Most people don't understand how urgent it is to take optimal care of your spine after a whiplash. Treatment gets postponed. Pain causes you to avoid movement. "Hope" puts things off as you naturally heal.
But you need to make sure you heal with better function.
Because if you don't, you could end up with a whole spectrum of problems.
Do you have pain after a whiplash injury, don't ignore it. If you started out with no pain on Monday, got into a car crash on Tuesday, and you have pain on Wednesday, it means you've been injured.
You could ignore the injury, and allow your body to heal on its own, which it will do no matter what, but allowing your body to heal with an excessive amount of inflammation and with dysfunction can cause chronic problems.
After more than 3 months, and you are still in pain, then you have "chronic neck pain", and in one paper I read recently, they called it "Late Whiplash Syndrome" after 6 months.
Late Whiplash Syndrome has been described as a disorder that is characterized by a constellation of clinical profiles including neck pain and stiffness, persistent headache, dizziness, upper limb paresthesias, and psychological emotional sequelae that persist more than six months after a whiplash injury.
Poorbaugh et al. 2008
If you've been in a car crash that causes whiplash, your chances of developing chronic pain are between 18% of 40%. Sometimes a delay in the symptom onset occurs. You might go without pain for several days before you start to feel the effects of the whiplash injury. Patients who seek medical care for acute whiplash injuries can have a 33% chance of developing late whiplash syndrome at more than 30 months after an injury.
A tap from behind to your rear bumper at even 3 mph can transmit the forces of the collision through your car's frame, your car seat, and into your upper back to create a sudden injury to your neck. If this happens, this represents a 3 mile prior force suddenly impacting your neck at less than 2/10 of a second.
If you are hit at 6 mph the force is transmitted to your spine are actually four times the amount of when it was 3 mph. However, your car's bumper is built to withstand no apparent damage up to 15 mph. So even if you have a car accident in your bumper was not damaged there can be a lot of forces that get transferred to your neck and upper back in the event of an injury.
As his forces push your seat back forward, it forces your spine to push the force up from your mid back to your neck. Within milliseconds, this causes your neck to the form into an S shaped curve instead of a sea shaped curve. Autopsies have shown us that various structures within your neck can be damaged when this happens. This includes supporting ligaments of the neck, the cartilage surface of the joints, the supportive and stabilizing muscles in the front and the back of the neck. Sometimes even the bones can become fractured.
If a whiplash soft tissue injury only involve the muscles, then we would all heal from the injury really quickly. Because muscles only takes several weeks to heal. The muscles have a great blood supply.
However, the ligaments, discs, and cartilage surfaces of the joints in your neck do not have a good blood supply. They take much longer to heal.
The integrity of your neck relies on bony structure, support of ligaments, and supporting and stabilizing muscles.
All three of these structures can become damage in a whiplash injury.
And when it comes to the muscles that support your spine, it's not just about the structure of the muscles. But, the muscles are controlled and coordinated by reflexes and the nerves that program the muscles to contract when they need to. This neurological programming gets disrupted in the event of an injury.
The way your muscles contract in the way the nerves tell the muscles to contract are heavily dependent on the way that your body is processing pain from the injured area too.
Headaches that come from the upper neck are also one of the side effects of a late whiplash injury. These headaches are called cervicogenic headaches. When you're in the whiplash injury, the structures of your upper neck can become bruised and torn, and the bruising and swelling that occurs can irritate nerves that lady just next to the joints and ligaments of your neck.
Have you heard that women become injured more often in whiplash injuries than men?
Women tend to have petite necks with small diameters compared to the size of their heads. Men, tend to have thick muscular necks especially compared to the size of our small brains.
Women have been shown to have a greater incidence of spinal instability after a whiplash injury. Also, women tend to have more injury to the facet joints in the neck after whiplash. The Cartlidge in the facet joints and women tend to have less thickness compared to men, so there is less cushion in the event of an injury.
Your neck can become unstable after whiplash injury because whiplash injury can lead to loss of integrity of the spinal stabilization system. The spinal stabilization system includes the ligaments, bones, and muscles of your neck.
