care can direct a health care professional as to the best way in which to handle the injury, whiplash injuries involve an unpredictable combination of nervous system, muscles joints and connective tissue disruption that is not simple to diagnose and can be even more of a challenge to treat. In order to help you understand the nature of whiplash injuries and how they should be treated, it is necessary to spend a bit of time discussing the mechanics of how whiplash injuries occur.
The Four Phases of a Whiplash Injury
During a rear-end automobile collision, your body goes through an extremely rapid and intense acceleration and deceleration. In fact, all four phases of a whiplash injury occur in less than one-half of a second! At each phase, there is a different force acting on the body that contributes to the overall injury, and with such a sudden and forceful movement, damage to the vertebrae, nerves, discs, muscles, and ligaments of your neck and spine can be substantial.
Phase 1
During this first phase, your car begins to be pushed out from under you, causing your mid-back to be flattened against the back of your seat. This results in an upward force in your cervical spine, compressing your discs and joints. As your seat back begins to accelerate your torso forward, your head moves backward, creating a shearing force in your neck. If your head restraint is properly adjusted, the distance your head travels backward is limited. However, most of the damage to the spine will occur before your head reaches your head restraint. Studies have shown that head restraints only reduce the risk of injury by 11-20%.
Phase 2
During phase two, your torso has reached peak acceleration - 1.5 to 2 times that of your vehicle itself - but your head has not yet begun to accelerate forward and continues to move rearward. An abnormal S-curve develops in your cervical spine as your seat back recoils forward, much like a springboard, adding to the forward acceleration of the torso. Unfortunately, this forward seat back recoil occurs while your head is still moving backward, resulting in a shearing force in the neck that is one of the more damaging aspects of a whiplash injury. Many of the bone, joint, nerve, disc and TMJ injuries that I see clinically occur during this phase.
Phase 3
During the third phase, your torso is now descending back down in your seat and your head and neck are at their peak forward acceleration. At the same time, your car is slowing down. If you released the pressure on your brake pedal during the first phases of the collision, it will likely be reapplied during this phase. Reapplication of the brake causes your car to slow down even quicker and increases the severity of the flexion injury of your neck. As you move forward in your seat, any slack in your seat belt and shoulder harness is taken up.
Phase 4
This is probably the most damaging phase of the whiplash phenomenon. In this fourth phase, your torso is stopped by your seat belt and shoulder restraint and your head is free to move forward unimpeded. This results in a violent forward-bending motion of your neck, straining the muscles and ligaments, tearing fibers in the spinal discs, and forcing vertebrae out of their normal position. Your spinal cord and nerve roots get stretched and irritated, and your brain can strike the inside of your skull causing a mild to moderate brain injury. If you are not properly restrained by your seat harness, you may suffer a concussion, or more severe brain injury, from striking the steering wheel or windshield.
Injuries Resulting from Whiplash Trauma
As we discussed briefly in the introduction, whiplash injuries can manifest in a wide variety of ways, including neck pain, headaches, fatigue, upper back and shoulder pain, cognitive changes and low back pain. Due to the fact that numerous factors play into the overall whiplash trauma, such as direction of impact, speed of the vehicles involved, as well as sex, age and physical condition, it is impossible to predict the pattern of symptoms that each individual will suffer. Additionally, whiplash symptoms commonly have a delayed onset, often taking weeks or months to present. There are, however, a number of conditions that are very common among those who have suffered from whiplash trauma.
Neck pain
It is the single most common complaint in whiplash trauma, being reported by over 90% of patients. Often this pain radiates across the shoulders, up into the head, and down between the shoulder blades. Whiplash injuries tend to affect all of the tissues in the neck, including the facet joints and discs between the vertebrae, as well as all of the muscles, ligaments and nerves.
Facet joint pain is the most common cause of neck pain following a car accident. Facet joint pain is usually felt on the back of the neck, just to the right or left of center, and is usually tender to the touch. Facet joint pain cannot be visualized on x-rays or MRIs. It can only be diagnosed by physical palpation of the area.
Disc injury is also a common cause of neck pain; especially chronic pain. The outer wall of the disc (called the anulus) is made up of bundles of fibers that can be torn during a whiplash trauma. These tears, then, can lead to disc degeneration or herniation, resulting in irritation or compression of the nerves running through the area. This compression or irritation commonly leads to radiating pain into the arms, shoulders and upper back, and may result in muscle weakness.
Damage to the muscles and ligaments in the neck and upper back are the major cause of the pain experienced in the first few weeks following a whiplash injury, and is the main reason why you experience stiffness and restricted range of motion. But as the muscles have a chance to heal, they typically don’t cause as much actual pain as they contribute to abnormal movement. Damage to the ligaments often results in abnormal movement and instability.
Headaches
After neck pain, headaches are the most prevalent complaint among those suffering from whiplash injury, affecting more than 80% of all people. While some headaches are actually the result of direct brain injury, most are related to injury of the muscles, ligaments and facet joints of the cervical spine, which refer pain to the head. Because of this, it is important to treat the supporting structures of your neck in order to help alleviate your headaches.
