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 ride 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 mishandled by unscrupulous individuals with a vested interest in the personal injury business.
Whiplash is a common name for a group of neck disorders known as cervical acceleration-deceleration injury or whiplash/strain injury. It occurs when the head and neck start to move and are suddenly forced to stop causing a hyperflexion or hyperextension movement. This irregular movement of the neck causes the ligaments in the spine to twist and the muscles to splint 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 pain in the neck (pun intended), but most people treat it like a sprained ankle and hope the pain will go away within a few weeks. However, there may be long-term consequences; even for people who do not have pain symptoms immediately. 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 evidence of physical damage (2). Furthermore, people who report whiplash injuries after a rear-end accident are likely to show headaches, TMJ, back pain, fatigue, and sleep problems 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 auto accident cases, the truth is that most drivers will be involved in a collision no matter how good a driver they are. Most probably won’t experience pain immediately after a collision, especially if you are in your teens or early 20s. However, impact from a vehicle traveling at speeds as low as 15 mph can show visible signs of structural damage to the neck. These include S-shaped curves in the neck, anterior ligament instability, displaced atlas, and anterior head syndrome. A recent study has found that this type of spinal trauma can cause parts of the brain and brain stem to slip 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 not done correctly over the course of several years.
As a chiropractor focused on structural correction, I see patients every day with secondary conditions such as headaches and TMJs related to accidents that occurred many years before. While some of these patients did sustain painful injuries and receive treatment after an accident, most people will come in and say they didn’t have any symptoms until years later. When someone asks why their pain seems to come out of nowhere, I can usually look at their X-ray and see that the neck structure conforms to the familiar S-shape from a previous rear-end collision.
Here 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 typically experience slow physiological changes in the brain and hormonal systems for years before they have a condition that doesn’t go away.
• Second, if you have a physical/structural problem, you must go beyond treating pain symptoms to help achieve complete resolution of the problem. Whiplash injuries cause a variety of structural problems in the spine. While pain relief is important, making the pain go away and leaving the structure in disrepair is like taking the battery out of a smoke detector when there’s 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 on your side who can look at you from a functional standpoint rather than mere pathology, who addresses the structure of your spine in 3 dimensions, and who understands the nature of traumatic injuries.
References:
1. Gaab J, Baumann S, Budnoik A et al. Reduced reactivity and increased negative feedback sensitivity of the hypothalamic-pituitary-adrenal axis in chronic whiplash-associated disorder. Bread. December 2005. 119(1). 219-224.
2. Banic B, Peterson-Felix S, Anderson OK et al. Evidence for 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 injuries: 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 and ankle sprain injuries: 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 tonsillar ectopia (Chiari) and head/neck trauma (whiplash). brain injection. 2010; 24(7-8): 988-94.
