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Posted on 12-05-2013

WHIPLASH: FACT OR FICTION?

Good morning!

With this icy weather there are no doubt going to be some motor vehicle collisions.  We see many of them here at WellnessOne.  For those of you who get into an accident you may feel from the insurance company that no vehicle damage = no injury.  This is NOT TRUE!  In fact the injuries can be WORSE!  This study from Orthopedic Clinics of America published in October 1988 shows that the whiplash syndrome from these sudden injuries can be devastating!

THESE AUTHORS NOTE:

“The cervical (neck) spine is frequently injured as the result of motor vehicle trauma.”

The whiplash syndrome “is real and is manifested by symptoms consistent with the anatomic injury sustained, and has the potential to cause significant impairment.”

Whiplash is a sprain/strain injury to the soft tissue structures about the cervical spine.

“In an 8-mile-per-hour rear-end collision, a 2 G force of acceleration of the vehicle may result in a 5 G force of acceleration of the occiput and head.”

“The amount of damage to the automobile may bear little relationship to the forces applied to the cervical spine and to the injury sustained by the cervical spine.”

“Seatbelts, which minimize injury to the chest wall and head, may intensify the potential for cervical trauma by restricting motion of the lower body.”

Whiplash forces frequently cause:

1)  Anterior (front) longitudinal ligament injury in the neck

2)  Anterior neck muscle injury, including the sternocleidomastoid, scalenes, and longus colli

3)  Esophageal hemorrhage; stretch injuries or contusion (bruising) of the esophagus and larynx may cause hoarseness and dysphagia

4)  Disc disruption

“Visual disturbances may result from vertebral, basilar, and vascular (blood vessel) injury, or from injury to the cervical sympathetic chain (special nerves).”

Following injury, symptoms are commonly delayed for several hours or several days. Associated symptoms include headaches and dizziness.

An examination of the patient made within the first few hours following injury “is frequently negative.”

The muscle most commonly found to be in spasm is the trapezius. Compression of the cervical spine will aggravate radicular (referred pain in arms and legs) symptoms. Altered sensory (touch) examination is often not in a nerve pattern.

In cervical whiplash patents, the mid and lower part of the spine should also be examined because of possible injuries. “In many patients with cervical sprain, movement of the lower back will cause discomfort in the neck.”

“The physical findings may vary significantly at different times within the same patient. There may even be variation within the course of a day or within the course of the work week.”

“X-ray findings may be minimal. Nevertheless, a full radiographic series is necessary to rule out bony injury or displacement in all of these patients.” [Very Important]

Pre-existing structural changes and degenerative (arthritis) changes are “frequently associated with a more difficult, more prolonged, and less complete recovery.”

“When whiplash injury occurs in the presence of pre-existing osteophyte (bone spur) formation, there is further narrowing of the spinal canal (where the spinal cord is), which increases the potential for injury to the nerve roots or cord.”

Soft tissue injuries may be present even when x-rays, MRI, CT, bone scan, and myelogram are all negative. [Very Important]

If a cervical collar is used, it should be used in an on and off basis for a period of no longer than 2 weeks. However, some patients will only be able to sleep while wearing a cervical collar.

Prolonged heat may aggravate symptoms and cause prolongation of the course of recovery.

Isometric exercises should be initiated immediately following the injury.

The following factors are associated with a poor prognosis for full recovery:

1)  Radiation of pain into an extremity

2)  Extremity paresthesias (numbness)

3)  Altered extremity sensory examination (touch)

4)  Altered extremity deep tendon reflex (when the doc hits your knee with a hammer)

5)  Extremity weakness

6)  Extremity muscle atrophy (muscle loss)

7)  Sharp or irregular reversal of the normal cervical curvature (our office fixes this)

8)  Pre-accident degenerative joint and/or disc disease

9)  Congenital anomalies such as a block vertebra

10)  Significant positive findings on EMG’s, CT, MRI, or myelogram

“Most patients with negative studies will heal, generally slowly and irregularly, on a program of initial rest and protection of the area, followed by mobilization, cautious exercises, and guided return to function. However, some of these patients will continue to be symptomatic, despite appropriate treatment.”

KEY POINTS YOUR FAMILY SHOULD KNOW:

1) The whiplash syndrome is FACT, not FICTION and “has the potential to cause significant impairment.”

2) An 8 mph rear-end collision produces a 2 G force of acceleration of the vehicle and a 5 G force of acceleration of the occiput and head of the vehicle occupant.

3) “The amount of damage to the automobile may bear little relationship to the forces applied to the cervical spine and to the injury sustained by the cervical spine.”

4) “Seatbelts, which minimize injury to the chest wall and head, may intensify the potential for cervical trauma by restricting motion of the lower body.”
[Very Important]

5) “Visual disturbances may result from vertebral, basilar, and vascular injury, or from injury to the cervical sympathetic chain.”

6) An examination of the patient made within the first few hours following injury “is frequently negative.”

7)  Cervical whiplash can injure the thoracolumbar spine.

8)  “The physical findings may vary significantly at different times within the same patient. There may even be variation within the course of a day or within the course of the work week.” [This is very important because it indicates that the findings in a one-time insurance examination might not truly represent the patient’s day-in and day-out clinical status.]

4 9) “Radiologic findings may be minimal. Nevertheless, a full radiographic series is necessary to rule out bony injury or displacement in all of these patients.” [Very Important]

10) Pre-existing structural changes and degenerative changes are “frequently associated with a more difficult, more prolonged, and less complete recovery.”

11) “When hyperextension injury occurs in the presence of pre-existing osteophyte formation, there is further narrowing of the spinal canal, which increases the potential for injury to the nerve roots or cord.”

12) Soft tissue injuries may be present even when x-rays, MRI, CT, bone scan, and myelogram are all negative. [Very Important]

FOLKS!  If you or someone you know has been involved in a motor vehicle accident…do them a favor…I promise you will be the HERO: Send them to WellnessOne!  Our TEAM is perfectly situated to handle these injuries and when there is a need for outside help…we have established relationships with our physician friends.  Call 530-243-9464 or to make an appointment online click HERE.

It's your future…be there healthy with WellnessOne!  Have a blessed day and be safe out there!

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