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Everything You Ever Wanted to Know About Whiplash

DEFINITION: Injuries to the neck caused by a sudden movement of the head, backward, forward, or sideways, are referred to as "Whiplash." Whether from a car accident, sport, or an accident at work, whiplash or other neck injuries warrant a thorough chiropractic check-up. The biggest danger with whiplash injuries is that the symptoms persist for years particularly if not treated appropriately. Even after whiplash victims settle their insurance claims, some 45% report they still suffer with symptoms two years later.

DISCUSSION: In the past a typical whiplash injury, where no bones were broken, was hard to document. Soft tissue injuries did not show up on normal x-rays/radiographs and insurance companies would deny coverage. New imaging devices (CAT Scans, Magnetic Imaging, and Ultra Sound) now show soft tissue injury and insurance companies now cover most whiplash injuries. When no bones are broken and the head doesn't strike the windshield, typical symptoms are as follows: 62% to 98% complain of neck pain, which typically starts two hours up to two days after the accident: This is often the result of tightened muscles that react to either muscle tears or excessive movement of joints from ligament damage. The muscles tighten in an effort to splint and support the head, limiting the excessive movement. Sixty-six to 70% of those suffering from whiplash complain of headache. The pain may be on one side or both, on again off again or constant, in one spot or more general. These headaches, like the neck pain are often the result of tightened, tensed muscles trying to keep the head stable and, like tension headaches, they are often felt behind the eyes. Shoulder pain often described as pain radiating down the back of the neck into the shoulder blade area, may also be the result of tensed muscles. Muscle tears are often described as burning pain, prickling or tingling. More severe disc damage may cause sharp pain with certain movements, with or without pain radiation into the arms, hand and fingers.

COMMON WHIPLASH SYMPTOMS:
Neck pain and/or stiffness - 92%
Impaired Concentration - 26%
Headaches - 57 %
Blurred Vision - 21 %
Fatigue - 56%
Irritability - 21%
Shoulder Pain - 49 %
Difficultly Swallowing - 16%
Anxiety - 44%
Dizziness - 15%
Pain between Shoulder Blades - 42%
Forgetfulness - 15%
Low Back Pain - 39%
Upper Limb Pain - 12%
Sleep Disturbance - 39%
Upper Limb Weakness - 6%
Upper Arm Numbness/Tingling - 30%
Ringing in Ears - 4%
Sensitivity to Noise - 29%
Jaw/Facial Pain - 4%

HOW DOES WHIPLASH HAPPEN? Whiplash is most commonly received from riding in a car that is struck from behind, or collides with another vehicle. When the head is suddenly jerked back and forth beyond its norma1limits, the muscles and ligaments supporting the spine can be overstretched or torn. In a rear end collision for example, the victim's car is first pushed or accelerated forward and then, because their foot is on the brake, or their car hits the vehicle in front, their car is rapidly slowed down, or decelerated. As the vehicle accelerates forward, it pushes the body forward too, but the head remains behind momentarily, rocking up and back, until some of the muscles and ligaments are stretched or torn. Too often, the injury occurs before the head rebounds off the headrest (Providing there is one. If not, the injuries sustained are much worse as there is no method to prevent hyperextension from occurring). These muscles, in a reflex action, contract to bring the occupant's head forward again, and to prevent excessive injury. This overcompensates because at this point the head is already traveling in a forward direction as the car decelerates. This violently rocks the head forward, stretching and tearing more muscles and ligaments, where the joint can become "jammed" and swollen. The soft pulpy discs between the vertebrae can bulge, tear, or rupture. Vertebrae can be forced out of their normal position, reducing range of motion. The spinal cord and nerve roots are stretched, irritated, and choked. If the victim is not properly restrained the occupants head may strike the steering wheel or windshield, possibly causing a concussion.

