The term "whiplash" is commonly
associated with rear-end auto accidents. It conjures up a variety
of reactions in different people. A large percentage think that
these accident victims overemphasize their condition to profit from
what may seem a trivial accident. Lawyers who specialize in this
type of case are often vilified as working the system to collect
damages beyond a reasonable amount for the whiplash victim. Doctors
are often in a quandary to find answers to patients' bizarre complaints.
Sometimes it seems the only people who have empathy for the person
who has recently suffered a whiplash are those who have suffered
the condition themselves.
The term "whiplash" is not a
diagnosis of a condition or description of an injury; it refers
to the injury's mechanism. An example of proper terminology is cervical
hyperextension/hyperflexion sprain and/or strain of whiplash dynamics.
Hyperextension means that the head and neck are bent backward beyond
their normal range of movement; hyperflexion means that the head
and neck are bent forward beyond the normal range of motion.
It is said that the term "whiplash"
originated with a lawyer describing the rapid back and forth movement
of the head and neck as comparable to that of cracking a whip. Another
term used to describe this action is "cervical acceleration/
deceleration syndrome." This is preferred by many doctors because
it describes the location (cervical = neck), speed, and possible
complexity of symptoms (the term "syndrome" refers to
a group of symptoms that occur together in a specific condition).
Although doctors prefer to use the descriptive
terms of injury, "whiplash" has become so ingrained in
our thinking that it will probably never be abandoned. It will be
used throughout this pamphlet for easy reading.
One reason for the variety of impressions
about whiplash injury is the extensive symptoms and bizarre complaints
one may have as a result of what appears to be a relatively mild
A stationary automobile at a stoplight may be rear-ended by a car
traveling no more than 10-15 mph; there may be minimal vehicle damage,
yet the injured person develops a characteristic whiplash complex
of symptoms, often requiring prolonged and extensive treatment.
Let's investigate why this may occur.
Within the neck region's 35 joints is some
of the most complex movement within the body. The cervical bones
house and protect the spinal cord. Nerves from the cord pass out
of the spine between each two vertebrae. The injury may entrap a
nerve at this area, resulting in pain, numbness, and weakness in
the neck and arms. The nerve entrapment may be associated with intervertebral
disc bulging into the area usually occupied by the nerve. This is
called radiculopathy, and it is usually recognized during examination.
Conservative chiropractic manipulation and adjunctive methods are
usually the treatments of choice. Occasionally surgery may be required
when properly indicated by specialized studies such as magnetic
resonance imaging (MRI) or computed axial tomography (CAT) scan.
Problems seem to mount for a whiplash victim
when initial examination does not reveal radiculopathy, and the
person is told there has been a simple strain that will heal with
rest and a little physiotherapy. A neck brace and pain medication
are often prescribed, and the person is dismissed from the emergency
room. Research has shown that a large percentage of those with negative
emergency room examination eventually develop additional problems
that may become severe as a result of the trauma. It is common for
symptoms to be delayed until twelve hours or even days after the
In addition to the radicular entrapment
noted previously, other nerves can be involved and often are often
missed during physical examination. The intervertebral disc, ligaments
of the spinal column, and other structures in the neck are well-endowed
with nerve endings, of predictable and unpredictable distribution,
that can refer pain to the head, neck, shoulders, arms, and upper
back. This is called "referred pain," and it requires
a different type of examination than radicular pain. Failure to
examine for and understand this type of pain leaves a patient in
an emotional quandary. The doctor finds no reason for the patient's
pain; yet it is real and not of a psychological nature, which is
The skull and pelvis have
functions that are often inadequately considered in whiplash cases.
There is a predictable micro-movement between the bones of the
skull and bones of the pelvis, called the cranial-sacral primary
respiratory mechanism. The violet whipping action at the time
of an accident can interfere with this mechanism because of the
intricate relationship of the bones, muscle, and fascia of the
neck with cranial bone movement. Poor function of the cranial
mechanism can interfere with cranial nerves, some of which control
neck muscles, muscles that move the eyes, and the jaw bone. Normal
neck muscle strength is especially important when there has been
injury to the neck joints. At this time it is even more important
that the muscles stabilize the neck for proper healing.
Many whiplash patients develop pain in
the jaw joint, called the temporomandibular joint (TMJ), that
is aggravated by chewing. Often the answer is correcting cranial
bone movement so that the nerves controlling the muscles that
move the jaw are returned to normal.
Examination of the cranial mechanism is
done in applied kinesiology by testing muscles, some of which
are controlled by the cranial nerves. Pressure applied to the
bones of the skull in the proper direction returns normal activity,
and one often observes the immediate return of muscle strength.
Some of the very bizarre symptoms of whiplash
trauma develop as a result of cranial dysfunction. Intricately
associated with this area are the nerves of equilibrium, i.e.,
the nerve endings responsible for balance. This includes cranial
nerveVIII, which supplies the balance mechanism of the middle
ear, cranial nerves III, IV, and VI that supply the muscles that
move the eyes and are intricately associated with the visual righting
reflexes, and - finally - the nerve endings in the upper cervical
vertebral ligaments that supply the head-on-neck reflexes. All
these reflexes must organize together. If there has been injury
causing improper nerve supply to one or more of the areas, neurologic
disorganization develops that can cause a change in muscle function
almost anywhere in the body. This accounts for some of the unusual
and little understood symptoms that the whiplash victim suffers.
The poor muscle function can cause random body aches of a wide-spread
nature. Additionally, there may be dizziness, ear ringing, nausea,
blurred or double vision, headache, and myriad other symptoms.
Unfortunately, the victim of a whiplash
trauma often becomes involved in controversy that may relate with
litigation, especially when there are ongoing symptoms. An insurance
company may request an independent medical examination to determine
if there really is a problem. This examination may fail to find
dysfunction, depending on the doctor's expertise in examining
for referred pain, cranial faults, TMJ dysfunction, or neurologic
disorganization. The report may be summarized with the statement
that no objective findings are present to substantiate the patient's
complaints. This in essence says that the doctor's examination
finds nothing wrong with this person.
Whiplash victims who become involved in
litigation will have an additional burden to bear. There will
probably be those who state and even testify that there is no
basis for the victim's continuing symptoms. It has even been stated
that the only thing that cures a whiplash is the "green poultice",
referring to a favorable cash settlement for the injuries. One
who provides therapy for these victims finds that in most cases,
this is not true. In a study of 266 patients involved in litigation,
121 continued to have symptoms two or more years after the litigation
was settled. This is probably an underestimate, because the investigator
considered al those unavailable for follow-up as being cured to
avoid biasing the study. Even with this consideration, 45% of
the patients continued to have problems after settlement.
The answer to regaining maximum return
to normal health following whiplash trauma is to be certain you
are examined by a doctor knowledgeable in the intricacies of this
area, including radiculopathy, the cranial-sacral and TMJ mechanisms,
and neurologic disorganization. It is also important that the
doctor be one who recognizes the intricate organization throughout
the body, and how trauma to this area can cause remote problems.
Finally, early examination by one knowledgeable in these factors
is important to obtain maximum results. The first week after trauma
is considered the "golden week of opportunity." Proper
early treatment is necessary to minimize swelling, with follow-up
to organize the formation of deep scar tissue for minimal future