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Category Archives: Whiplash Neck Pain
When neck movements occur suddenly, or unexpectedly, it is very likely an injury will occur.
An injury occurs typically because the muscles of the neck are unable to tighten quick enough to the sudden or unexpected movement. When it is from a motor vehicle accident, especially from an impact from behind, it easy to envision the resultant injury to the neck.
The impact is definitaley forcefull enough, and in most cases sudden and unexpected, to cause an injury to the neck. But even if the impending collision is expected, the muscle of the neck are overpowered to result in trauma as well.
That said, there are very basic pieces of advice to reduce the chances of being in a car accident in the first place. This may seem like basic suggestions, but prevention is always the best medicine, and when a neck injury and life long pain and suffering are common consequences of car accident, being reminded of these suggestions are helpful.
1) Consuming Alcohol and Driving: I know, simple, common sense advice, but you’d be surprised how often this happens, and really neck pain and suffering is but one of many evils that happen with drinking and driving.
2) Using your Cell phone and driving: Again, seems like common sense, but having one hand on the wheel, and one hand on the phone, decreases reaction time, decreases concentration, and decreases physical ability to maneouver your vehicle.
3) Don’t Text on your phone and drive: How often do you see someone doing this? Scarry isn’t. For the reasons above, and mostly not paying attention, will significantly increase your chances in causing a car accident.
University of Utah actually determined that being intoxicated was less of a problem for causing motor vehicle accidents, when compared with distractions from cell phone use.
Not paying attention while driving is hypothesized to be involved in 20-50% of motor vehicle accident, reported by police in which up to 13% resulted from the driver not paying attention.
Another reported study found that using the speaker component of your phone vs using the cell phone with your hands were alike. Both decrease the drivers ability to respond in time, when measured against a driver not using a phone at all.
It would seem that hands free would be less likely to result in an accident vs hand held. However, it is believed that the energy it takes our brain to concentrate or, the “thinking” part during the conversation causes the primary distraction, not the use of hands.
South Carolina University also found that when compared to talking with a passenger, planning to speak put far more demands on the brain than listening. Thus, we become “distracted”, and it is these “distractions” that increase the probability of an accident.
Okay, rubbernecking doesn’t exactly look like this, but you get the idea.
Another form of “distraction”, the obvious concern are the eyes of the road, while the vehicle is still moving. We have a fascination with other accidents, and we rubberneck when an accident is ahead.
As we focus on the other accident, not only are our eyes off the road, more then likely, traffic ahead is slowed, if not stopped. Whamm, another accident.
5) Changing Stations/CD Player: another distraction in which we are not focused on the road.
Of all the factors listed above, Texting seems to be the most worry some. The University of Utah study found a factor of 6x times more likely to be in a car accident due to being distracted because of texting.
It seems that texting while driving is more common with the young. Half the drivers asked between the ages of 16-24 admitted to texting while driving, whereas with drivers between the ages of 35 years old and 44 years, 22% admitted to texting.
6) Drowsiness: another significant distraction responsible for an increased risk for a motor vehicle accident is being drowsy, which increased the drivers risk of a crash or near crash by 4 times, according to a July 2009 Virginia Tech report.
They studies analysis of videos of 200 truck drivers, Combined, the drivers studied logged over 3 million miles.
Results indicated that texting while driving had the greatest safety risk at 23 times more likely to have their eyes being off the road.
Other variables for increase in saftery risk was reaching for a moving object, with a 9 fold increase, while rubbernecking increased the risk 3.7 timess, reading increased it 3 times, dialing a cell phone increased risk 3 times, and talking or listening on a hand held device increased the risk 1.3 times.
The bottom line: Neck injuries from motor vehicle accident, let alone fatalities, are a very real concern. Concentrating on the function of “driving” is paramount, but avoiding the above distractions can not only save your neck in the future, it may even safe your life.
Till next time, watching your back and neck.
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IF you have every had a whiplash accident, this post is going to provide you with a lot of information you will find very valuable.
It turns out that many chronic neck pain sufferers have been involved in a prior motor vehicle accident. That seems rather obvious, but what really happens in theseand “whiplash” type injuries?
Whiplash Type Injuries:
One of the longest studies looking at the long term effects of whiplash type injuries from a car accident determined that 55% of the people studied had residual consequences 17 years later(1).
Unfortunately, many of these participants still continue to receive some type of ongoing rehab.
When of the many questions I get from my patient is whether they should use a collar immediately after their injury, especially if the injury is a whiplash type injury to the neck.
I remember having an old lady on my street using a neck collar for years every time she got in her car, and even then, I wasn’t sure if she needed to wear it, as she wore it for years and years.
Many of my own patients ask me whether or not they should use a neck collar after a whiplash accident. With respect to this topic, a lot of controversy exists.