Ligaments can have what's called a "physiological limit" to the stretch force that they can endure. Whiplash injury can easily exceed this physiological limit and tear the support of the ligaments of your neck and spine.
A frontal impact can tear the supraspinous and interspinous ligaments, as well as ligamentum flavum. This can cause segmental instability, and you can detect this instability if you take a flexion, extension x-ray. This functional x-ray will show the bones sliding over each other in a way that shows that there is an obvious instability.
In your upper neck, there are ligaments that hold the top two bones together, and they are in a cross shape. They are often injured in the whiplash injury, and they are missed by most doctors. But they can cause chronic pain and their logical problems for the patient who has had this injury. These ligaments are important for neck extension, side bending, and rotation. If these ligaments are disrupted, your body must rely on the muscles to control and stabilize the upper neck, which will lead to fatigue and headaches.
Your muscles in the nerves that control the muscles are the locomotive stabilizers.
Locomotion describes what happens within the nerves and muscles in your spine when you walk. Within your spinal cord there are reflexes for cross walking or cross-crawl. When you flex your right arm your left leg also flexes. When you are crawling or walking, your muscles in your neck are also active and they contract to the movement of your arms and legs. Your neck needs to be stabilized when you are walking or running so it is not bouncing around excessively. These are all primitive reflexes deep within the spinal cord, and your muscles are programmed to contract and coordinate in response.
We see neck muscle dysfunction early on in whiplash injury, even if the neck pain is subclinical (mild.) Neck muscle dysfunction is an early correlate of subclinical neck pain. Neck muscle spasms from an injury will reduce range of motion, but also interfere with the normal axis of rotation of segments of the spine. In other words, your coordination is way off.
In a long-term muscle injury the muscle fibers change characteristics to. Your muscles will change from pattern of muscle fiber from "slow oxidative" to "fast glycolytic". This means her muscles will no longer have the endurance and postural stabilization that once had. Rather, your muscle fatigue quickly, and this will cause pain.
Researchers think that your muscles change fiber types after an injury because of several factors. This includes repeated muscle activity, increased muscular tension, decreased physical activity, or pain. A higher ratio of type IIB fibers indicate that the muscles transformed from slow oxidative too fast glycolytic in nature, suggesting a decrease in the muscle resistance to fatigue.
This impairs spinal stability.
Specifically, there are five ways that your neck can become injured in the whiplash injury. These are the neck pathologies that researchers have seen after whiplash injuries:
Your facet joints are the joints behind the discs in your neck. They allow for a gliding motion every time you flex or extend your head. Bring your chin down your neck goes in the flexion. Put your head to look up at the ceiling, and your neck is in extension.
The facet joints control this glide. Unfortunately, it is common after whiplash injury for these facet joints that become unstable and painful. These joints are the single greatest source of pain after whiplash injury. They will be the primary cause of pain in 60% of all injuries.
Discs in the neck can become injured too. Unlike the soft tissue surrounding the bones and joints of the neck, a disc injury can arise later in the course of the healing process.
Early in the event of an injury, a disc can be pretty asymptomatic, but as the healing process advances, and scar tissue gets deposited in other parts of the neck, the fibers of a disc can break down over time. You can be left with pain coming from the disc in your neck after several weeks.
Whiplash injury can cause chronic arthritic degeneration in your discs if left untreated. When researchers looked at the necks of victims of car accidents 10 years after the event, they found a significantly higher incidence of disc degeneration compared to those who did not have a car accident.
Most of the strain of whiplash injury in a young individual happens at the C5–6 disc. This is also the most common location of a disc injury in with late whiplash syndrome.
Your whiplash Injury can upset the balance of signals between movement sensors and pain sensors at your nerve endings. This causes disturbances in the sensory motor control system. Micro trauma to the tiny muscles in your neck can disrupt the muscle spindle cells within the muscle belly. This will upset the contraction and coordination of all of these little muscles.
Your brain and cerebellum rely a lot on the muscles and joints of your spine to detect where you are in space. If you disrupt the system, you will lose balance, and muscle coordination. Your muscles will spasm to try to make up for this lack of awareness of movement. Without proper muscle rehab, this can become a chronic permanent thing.