TMJ problems
A less common, but very debilitating disorder that results from whiplash is temporomandibular joint dysfunction (TMJ). TMJ usually begins as pain, clicking and popping noises in the jaw during movement. If not properly evaluated and treated, TMJ problems can continue to worsen and lead to headaches, facial pain, ear pain and difficulty eating. Many chiropractors are specially trained to treat TMJ problems, or can refer you to a TMJ specialist.
Brain injury
Believe it or not, mild to moderate brain injury is common following a whiplash injury, due to the forces on the brain during the four phases mentioned earlier. The human brain is a very soft structure, suspended in a watery fluid called cerebrospinal fluid. When the brain is forced forward and backward in the skull, the brain bounces off the inside of the skull, leading to bruising or bleeding in the brain itself. In some cases, patients temporarily lose consciousness and have symptoms of a mild concussion. More often, there is no loss of consciousness, but patients complain of mild confusion or disorientation just after the crash. The long-term consequences of a mild brain injury can include mild confusion, difficulty concentrating, sleep disturbances, irritability, forgetfulness, loss of sex drive, depression and emotional instability. Although less common, the nerves responsible for your sense of smell, taste and even your vision may be affected as well, resulting in a muted sense of taste, changes in your sensation of smell and visual disturbances.
Dizziness
Dizziness following a whiplash injury usually results from injury to the facet joints of the cervical spine, although in some cases injury to the brain or brain stem may be a factor as well. Typically, this dizziness is very temporary improves significantly with chiropractic treatment.
Low back pain
Although most people consider whiplash to be an injury of the neck, the low back is also commonly injured as well. In fact, low back pain is found in more than half of rear impact-collisions in which injury was reported, and almost three-quarters of all side-impact crashes. This is mostly due to the fact that the low back still experiences a tremendous compression during the first two phases of a whiplash injury, even though it does not have the degree of flexion-extension injury experienced in the neck.
Recovery from Whiplash
With proper care, many mild whiplash injuries heal within six to nine months. However, more than 20% of those who suffer from whiplash injuries continue to suffer from pain, weakness or restricted movement two years after their accident. Unfortunately, the vast majority of these people will continue to suffer from some level of disability or pain for many years after that, if not for the rest of their lives.
Whiplash is a unique condition that requires the expertise of a skilled health professional specially trained to work with these types of injuries. The most effective treatment for whiplash injuries is a combination of chiropractic care, rehabilitation of the soft tissues and taking care of yourself at home.
Chiropractic Care
Chiropractic care utilizes manual manipulation of the spine to restore the normal movement and position of the spinal vertebrae. It is by far the single-most effective treatment for minimizing the long-term impact of whiplash injuries, especially when coupled with massage therapy, trigger point therapy, exercise rehabilitation and other soft tissue rehabilitation modalities.
Soft Tissue Rehabilitation
The term ‘soft tissue’ simply refers to anything that is not bone, such as your muscles, ligaments, tendons, nervous system, spinal discs and internal organs. During a whiplash injury, the tissues that are affected most are the soft tissues, the muscles, ligaments and discs in particular. In order to minimize permanent impairment and disability, it is important to use therapies that stimulate the soft tissues to heal correctly. These include massage therapy, electro-stimulation, trigger point therapy, stretching and specific strength and range of motion exercises.
Home Care
The most effective chiropractic care and soft tissue rehabilitation will be limited in its benefit if what you do at home or at work stresses or re-injures you on a daily basis. For this reason, it is important that your plan of care extend into the hours and days between your clinic visits to help speed your recovery. Some of the more common home care therapies are the application of ice packs, limitations on work or daily activities, specific stretches and exercises, taking nutritional supplements and getting plenty of rest.
Medical Intervention
In some severe cases of whiplash, it may be necessary to have some medical care as part of your overall treatment plan. The most common medical treatments include the use of anti-inflammatory medications, muscle relaxants, trigger point injections and, in some cases, epidural spinal injections. These therapies should be used for short-term relief of pain, if necessary, and not be the focus of treatment. After all, a drug cannot restore normal joint movement and stimulate healthy muscle repair. Fortunately, surgery is only needed in some cases of herniated discs, when the disc is pressing on the spinal cord, and in some cases of spine fractures.
Due to their complicated nature and profound impact on peoples lives, few topics in health care generate as much controversy as whiplash injuries. Unlike a broken bone where a simple x-ray can validate the presence of the fracture and standards of care can direct a health care professional as to the best way in which to handle the injury, whiplash injuries involve an unpredictable combination of nervous system, muscles joints and connective tissue disruption that is not simple to diagnose and can be even more of a challenge to treat. In order to help you understand the nature of whiplash injuries and how they should be treated, it is necessary to spend a bit of time discussing the mechanics of how whiplash injuries occur.
The Four Phases of a Whiplash Injury
During a rear-end automobile collision, your body goes through an extremely rapid and intense acceleration and deceleration. In fact, all four phases of a whiplash injury occur in less than one-half of a second! At each phase, there is a different force acting on the body that contributes to the overall injury, and with such a sudden and forceful movement, damage to the vertebrae, nerves, discs, muscles, and ligaments of your neck and spine can be substantial.