The purpose of this blog post is to discuss the research related to Whiplash injuries.
So lets have some fun with this topic.
Think of it as a battle: In the red corner, we have the champion, the “SOFT COLLAR”, and in the Blue Corner, we have the challenger, the “Early Mobilization and Movement”
However, in order to evaluate the pros and cons of using a soft collar for the neck after a motor vehicle/whiplash type accident, it’s important to first talk about the basic fundamentals of soft tissue injuries and the healing process itself.
What happens to my neck in a whiplash type injury?
Fundamentals of Soft Tissue Injuries and The Healing Process
John Kellet M.D, an Australian physician published a comprehensive reivew of the literature on this topic in the journal Medicine and Science in Sports and Exercise and titled it: Acute soft tissue injuries-A review of the literature(2)
The article goes on to describe 3 phases of soft tissue repair when injured.
Phase 1: The Acute Inflammatory or Reaction Phase
Lasting up to 72 hours immediately after the whiplash injury, it involves dilation of the blood vessels, increased blood flow with the accompanied immune response, cleaning up of the area by white blood celss, and the resultant inflammation.
Pain is produced from tissue damage and the inflammation itself.
Phase 2: Regeneration of Repair Phase
This phase lasts anywhere between 48hours to 6 weeks after the whiplash injury. It is in this phase that the injured tissue is trying to “repair” itself, as collagen is produced and laid down at the injured site.
However, the collagen that is laid down is weak, and laid down in an irregular pattern. The collagen fibers continue to strengthen between 3 to 14 weeks after the injury, and even up to 6 months.
Phase 3: The Remodeling Phase
Overlapping with phase 2, this phase may last up to 12 months or longer after the whiplash injury. In this phase, the collagen cells that have been laid down continues to be “remodeled” in the way that its strength is improved, and oriented along with the healthy tissue.
So in the words of William Shakespeare:
“To Collar or Not To Collar?” That is the Question?
When a soft collar is recommended and used after an accident the goal is to immobize the injured area. This supposedly prevents more trauma/injury to the unstable area, as well as lends support to the injured tissue caused by the whiplash mechanism.
All things being equal, with no resultant bone trauma (ie, dislocation and/or fracture), the injury is said to be a “soft tissue” injury.
So in the case of soft tissue injuries, immobilization with a soft collar would be detrimental to the process of healing as described by Dr. Kellet, as early mobilization and movement would seem to improve the timing and healing quality, and help you with the whiplash symptoms.
In fact, Dr. Kellet states: “early mobilization guided by the pain response, promotes a more rapid return to full activity“.
If we think about the second phase of healing, where the collagen fibers that are laid down are trying to orientate themselves along the line of stress, then it would make sense that it is the early mobilization and movement that is in fact responsible for its organization.
Other benefits to early movement after a whiplash accident identified by Dr. Kellet are:
- strengthening of bone and ligaments, which in turn reduces injury recurrence
- stimulation of collagen fiber growth and realignment
- joint awareness is maintained and developed earlier, which is also important in minimizing recurrence of injury
- and better nutrition of cartilage
Dr. Kellet expresses that immobilization of soft tissue injuries with the use of soft collars in particular, results in diminished endurance, that ultimately causes loss of strength and muscle wasting that may delay full recovery “for a year or more”
The scar tissue that occurs after an injury is one of the main factors responsible for strength loss, elasticity loss, and resulting residual symptoms from you whiplash injury.
In their book entitled: Sports Medicine: Prevention, Evaluation, Management, and Rehabilitation (3) physicians Steven Roy and Richard Irvin state that early motion helps to prevent these fibrotic (scar) tissue changes.
They also go on to state “another reason for encouraging controlled motion is that any adhesions that develop will be flexible and will thus allow the tissues to move easily on each other.”
Another study done in 2000 by Dr. Pekka Kannus, MD, PhD, adds to our understanding of soft tissue injuries. Published in the journal The Physician and Sports Medicine his article was titled:
Immobilization or Early Mobilization after an Acute Soft-Tissue Injury/Whiplash Injury?(4)
Dr. Kannus basically summarizes his study with the following: “Experimental and clinical studies demonstrate that early, controlled mobilization is superior to immobilization for primary treatment of acute musculoskeletal soft-tissue injuries and postoperative management”
This article too adds to the support focusing on early mobilization following a whiplash injury and avoiding immobilization.
What about any studies that specifically looked at the outcomes of people who actually used cervical collars, and compared them to those that didn’t and utilized early mobilization, for treatment of acute soft tissue whiplash injuries?
Well, orthopedist K Mealy and colleagues asked this question and published their study in the British Medical Journal in an article titled (5):
Should I move my neck after a whiplash injury?
Early Mobilization of Acute Whiplash Injuries.