In our clinic, we use a laser pointer affixed to a head strap to see if we can reproduce neck positioning. It is often the case in a severe whiplash injury that people cannot reproduce where their head is pointed because of what happens to the coordination of the muscles in the neck. Unfortunately it is too common for this to happen in chronic cases too.
If you tore the ligaments in your neck, and you upset the postural control system in your neck, this can lead to instability. And, it's not just the end range of the joints range of motion that is affected. The neutral zone of the joint's range of motion will grow larger after an injury making it so as you move your neck with tiny movements, you'll experience some clunking sensations.
Patients who have had late whiplash syndrome demonstrate performance deficits during the head and neck flexion test. This means that there is dysfunction in the way that the muscles can contract and coordinate and stabilize your neck. When you have the clunk sensation in the middle of your neck, it means that you have an impaired ability to activate the deep neck flexor muscles along with the spinal extensor muscles.
With your eyes closed, if you've had a whiplash injury, you'll experience more trunk sway than you would have if you weren't injured.
As I said above, your brain, brainstem, and cerebellum really relies a lot on the inputs form the nerve sensors in your neck and spine to give feedback of your awareness of where you are in space.
There is an increase of "silent" nociceptors (pain receptors) after an injury. Too many pain signals too often, and for far too long can cause physiological changes in the nerves themselves. This neurophysiological adaptation can cause chronic pain.
This is very much a function of neuroplasticity. You know, where your nerves grow stronger connections in response to repetition. Neuroplasticity allows you to learn how to play the piano, but it also can teach you to experience chronic pain, or hypersensitive pain.
Repetitive pain stimulation, even if it below the threshold of your feeling the pain, can lead to more axonal/dendritic sprouting to form new connections. It will cause a wind-up loop of stimulation where the pain pathway ends up stimulating itself, keeping that connection strong.
This chronic pain stimulation, and this neuroplasticity that forms will lead to "central sensitization." Chronic pain signals, winding up the loop of pain signals. It's a big problem in people with both physical trauma and psychological trauma.
The pain signals keep the pain pathway efficient as the pain signals keep coming. (Remember, the pain signals can even be there even when you aren't experiencing pain.) This sprouts new connections, and like a strong oak tree, the roots grab on strong.
One of the keys early on with persistent pain is to keep your body moving. Movement nerve signals will override the pain nerve signals. This is a strategy to prevent chronic pain from happening.
But if you have chronic pain already, you have to recognize the pain, and you have to be aware that the pain is a lie. It's no longer signaling danger or an injury. It's there in normal tissue that has healed. So you need a strategy to function through the pain, and discern what is a genuine pain response that is protecting you, verses a pain response that is bothering you during normal moment.
Whiplash injures can physically cause stretch damage to the axons in your brainstem and spinal cord. It can cause brain concussions, and stretching of cranial nerves. In the Poorbaugh review article for late whiplash syndrome, they say that the physical damage to nerve tissue can cause or contribute to psychological distress.
The amount of physical impairment correlates well with the amount of psychological distress someone goes through after an injury. So, if you are left with reduced range of motion in your neck because of injury to the soft tissue, you'll likely suffer some psychological effect too. Post-traumatic stress disorders affect about 10% of car accident victims. A referral to the proper professional is indicated to develop strategies to reduce these effects.
If you have been involved in a whiplash injury, then you need to take action with a team of experts right away. At adjust.clinic, we have built our clinic to be a resource for both passive care in the acute stage of injury as well as a center for rehabilitation in the subacute and chronic phases of injury. It's important that you move well through your tolerances early in the injury, and you strengthen the muscles in the body parts involved.
If you suffer the chronic effects of an injury, we can help too. Coping with the chronic pain or stiffness years after an injury is a job done will with the scope of chiropractic care. Mobilizing your spine through adjustments along with exercises that you can easily do at home is a strategy that works for millions of people in the United States. In Petaluma and Sonoma county, we can help you.