Phase 1
During this first phase, your car begins to be pushed out from under you, causing your mid-back to be flattened against the back of your seat. This results in an upward force in your cervical spine, compressing your discs and joints. As your seat back begins to accelerate your torso forward, your head moves backward, creating a shearing force in your neck. If your head restraint is properly adjusted, the distance your head travels backward is limited. However, most of the damage to the spine will occur before your head reaches your head restraint. Studies have shown that head restraints only reduce the risk of injury by 11-20%.
Phase 2
During phase two, your torso has reached peak acceleration - 1.5 to 2 times that of your vehicle itself - but your head has not yet begun to accelerate forward and continues to move rearward. An abnormal S-curve develops in your cervical spine as your seat back recoils forward, much like a springboard, adding to the forward acceleration of the torso. Unfortunately, this forward seat back recoil occurs while your head is still moving backward, resulting in a shearing force in the neck that is one of the more damaging aspects of a whiplash injury. Many of the bone, joint, nerve, disc and TMJ injuries that I see clinically occur during this phase.
Phase 3
During the third phase, your torso is now descending back down in your seat and your head and neck are at their peak forward acceleration. At the same time, your car is slowing down. If you released the pressure on your brake pedal during the first phases of the collision, it will likely be reapplied during this phase. Reapplication of the brake causes your car to slow down even quicker and increases the severity of the flexion injury of your neck. As you move forward in your seat, any slack in your seat belt and shoulder harness is taken up.
Phase 4
This is probably the most damaging phase of the whiplash phenomenon. In this fourth phase, your torso is stopped by your seat belt and shoulder restraint and your head is free to move forward unimpeded. This results in a violent forward-bending motion of your neck, straining the muscles and ligaments, tearing fibers in the spinal discs, and forcing vertebrae out of their normal position. Your spinal cord and nerve roots get stretched and irritated, and your brain can strike the inside of your skull causing a mild to moderate brain injury. If you are not properly restrained by your seat harness, you may suffer a concussion, or more severe brain injury, from striking the steering wheel or windshield.
Injuries Resulting from Whiplash Trauma
As we discussed briefly in the introduction, whiplash injuries can manifest in a wide variety of ways, including neck pain, headaches, fatigue, upper back and shoulder pain, cognitive changes and low back pain. Due to the fact that numerous factors play into the overall whiplash trauma, such as direction of impact, speed of the vehicles involved, as well as sex, age and physical condition, it is impossible to predict the pattern of symptoms that each individual will suffer. Additionally, whiplash symptoms commonly have a delayed onset, often taking weeks or months to present. There are, however, a number of conditions that are very common among those who have suffered from whiplash trauma.
Neck pain
It is the single most common complaint in whiplash trauma, being reported by over 90% of patients. Often this pain radiates across the shoulders, up into the head, and down between the shoulder blades. Whiplash injuries tend to affect all of the tissues in the neck, including the facet joints and discs between the vertebrae, as well as all of the muscles, ligaments and nerves.
Facet joint pain is the most common cause of neck pain following a car accident. Facet joint pain is usually felt on the back of the neck, just to the right or left of center, and is usually tender to the touch. Facet joint pain cannot be visualized on x-rays or MRIs. It can only be diagnosed by physical palpation of the area.
Disc injury is also a common cause of neck pain; especially chronic pain. The outer wall of the disc (called the anulus) is made up of bundles of fibers that can be torn during a whiplash trauma. These tears, then, can lead to disc degeneration or herniation, resulting in irritation or compression of the nerves running through the area. This compression or irritation commonly leads to radiating pain into the arms, shoulders and upper back, and may result in muscle weakness.
Damage to the muscles and ligaments in the neck and upper back are the major cause of the pain experienced in the first few weeks following a whiplash injury, and is the main reason why you experience stiffness and restricted range of motion. But as the muscles have a chance to heal, they typically don’t cause as much actual pain as they contribute to abnormal movement. Damage to the ligaments often results in abnormal movement and instability.
Headaches
After neck pain, headaches are the most prevalent complaint among those suffering from whiplash injury, affecting more than 80% of all people. While some headaches are actually the result of direct brain injury, most are related to injury of the muscles, ligaments and facet joints of the cervical spine, which refer pain to the head. Because of this, it is important to treat the supporting structures of your neck in order to help alleviate your headaches.
TMJ problems
A less common, but very debilitating disorder that results from whiplash is temporomandibular joint dysfunction (TMJ). TMJ usually begins as pain, clicking and popping noises in the jaw during movement. If not properly evaluated and treated, TMJ problems can continue to worsen and lead to headaches, facial pain, ear pain and difficulty eating. Many chiropractors are specially trained to treat TMJ problems, or can refer you to a TMJ specialist.