STAGES OF HEALING &TREATMENT: The soft tissues that are traumatized will go through four stages of healing: * The first stage involves simply the immediate effects of injury, including bleeding, blood -clotting, and cellular breakdown. The inflammatory response is the primary means that the body uses to respond to-the injury. * The purpose of the inflammatory stage is to surround the area of injury in an attempt to protect it. The effect of this response is usually proportional to the amount of injury sustained. This phase can last up to 3 days. At this time the doctor may discuss with you the importance of utilizing ice packs, as this is important to reduce sweI1ing and control pain. Other therapies that will aid in the healing process include electrical stimulation & ultrasound. * The repair stage is the process following and is dictated by the severity of the injury. The injury will heal by regeneration, which is essentially the replacement of the surrounding tissues by fibrous tissue, resulting in scarring or adhesions. This phase can 1ast from 2 days to 6 weeks. In this phase of healing, the doctor may recommend such things as alternating heat and ice to create a "flushing effect" in the blood supply and surrounding tissues. He may begin you on a stretching and/or strengthening exercise program, or recommend that you get a soft tissue massage for tightened muscles. Adjustments may be performed on, above, or below the site of injury. The goals of your adjustments are to relieve nerve irritation and pressure, relieve pain and spasm, restore the normal motion of your neck, and increase its strength and stability. * The body's response to stress constitutes the remodeling stage. This occurs when the residual scar tissue undergoes reorganization and reorientation along the lines of stress. This phase is significant to the patient. The importance of continuing with the prescribed exercises and continuing to use moist heat on tight and sore muscles will be stressed by the doctor. doctor. The resulting instability of the spine and soft tissues are noteworthy and depend on several FACTORS. The aforementioned does not exclude children. In fact, children involved in automobile accidents are often neglected in these types of injuries when in actuality; they suffer from the same symptoms and are at a 2/3 risk for damages. * VEHICLE SIZE. Obviously, the faster and heavier the rear car is moving, the more severe the forces placed on the occupant in the front car. A large truck going 5 mph can do much more damage than a sma1l car going 20 mph. * HEADREST POSITION. This can make an injury much worse if too low, and even at the right height, it must be close enough to catch the head in time (about 2 inches). A seat that is rec1ined to increase this distance, as will poor posture and driving habits if leaning forward. * The POSITION OF THE HEAD is important. When turned to the side, for instance, it can only move about half as far as a straightforward position. Hence, the mechanism of injury can occur much sooner and substantially increase the severity of injuries. * AGE -plays an important role because as the body becomes alder, ligaments become less pliable, muscles weaker and less flexible, and decreases in range of motion. * WOMEN -seem to be injured more seriously than men are. This is most notable due to the fact that they tend be shorter, have less muscle mass and less bone structure. Because of this, they are either too close to the steering wheel/airbag and or have improper fitting shoulder harness/ seatbelts. * And PRE-EXISTING HEALTH PROBLEMS -such as arthritis, lend to the severity of the injuries.

NUTRITIONAL RECOMMENDATIONS: During the first two weeks after injury it is critical to create an optimal healing environment for the various damaged nerves, ligaments, and muscles. They need adequate minerals, vitamins, water, and amino acids if they are to heal properly. A balanced diet with abstinence from dehydrating substances such as alcohol, caffeine, hot dogs and too much hormone grown red meat can be beneficial. During the first day after trauma, the body is in its injury-shock phase. Nutritional changes are not advised for the first day because of the potential for disturbing the body's preprogrammed metabolic balance system. Megadoses of synthetic vitamins and minerals are not suggested. A well balanced, digestible whole food concentrated multivitamin supplement will suffice. Supplement to facilitate the growth of ligaments, muscle and cartilage can be found on one of our Absolute Health links page. OF SPECIAL NOTE: Cigarette Smoking Smoking during the first few weeks following an injury may interfere with the normal healing process. If you smoke during this time you may slow your recovery down or end up with pain that you would not have otherwise. This may result in your requiring more treatment and a worse outcome. Cigarette smoking, which results in oxygen deficiency to already injured tissues, also, it can deplete tile Vitamin C supply in your body and should be increased. Smoking is not recommended for 4-6 weeks after a traumatic injury.

References: Chiropractic Health and Rehabilitation Group. P.C. Copyright @ 1996 Langlitz Krames Communications @ 1989, 1991. Randanov BP, et al. Long-term outcome after whiplash injury: a two-year follow-up considering features of injury mechanism and somatic, radiologic and psychosocial factor. Medicine 74(5):281-297, 1995. Randanov BP, et al. The role of psychological stress in recovery from common whiplash. Lancet 338: 712-715, 1991. Nordhoff, L.S. Motor Vehicle Collision Injured. Mechanism. Diagnosis and Management. @1996, Aspen Publishers, Inc. Melton MR. The complete guide to whiplash. Body-Mind Publications @1998 Balch PA, Balch JF. @ 1997. Avery Publishing Group.

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