In this study, 61 patients with acute whiplash injuries were studied. Of the patients studied, 31 received active treatment, while 30 received a cervical collar and were called the “standard treatment” group, in this whiplash study.
The active treatment group received ice in the first 24 hours and then mobilization of the neck and daily exercises for the neck.
These daily exercises were performed every hour at home, within the limits of pain, and no pain medications was needed.
The other group that received the soft collar were advised to rest for 2 weeks before beginning gradual mobilization.
So what were the findings?
“At four weeks, a significant increase in cervical movement occured in the patients given active treatment but not in those given standard treatment.
At eight weeks cervical movement was significantly greater in the patients given active treatment than those given the standard treatment, indicating that the increase in cervical mobility occurrred earlier and to a significantly greater degree with active treatment”
As well, the authors concluded:
“our results confirmed expectations that initial immobility after whiplash injuries gives rise to prolonged symptoms whereas a more rapid improvement can be achieved by early active management without any consequent increase in discomfort”.
Again, clearly early mobilization was superior to the cervical collar in this study.
Another study by Physical Therapist Mark Rosenfeld and colleagues was publised in the journal Spine in 2000 tittle(6):
Early Intervention in Whiplash-Associated Disorders A Comparison of Two Treatment Protocols.
They too looked at patients with whiplash injuries who either got a collar or did early mobilization. They studied 97 patients and were reevaluated at 6 months.
The authors mentioned that 3 studies show negative effects of rest and use of a cervical collars. Yet, oddly enough, this type of treatment is still commonly recommended to patients in early management of whiplash injuries.
The main finding again from this study was
“that active treatment of Whiplash-Associated Disorders (WAD) resulted in a significantly greater pain reduction than standard treatment” and that “the current results confirm that frequent active mobilization exercises decrease symptoms more than a gradual mobilization program.
Thus, a soft collar for the first period after injury is not the best treatment for WAD”
What was interesting about Mark Rosenfeld’s study, was the fact that they published a 3 year prospective follow-up as to the clinical status of these 97 patients.
The authors concluded in their follow up:
“The main finding in this study was that active interventin in patients with whiplash-associated disorders resulted in a significantly greater reduction in pain intensity, a greater chance to retain or regain cervical range of motion, and reduced sick leave compared with a standard intervention”
With all these studies, they really point in favor of the the use of early mobilization, and discourage the use of soft collars.
Back to our analogy of a battle, it seems that the soft collar has been knocked out in the first round, and is down for the count.
But what kind of motion or mobilization is best?
Rosenfeld and colleagues propose that the most effective active motion is rotational.
They explain that the rotation motion “encourages regional blood flow, and facilitates the removal of exudate, thus allowing healing to occur by aiding nutrition of joint structures”
That certainly is a mouthful, What it basically means is that rotating and or turning the neck is the most effective motion and accelerates the healing process.
So what should we take away from this lopsided victory?
Well, again, all things being equal, with a soft tissue injury of the neck due to a whiplash type accident, soft tissue collar may promote inactivity which can delay recovery with patients with Whiplash.
As well, early mobilization, and familiarity with proper exercises and movements to properly manage both the acute and chronic whiplash injured patient is supported by all the research, and is highly recommended.
Many times, whiplash injuries also create neck pain and dizziness, read hear to find out more.
1) Mark Rosenfeld, RPT; Aris Seferiadis, RPT; Jane Carlsson, RPT, PhD; Ronny Gunnarsson, MD, PhD; Active Intervention in Patients with Whiplash-Associated Disorders Improves Long-Term Prognosis: A Randomized Controlled Clinical Trial; Spine 2003; 28(22):November 15, 2003: 2491-2498
2) Kellet J; Acute soft tissue injuries-a review of the literature; Medicine and Science in Sports and Exercise; October 1986;18(5): 489-500.
3) Roy, Steven M.D,, and Irvin, Richard, Sports Medicine: Prevention, Evaluation, Management, and Rehabilitation, Prentice-Hall, Inc. (1983)
4)Pekka Kannus, MD, PhD; Immobilization or Early Mobilization After an Actue Soft Tissue Injury? The Physician And Sports Medicine; March 2000; Vol. 25 No 3. pp 55-63.
5) K Mealy , H Brennan, GCC Fenelon; Early Mobilisation of acute whiplash injuries; British Medical Journal; Vol. 292, March 8, 1986, pp 656-657
6) Mark Rosenfeld; Ronny Gunnarsson; Peter Borenstein; Early Intervention in Whiplash-Associated Disorders: A Comparison of Two Treatment Protocols; Spine, 2000;25:1782-1787
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Ever her the term whiplash before?
Worse, ever experience a whiplash related injury?
If not, envision this scenario.
While driving to work, you’re stopped at a red light and glance in the rearview mirror and notice that a car is approaching from behind way too fast.