Brain injury
Believe it or not, mild to moderate brain injury is common following a whiplash injury, due to the forces on the brain during the four phases mentioned earlier. The human brain is a very soft structure, suspended in a watery fluid called cerebrospinal fluid. When the brain is forced forward and backward in the skull, the brain bounces off the inside of the skull, leading to bruising or bleeding in the brain itself. In some cases, patients temporarily lose consciousness and have symptoms of a mild concussion. More often, there is no loss of consciousness, but patients complain of mild confusion or disorientation just after the crash. The long-term consequences of a mild brain injury can include mild confusion, difficulty concentrating, sleep disturbances, irritability, forgetfulness, loss of sex drive, depression and emotional instability. Although less common, the nerves responsible for your sense of smell, taste and even your vision may be affected as well, resulting in a muted sense of taste, changes in your sensation of smell and visual disturbances.
Dizziness
Dizziness following a whiplash injury usually results from injury to the facet joints of the cervical spine, although in some cases injury to the brain or brain stem may be a factor as well. Typically, this dizziness is very temporary improves significantly with chiropractic treatment.
Low back pain
Although most people consider whiplash to be an injury of the neck, the low back is also commonly injured as well. In fact, low back pain is found in more than half of rear impact-collisions in which injury was reported, and almost three-quarters of all side-impact crashes. This is mostly due to the fact that the low back still experiences a tremendous compression during the first two phases of a whiplash injury, even though it does not have the degree of flexion-extension injury experienced in the neck.
Recovery from Whiplash
With proper care, many mild whiplash injuries heal within six to nine months. However, more than 20% of those who suffer from whiplash injuries continue to suffer from pain, weakness or restricted movement two years after their accident. Unfortunately, the vast majority of these people will continue to suffer from some level of disability or pain for many years after that, if not for the rest of their lives.
Whiplash is a unique condition that requires the expertise of a skilled health professional specially trained to work with these types of injuries. The most effective treatment for whiplash injuries is a combination of chiropractic care, rehabilitation of the soft tissues and taking care of yourself at home.
Chiropractic Care
Chiropractic care utilizes manual manipulation of the spine to restore the normal movement and position of the spinal vertebrae. It is by far the single-most effective treatment for minimizing the long-term impact of whiplash injuries, especially when coupled with massage therapy, trigger point therapy, exercise rehabilitation and other soft tissue rehabilitation modalities.
Soft Tissue Rehabilitation
The term ‘soft tissue’ simply refers to anything that is not bone, such as your muscles, ligaments, tendons, nervous system, spinal discs and internal organs. During a whiplash injury, the tissues that are affected most are the soft tissues, the muscles, ligaments and discs in particular. In order to minimize permanent impairment and disability, it is important to use therapies that stimulate the soft tissues to heal correctly. These include massage therapy, electro-stimulation, trigger point therapy, stretching and specific strength and range of motion exercises.
Home Care
The most effective chiropractic care and soft tissue rehabilitation will be limited in its benefit if what you do at home or at work stresses or re-injures you on a daily basis. For this reason, it is important that your plan of care extend into the hours and days between your clinic visits to help speed your recovery. Some of the more common home care therapies are the application of ice packs, limitations on work or daily activities, specific stretches and exercises, taking nutritional supplements and getting plenty of rest.
Medical Intervention
In some severe cases of whiplash, it may be necessary to have some medical care as part of your overall treatment plan. The most common medical treatments include the use of anti-inflammatory medications, muscle relaxants, trigger point injections and, in some cases, epidural spinal injections. These therapies should be used for short-term relief of pain, if necessary, and not be the focus of treatment. After all, a drug cannot restore normal joint movement and stimulate healthy muscle repair. Fortunately, surgery is only needed in some cases of herniated discs, when the disc is pressing on the spinal cord, and in some cases of spine fractures.
The truth about low impact injuries
Low Speed Auto Accidents
Thousands of car accidents occur everyday. And every day thousands are injured. Researchers note that the majority of auto accident injury claims occur at relatively low speeds of about 12 mph or less.
Car Accident Disputes
This causes tremendous disputes between injured parties and the insurance companies that are responsible for compensating them for their car accident claim. To insurers, there really is no speed at which they want to admit an injury could occur. For economic reasons they try to dismiss whiplash or car accident injuries entirely, as if they don’t exist.
Thanks to recent irrefutable research studies proving the existence and exact mechanism of whiplash car injuries, insurers are hard pressed to try the “whiplash is a hoax” defense nearly as much as in the past.
A more recent tactic is to claim the speed of the collision is too low to cause injury. Enter the “low speed collision” or “slow speed collision” defense. The defense often relies on their insured’s reports of how fast they were going when they ran into the back of the other party-obviously biased data.
Other times photographs of the vehicle damage is used to show a low speed car accident. Often, the photographs are shown to an Accident Reconstructionist who by merely looking at photographic damage of a car crash then renders an opinion on how fast the vehicles were traveling. They will even go so far to make statements such as “the evidence suggests there was insufficient force to cause human bodily injury…” This would be laughable if it didn’t cause so many problems for injured car accident victims. By the way, in most states Auto Crash Reconstructionists are only allowed to testify or ender an expert opinion as to vehicle damage. They are not trained to determine bodily injury.
The Truth
Here are but a few facts concerning motor vehicle injuries and their relationship to speed with supporting scientific evidence.
