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Whiplash


Whiplash

 
 

    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 accident.
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 accident.
    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 often alleged.


Cranial-Sacral Mechanism

    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 adverse effect.



COPYRIGHT-SYSTEMS DC.
 

JIM BARTLEY, DC DIBAK is a Chiropractor and Applied Kinesiologist practicing Applied Kinesiology in central and Bend, Oregon who treats conditions such as Sports Injuries, neck pain, back pain, headaches, shoulder problems, elbow problems, knee pain, ankle pain, foot pain, orthopedic conditions, TMJ jaw or temporomandibular joint problems using natural Chiropractic healthcare and Applied Kinesiology