The next thing you remember is the squeal of the tires and a loud crash with an accompanied sudden jolt as your car is propelled forward by the impact.
Hopefully they managed to slow down enough to not result in a lot of vehicle damage like this vehicle seen below.
No matter how intense the impact is, most likely your initial reaction is one of shock.
Not exactly sure what happened. A rush of thoughts going through your head, without releasing what has just happened.
Wondering is anyone hurt? Am “I” hurt? What just happened.
How bad is my car damaged? Should I get out of the car? I’m going to be late for work!
Within a few minutes, the police arrive and after about an hour of taking statements from the two drivers and a few witnesses, you decline an ambulance offer to take you to a nearby hospital.
You realize that being hit from behind literally whipped you neck and head forward and backwards (ie. WHIPLASH).
However, although it hurts, it probably isn’t bad enough where you feel you need to be immobilized, and taken in an ambulance to a hospital to do extensive testing.
Happy that you can still drive your car, you arrive at work an hour and a half late.
After reviewing the details of the crash with co-workers several times, you keep re-living the whiplash accident that you have just been through.
You begin to notice a headache, your neck is stiffening up, and it seems like all movements of your neck and head have become limited and painful.
After another couple of hours and a few Ibuprofen, the pain has increased and you now have a whopping headache.
What To Do About Whiplash Injuries:
Many People will decide to take the rest of the day off. Maybe later in that day or the next, as your neck continues to get worse and worse, you think to yourself, “I better go see my doctor to see if something is wrong”.
Maybe you decide to go to the emergency room afteral.
After the exam and x-rays, most likely, the doctor tells you not to worry, nothing is broken, that you “strained” your neck, you should be fine, take a couple of muscle relaxers or anti inflammatories, and maybe some pain killers.
But is this advice accurate? Will the pain medications actually fix the neck if they’re is any damaged caused by the whiplash accident?
Far too often, no one explains the mechanism of whiplash injuries.
Complicating matters is the fact that either you or your insurance company would like you to believe that such a low speed rear-end collision couldn’t possibly cause any long-term injuries.
I see patient’s like this on a day to day basis. I believe that education about whiplash injuries is vital for the patient to understand if they want to avoid any long term consequences of their whiplash injury.
What I tell my patients is a couple of things that really hit home in helping them to understand how such a seemingly minor crash can create so much pain.
The first thing I explain is the fact that “it is not possible” to voluntarily contract a muscle quick enough to “brace” your muscles, in order to prevent the acceleration of the head.
Translation: No matter who light the impact, you can’t physically protect your neck from going forward in a whiplash accident.
Upon impact, as the car is propelled forward, the head initially goes backwards and then when the muscles in front of the neck are stretched to their limit, the head is then “whipped” forwards in a “crack the whip” type of response.
All of this takes less than 600-700 milliseconds!
The second point I try to have my patients understand in a whiplash type injury is the fact that your head (in the very least) was rotated at the time of impact.
Whether you were looking in the rearview mirror, side view mirror, the passengers in the back seat. All these angles, whether 1 degree or 180 degrees, places the neck at a greater risk of injury.
That’s because of the twisting motion that occurs during the “crack the whip” process in a whiplash injury.
Another interesting point: even if they was not a lot of car damage, the shock and force of the impact was not absorbed by crushing metal of the impact between the cars.
Rather, the energy is therefore transferred to the contents in the vehicle, including the occupants. That is why your briefcase ended up on the floor and your glasses flew off during the crash.
IF that happened, think about what happens to your neck.
Last point to consider is the difference between genders and the degree of injury
Unfortunately, women are more likely to be injured more severely because of the less muscular and sometimes longer female neck.
The degree of injury is also at greater risk when there is osteoarthritis in the neck that pre-exists the crash.
That is, the older you are, the worse the whiplash injury will be to your neck.
An analogy of how a young sapling branch can bend without breaking verses the “old oak branch” which snaps and breaks when its only bent slightly.
So, if you are a middle aged, female with a long slender neck with pre-existing arthritis looking in the rearview mirror prior to impact in a rear-end collision, ligament over stretching / tearing is highly probable.
In summary, it is important to obtain prompt evaluation and treatment by your a doctor who is going to explain to you why your neck pain is related to the whiplash accident.
You should do this as soon as possible as because when time passes without treatment, it is more difficult to bring about a reduction of pain and increased motion and, it will generally take longer.
Taking medication for pain only postpones the needed process of restoring movement and function of the neck so that should not be the only treatment.
Generally speaking, a “wait and watch” approach is not wise in these types of injuries.
So if you or a loved one is suffering with whiplash, or have even experienced a whiplash injury in your lifetime, understanding and sharing this information may be one of most significant acts of kindness that you can give to those that you care about.
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