Three different studies (Panjabi, Panjabi and Cholewicki and Kaneoka) proved the mechanism by which the neck is injured by a rear impact force simulating a car accident. [1], [2], [3] The studies involved simulating a rear impact collision on live human test subjects and recording the results with cineradiography (high speed motion x-rays). The researchers found that the neck was injured by deforming into an “S- shaped” configuration within fractions of a second of the impact before the occupant is aware of the impact and before reflexes can protect them. All three of these studies found that this physical event occurred at speeds as low as 2.5 mph. In other words, when they simulated car crashes sufficient to cause the head to move in relationship to the body at a rate of 2.5 mph, injuries were recorded.
The radiographically proven human threshold for injury in a rear impact auto accident therefore is 2.5 mph. Other authors have disputed these figures and some insurance company sponsored studies have found the threshold to be closer to 5 mph.
For the sake of argument, let’s stipulate that the 5 mph threshold is correct. It still means that a collision of only 5 mph can cause damage to the neck.
Freeman et. al. in Spine, Vol. 23, Number 9, 1998, p. 1046 shows the damage thresholds for many cars. This is the minimum speed required to cause the car to show visible signs of damage. The smallest, lightest vehicle listed was the 1980 Toyota Tercel, which required a collision of 8.1 mph to become damaged. On the other end of the spectrum was the 1989 Chevrolet Citation, which required 12.7 mph. A Ford F-250 pick up required 11.7 mph.
Cars built today are equipped with rear bumpers designed not to show any damage below 5 mph. In an attempt to reduce repair costs shouldered by insurance companies, crash standards were adopted to mandate rear bumpers must withstand a 5 mph collision into a fixed barrier (wall, pole, etc) without any visible evidence of damage. It should be noted that this standard involves testing of “vehicle to barrier” crashes not “vehicle to vehicle” testing.
Hitting a pole as in “vehicle to barrier” testing yields more damage at lower speeds. The barrier does not move or absorb any energy.
In “vehicle to vehicle” crashes where the bumpers line up well, it takes considerably more force to cause visible bumper damage than a 5 mph collision. Some tests have shown that cars could be crashed repeatedly at 20 mph and not show outer damage. In a “vehicle to vehicle” crash it is estimated that the minimum speed to cause visible damage is approximately 15 mph.
What happens to the occupant in these collisions is what matters. If you are backing up in a parking lot and run into a pole at 6 mph. You will feel a crunch and a bump. You’ll be startled and upset about your bumper, but it is unlikley you’ll be injured.
On the other hand, if you are stopped in a parking lot waiting for a space and another vehicle strikes you at 12 mph (the average speed of a car in a parking lot) you will likely feel a tremendous jolt, hear a loud bang and your car will be pushed forward a few feet. It is probable that your neck will be injured, although it may not show up for hours or days, but your bumper may not even show a dent.
In the first scenario all the energy of the crash was absorbed by the bumper. In the second, some of the energy was bled off into the two vehicles, but much of it was transmitted into your body causing your neck to deform into the “S” configuration resulting in injury.
Another consideration is that while a bumper may look undamaged from the outside after a collision, inside under the skin, the foam or plastic may be crushed or cracked. This is not seen from the outside, so photographs would make it appear as if no damage was sustained. Still further, the bumper may appear intact, but on unibody vehicles, the unibody may be bent or deformed by a collision. This may not be apparent and some auto repair facilities may miss it.
So what does this mean? It means that if you are rear-ended and your bumper is cracked, dented, or misplaced at all, your collision involved speeds in excess of 15 mph. That’s 3 times the human threshold for injury if we use the 5 mph figure. In reality, the proven threshold is only 2.5 mph, so a collision of 15 mph is 6 times the threshold for injury.
Now let’s say your vehicle sustained no visible damage, but your neck hurts after the collision. Does that mean you weren’t really injured? No. It means that the vehicle’s threshold for damage was not exceeded. The impact could have been 10 mph. Too low for bumper damage, but still 4 times the threshold for human injury.
In a low speed collision, the kinetic forces that are transferred from the other vehicle into your vehicle are not dampened or bled off by your bumper. Instead, the force is transmitted through the vehicle, into your seat and to your neck resulting in injury. If your body or neck are jolted or jerked by the impact, an injury could occur.
Another aspect to consider is if your vehicle is moved forward by the impact. An average car weighs close to 4,000 lbs. Let’s say you are hit from behind and your car is pushed forward a few feet, but shows no signs of bumper damage. Is it possible to be hurt? Yes, of course. The force required to move a stationary 4,000 lb object is tremendous. Can you walk up to a car sitting at a red light with its brakes on and shove it forward even an inch? Not likely. A collision that is strong enough to propel a car forward by even inches is plenty enough force to cause a whiplash injury.
So, as you have now learned, there really shouldn’t be any dispute on whether a low speed car accident collision can cause injuries. It has been scientifically proven by several studies. It is also a fact that the speed required to cause bodily injury is quite low, a scant 2.5 mph. It has also been shown that any accident that causes damage to the rear bumper is likely to cause injuries and even in accidents where there is no outward physical damage to the vehicle, there may still be sufficient forces involved to cause bodily injuries.
About North Dallas Chiropractic
They are a car accident injury specialist. They specializes in back pain and neck pain from car accidents. Their opinion is often sought by other doctors, attorneys and insurance companies. You may contact North Dallas Chiropracitc at (972) 392-4476 for a Car Accident Severity consultation. North Dallas Chiropractic
References
Panjabi MM, Grauer JN (1997): “Whiplash produces a S-shape curvature of the neck with hyperextension at lower levels. ” Spine 22 (21): 2489-94.
Panjabi MM, Cholewicki J, Nibu K, Grauer JN, Babat LB, Dvorak J, Bar HF (1998-12-01): “[Biomechanics of whiplash injury].” Orthopade 1998 Dec; 27(12): 813-9.
Koji Kaneoka, Koshiro Ono, Satoshi Inami and Koichiro Hayashi (99-04-15). “Motion analysis of cervical vertebrae during whiplash loading.” Spine 24(8): 763-770
Characteristics of Specific Automobile Bumpers in Low Velocity Impacts, SAE 940916
Thousands of car accidents occur everyday. And every day thousands are injured. Researchers note that the majority of auto accident injury claims occur at relatively low speeds of about 12 mph or less.
Car Accident Disputes
This causes tremendous disputes between injured parties and the insurance companies that are responsible for compensating them for their car accident claim. To insurers, there really is no speed at which they want to admit an injury could occur. For economic reasons they try to dismiss whiplash or car accident injuries entirely, as if they don’t exist.
Thanks to recent irrefutable research studies proving the existence and exact mechanism of whiplash car injuries, insurers are hard pressed to try the “whiplash is a hoax” defense nearly as much as in the past.
A more recent tactic is to claim the speed of the collision is too low to cause injury. Enter the “low speed collision” or “slow speed collision” defense. The defense often relies on their insured’s reports of how fast they were going when they ran into the back of the other party-obviously biased data.
Other times photographs of the vehicle damage is used to show a low speed car accident. Often, the photographs are shown to an Accident Reconstructionist who by merely looking at photographic damage of a car crash then renders an opinion on how fast the vehicles were traveling. They will even go so far to make statements such as “the evidence suggests there was insufficient force to cause human bodily injury…” This would be laughable if it didn’t cause so many problems for injured car accident victims. By the way, in most states Auto Crash Reconstructionists are only allowed to testify or ender an expert opinion as to vehicle damage. They are not trained to determine bodily injury.
The Truth
Here are but a few facts concerning motor vehicle injuries and their relationship to speed with supporting scientific evidence.
Three different studies (Panjabi, Panjabi and Cholewicki and Kaneoka) proved the mechanism by which the neck is injured by a rear impact force simulating a car accident. [1], [2], [3] The studies involved simulating a rear impact collision on live human test subjects and recording the results with cineradiography (high speed motion x-rays). The researchers found that the neck was injured by deforming into an “S- shaped” configuration within fractions of a second of the impact before the occupant is aware of the impact and before reflexes can protect them. All three of these studies found that this physical event occurred at speeds as low as 2.5 mph. In other words, when they simulated car crashes sufficient to cause the head to move in relationship to the body at a rate of 2.5 mph, injuries were recorded.
The radiographically proven human threshold for injury in a rear impact auto accident therefore is 2.5 mph. Other authors have disputed these figures and some insurance company sponsored studies have found the threshold to be closer to 5 mph.
For the sake of argument, let’s stipulate that the 5 mph threshold is correct. It still means that a collision of only 5 mph can cause damage to the neck.
Freeman et. al. in Spine, Vol. 23, Number 9, 1998, p. 1046 shows the damage thresholds for many cars. This is the minimum speed required to cause the car to show visible signs of damage. The smallest, lightest vehicle listed was the 1980 Toyota Tercel, which required a collision of 8.1 mph to become damaged. On the other end of the spectrum was the 1989 Chevrolet Citation, which required 12.7 mph. A Ford F-250 pick up required 11.7 mph.
Cars built today are equipped with rear bumpers designed not to show any damage below 5 mph. In an attempt to reduce repair costs shouldered by insurance companies, crash standards were adopted to mandate rear bumpers must withstand a 5 mph collision into a fixed barrier (wall, pole, etc) without any visible evidence of damage. It should be noted that this standard involves testing of “vehicle to barrier” crashes not “vehicle to vehicle” testing.
Hitting a pole as in “vehicle to barrier” testing yields more damage at lower speeds. The barrier does not move or absorb any energy.
In “vehicle to vehicle” crashes where the bumpers line up well, it takes considerably more force to cause visible bumper damage than a 5 mph collision. Some tests have shown that cars could be crashed repeatedly at 20 mph and not show outer damage. In a “vehicle to vehicle” crash it is estimated that the minimum speed to cause visible damage is approximately 15 mph.
What happens to the occupant in these collisions is what matters. If you are backing up in a parking lot and run into a pole at 6 mph. You will feel a crunch and a bump. You’ll be startled and upset about your bumper, but it is unlikley you’ll be injured.
On the other hand, if you are stopped in a parking lot waiting for a space and another vehicle strikes you at 12 mph (the average speed of a car in a parking lot) you will likely feel a tremendous jolt, hear a loud bang and your car will be pushed forward a few feet. It is probable that your neck will be injured, although it may not show up for hours or days, but your bumper may not even show a dent.
In the first scenario all the energy of the crash was absorbed by the bumper. In the second, some of the energy was bled off into the two vehicles, but much of it was transmitted into your body causing your neck to deform into the “S” configuration resulting in injury.
Another consideration is that while a bumper may look undamaged from the outside after a collision, inside under the skin, the foam or plastic may be crushed or cracked. This is not seen from the outside, so photographs would make it appear as if no damage was sustained. Still further, the bumper may appear intact, but on unibody vehicles, the unibody may be bent or deformed by a collision. This may not be apparent and some auto repair facilities may miss it.
So what does this mean? It means that if you are rear-ended and your bumper is cracked, dented, or misplaced at all, your collision involved speeds in excess of 15 mph. That’s 3 times the human threshold for injury if we use the 5 mph figure. In reality, the proven threshold is only 2.5 mph, so a collision of 15 mph is 6 times the threshold for injury.
Now let’s say your vehicle sustained no visible damage, but your neck hurts after the collision. Does that mean you weren’t really injured? No. It means that the vehicle’s threshold for damage was not exceeded. The impact could have been 10 mph. Too low for bumper damage, but still 4 times the threshold for human injury.
In a low speed collision, the kinetic forces that are transferred from the other vehicle into your vehicle are not dampened or bled off by your bumper. Instead, the force is transmitted through the vehicle, into your seat and to your neck resulting in injury. If your body or neck are jolted or jerked by the impact, an injury could occur.
Another aspect to consider is if your vehicle is moved forward by the impact. An average car weighs close to 4,000 lbs. Let’s say you are hit from behind and your car is pushed forward a few feet, but shows no signs of bumper damage. Is it possible to be hurt? Yes, of course. The force required to move a stationary 4,000 lb object is tremendous. Can you walk up to a car sitting at a red light with its brakes on and shove it forward even an inch? Not likely. A collision that is strong enough to propel a car forward by even inches is plenty enough force to cause a whiplash injury.
So, as you have now learned, there really shouldn’t be any dispute on whether a low speed car accident collision can cause injuries. It has been scientifically proven by several studies. It is also a fact that the speed required to cause bodily injury is quite low, a scant 2.5 mph. It has also been shown that any accident that causes damage to the rear bumper is likely to cause injuries and even in accidents where there is no outward physical damage to the vehicle, there may still be sufficient forces involved to cause bodily injuries.
About North Dallas Chiropractic
They are a car accident injury specialist. They specializes in back pain and neck pain from car accidents. Their opinion is often sought by other doctors, attorneys and insurance companies. You may contact North Dallas Chiropracitc at (972) 392-4476 for a Car Accident Severity consultation. North Dallas Chiropractic
References
Panjabi MM, Grauer JN (1997): “Whiplash produces a S-shape curvature of the neck with hyperextension at lower levels. ” Spine 22 (21): 2489-94.
Panjabi MM, Cholewicki J, Nibu K, Grauer JN, Babat LB, Dvorak J, Bar HF (1998-12-01): “[Biomechanics of whiplash injury].” Orthopade 1998 Dec; 27(12): 813-9.
Koji Kaneoka, Koshiro Ono, Satoshi Inami and Koichiro Hayashi (99-04-15). “Motion analysis of cervical vertebrae during whiplash loading.” Spine 24(8): 763-770
Characteristics of Specific Automobile Bumpers in Low Velocity Impacts, SAE 940916
Low Impact injuries from Auto/Car Accidents or Wrecks
When assessing injury in patients after a
MVA, should speed of the impact be considered? Here is what Arthur
Croft, DC, MS, MPH, FACO of the Spine Research Institute of San Diego
has to say:
“Here, the relationship between property damage and injury risk is nonlinear. In the lower velocity range, vehicles are relatively stiff, the collisions more elastic. In engineering parlance, there is a relatively higher coefficient of restitution in lower velocity crashes. Then, as crash velocity increases, so too does the amount of residual crush of the vehicle. Interestingly, though, the actual risk to the occupants decreases as this occurs. This has been demonstrated in several studies. So, over this range of crash velocities, there is no good correlation between injury risk, injury severity, or long-term outcome and property damage. This is, of course, an important distinction to understand.”
Here is an article which explains how insurance companies are perpetuating the myth that injurie are not likely at low impact: DISPELLING THE MYTHS THAT YOU CANNOT BE INJURED IN A “LOW IMPACT” AUTO ACCIDENT
Great article laying out the truth about low impact injuries: Soft Tissue Injuries From A Low Impact Auto Accident
The research is overwhelming in showing that injuries and even death can occur in low impact crashes.
“Here, the relationship between property damage and injury risk is nonlinear. In the lower velocity range, vehicles are relatively stiff, the collisions more elastic. In engineering parlance, there is a relatively higher coefficient of restitution in lower velocity crashes. Then, as crash velocity increases, so too does the amount of residual crush of the vehicle. Interestingly, though, the actual risk to the occupants decreases as this occurs. This has been demonstrated in several studies. So, over this range of crash velocities, there is no good correlation between injury risk, injury severity, or long-term outcome and property damage. This is, of course, an important distinction to understand.”
Here is an article which explains how insurance companies are perpetuating the myth that injurie are not likely at low impact: DISPELLING THE MYTHS THAT YOU CANNOT BE INJURED IN A “LOW IMPACT” AUTO ACCIDENT
Great article laying out the truth about low impact injuries: Soft Tissue Injuries From A Low Impact Auto Accident
The research is overwhelming in showing that injuries and even death can occur in low impact crashes.
There's still hope even if the Auto/Car Accident was your fault!
Personal Injury Protection (PIP)
The Texas Department of Insurance requires automobile insurance carriers in our state to issue all automobile policies it writes at least $2500 worth of coverage and you have this coverage unless you reject it in writing. Most people are unaware of this coverage or even know what it is and therefore very few people use it. You end up paying for coverage that they don’t inform you about and you’re entitled to.
Why? Insurance is not understood and most people rely on their agent and claims adjusters to advise them on what to do after an accident. Insurance is a multi-billion dollar industry and are in business to make money. They keep their costs down, less payout, more profits and bonuses at the end of the year. Good for them and not for you.
What is PIP?
PIP is no fault coverage similar to health insurance but on your auto policy for your injuries and your passengers injuries. This coverage is available regardless who is at fault. Yes, you can be the cause of the accident and you will still be covered. There’s no deductible and no co-payment. There is other separate coverage that will cover the other party if you were at fault. If you do not have PIP then you could still be covered if you were in an accident in another state besides Texas. You may also be covered if you were hit in a crosswalk by a car or on a bicycle or borrowing someone else’s car.
What will a claim do to my insurance rates and policy renewal?
Under section 5.7016 of the Texas insurance code, automobile insurance carriers cannot non-renew you for filing one PIP claim in a 12 month period. Also, it is unlikely that they would raise your rates for a sole PIP claim.
Why doesn’t the other guy’s insurance pay for my medical expenses and why should I use my insurance?
Medical treatment is expensive and you are liable for the costs. There is a chance that the other party may never pay for your medical expenses leaving you a financial burden. PIP gives you peace of mind that your medical bills are covered. If you use your health insurance, you may have to pay a deductible and co-pays to your doctor and if the health insurance finds out that you were in an accident they could request to be reimbursed. Some people get referred to a medical provider by their attorney and the medical provider agrees to be paid months or even years later. Since there are a limited number of medical providers who agree to this arrangement, your choice and quality of healthcare may be limited. The answer is to use your PIP coverage so you will not have to pay for medical expenses out of your pocket and get the best possible healthcare treatment available for you and your family’s injuries caused by the accident.
The Texas Department of Insurance requires automobile insurance carriers in our state to issue all automobile policies it writes at least $2500 worth of coverage and you have this coverage unless you reject it in writing. Most people are unaware of this coverage or even know what it is and therefore very few people use it. You end up paying for coverage that they don’t inform you about and you’re entitled to.
Why? Insurance is not understood and most people rely on their agent and claims adjusters to advise them on what to do after an accident. Insurance is a multi-billion dollar industry and are in business to make money. They keep their costs down, less payout, more profits and bonuses at the end of the year. Good for them and not for you.
What is PIP?
PIP is no fault coverage similar to health insurance but on your auto policy for your injuries and your passengers injuries. This coverage is available regardless who is at fault. Yes, you can be the cause of the accident and you will still be covered. There’s no deductible and no co-payment. There is other separate coverage that will cover the other party if you were at fault. If you do not have PIP then you could still be covered if you were in an accident in another state besides Texas. You may also be covered if you were hit in a crosswalk by a car or on a bicycle or borrowing someone else’s car.
What will a claim do to my insurance rates and policy renewal?
Under section 5.7016 of the Texas insurance code, automobile insurance carriers cannot non-renew you for filing one PIP claim in a 12 month period. Also, it is unlikely that they would raise your rates for a sole PIP claim.
Why doesn’t the other guy’s insurance pay for my medical expenses and why should I use my insurance?
Medical treatment is expensive and you are liable for the costs. There is a chance that the other party may never pay for your medical expenses leaving you a financial burden. PIP gives you peace of mind that your medical bills are covered. If you use your health insurance, you may have to pay a deductible and co-pays to your doctor and if the health insurance finds out that you were in an accident they could request to be reimbursed. Some people get referred to a medical provider by their attorney and the medical provider agrees to be paid months or even years later. Since there are a limited number of medical providers who agree to this arrangement, your choice and quality of healthcare may be limited. The answer is to use your PIP coverage so you will not have to pay for medical expenses out of your pocket and get the best possible healthcare treatment available for you and your family’s injuries caused by the accident.
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