Let's delve into the intricacies of the often misinterpreted Whiplash Associated Disorder (WAD), a frequent yet multifaceted aftermath of vehicular accidents. While some instances may resolve swiftly, others may evolve into enduring pain or disability, requiring a meticulous approach in diagnosis and management.
The addition of legal complexities further underscores the importance of engaging a healthcare professional well-versed in these injuries. A proficient expert can perform a comprehensive physical examination, formulating the ideal treatment and exercise plan for optimal recovery.
Article Index:
Overview
In this three-part series, we'll dissect whiplash injuries from every angle. Initially, we'll scrutinize how they manifest, focusing on the stages of a car accident and the impacted body parts.
Part two will unveil whiplash symptoms, the workings of a physical examination, and introduce the WAD classification system. In part three, we'll spotlight various non-invasive treatments and demonstrate the power of a well-structured exercise regimen in the concluding part, complete with video demonstrations.
Join us on this journey, where we demystify the complex and make it compelling. Remember, understanding is the precursor to resolution.
Whiplash Motions
Think of whiplash injuries as a seesaw of extremes – an abrupt dance between hyper-extension and hyper-flexion – that's the core of the biomechanics at work here. The astonishing rapidity of these injuries is notable; they unfurl in a near-instantaneous 250 milliseconds. In the chaos of a rear-end collision, there's scant time for passengers to react or brace against the impending impact.
Breaking down the whiplash sequence, we identify three distinctive stages: The Initial Impact, The Neck's Over-Extension, and The Neck's Flexion.
Stage 1: The Initial Impact
Imagine a rear-end collision, the typical culprit behind whiplash. As the trailing vehicle crashes into the one ahead, an impulsive force catapults the front car onward.
The seat of the impacted car, solidly rooted in the vehicle's structure, follows suit. But the driver, unanchored from the car's frame, tends to remain stationary due to inertia. This principle – the resistance to motion change – is starkly illuminated in the chaos of a car crash.
In an abrupt chain reaction, the seat slams into the driver's lower and mid-back, propelling the lower neck forward. This motion obliterates the natural curvature of the driver's neck (the lordotic curve) and mid-back (the kyphotic curve), contorting the cervical spine into an unnatural S-shape.
This Impact Stage has the potential to wreak significant havoc. The neck, trapped in this abnormal S-posture, forces the small neck joints, or facet joints, to overextend. This undue movement risks injuring the areas encircling the facet joints, including tearing of the facet capsule ligaments, bone-on-bone collisions, and internal joint bleeding (intra-articular hemorrhages). The collision's severity largely dictates the degree of joint damage.
Stage 2: The Neck's Over-Extension
This next act sees the car's sudden forward thrust flinging the driver's head backwards, often launching over the headrest, especially when it's inadequately positioned or poorly designed. A forceful collision can strain the soft tissues and joints along the neck's front as the head is hurled back.
Stage 1, Stage 2 - The Damage
Several body components may bear the brunt during the first two stages of a collision. These being:
Facet Joints & Capsules: The Fall Guys These small joints in the neck, the usual suspects in chronic neck pain post-whiplash, help bear weight and modulate vertebral movements. During a whiplash episode, the protective sheaths around these joints, or facet capsules, often fall prey to injury.
Ligament Injuries: The Anterior Longitudinal Ligament (ALL), lining the vertebrae's front, inhibits excessive head backward movement. Damage to this ligament can destabilize the neck, potentially inciting persistent neck pain.
Longus Colli Muscle: The Unsuspecting Victim This deep-seated neck muscle, extending from the top vertebra (C1) down to the mid-upper chest (T3), is a common casualty in whiplash incidents. Injury to this muscle can disrupt a variety of motor functions due to its role in fine motor control, muscle tone, and positional sense.
Platysma Muscle & The Facial Nerve: The Platysma, overlaying the sternocleidomastoid muscle (SCM), extends from the neck and chest's upper regions over the shoulder and down the collarbone. Damage to this muscle, controlled by the Facial Nerve, can cause tingling sensations across the face and upper chest.
Scalene Muscles: A Critical Intersection The Scalenes, three muscles on the neck's side, house a network of nerves (the brachial plexus) and a major artery (the subclavian artery). Injury to this area can result in Thoracic Outlet Syndrome (TOS), a condition manifesting as neurological or vascular issues extending down to the wrist and fingers.
Sternocleidomastoid Muscle: A Key Player The SCM, contributing to neck flexion and rotation, is susceptible to compression injuries, potentially causing a condition known as occipital neuralgia, characterized by chronic upper neck, back of the head, and eye-area pain. Compression to the Spinal Accessory Nerve, controlling the SCM and Trapezius muscles, can also diminish neck and shoulder strength.
Stage 3 - Hyper-Flexion Unleashed
In this final act, we witness the 'hyper-flexion'—a dramatic forward arching of the neck—as the driver's seat recoils, launching the driver forward with unrelenting force. Picture this stage as the coiled spring's final tightening moment before its release. While the seat leaps forward, the head initially, continues its rearward journey.
In a blink, both torso and head are slung forward. The propulsion is so forceful that, absent seatbelts, occupants could be pitched out of their seats, colliding with the steering wheel, or even thrown through the window, contingent on the collision's intensity.
This violent surge triggers the driver's entire spine to bow forward, often stretching beyond its natural limits. This aggressive motion can inflict substantial damage on the neck, mid-back, shoulder, and lower back.
Regions at Risk during Hyper-Flexion
During the third phase of whiplash, hyper-flexion, joints, soft tissues, muscles, and ligaments can face extreme stress and potentially incur serious damage.
Joint Injury
Facet Joints: As previously discussed, facet joints are frequent victims of whiplash injuries, the most common joints affected in the neck. They undergo considerable strain during a whiplash incident's Hyper-Extension and Hyper-Flexion phases.
Soft Tissue Injury
Research indicates that MRI scans often reveal damage to the muscles in the neck's posterior region. Patients suffering from long-lasting neck pain typically present MRI results showing fat deposits within these rear neck muscles (cervical extensors). This type of fat infiltration has been linked to sensory, motor, and physical deficits in enduring cases of whiplash-associated disorders (WAD).
The Suboccipital Triangle
The Suboccipital Triangle Located at the skull's base is the suboccipital triangle, delineated by three pivotal muscles: Obliquus Capitus Superior, Obliquus Capitus Inferior, and Rectus Capitis Posterior.
The importance of these suboccipital muscles lies in their high concentration of neurological receptors. A neck injury doesn't just impact ligaments, tendons, and muscle fibers and affects the neurological structures within them, such as Golgi tendon organs, muscle spindles, and joint receptors. These structures play a crucial role in maintaining posture.
Damage to them may compromise spinal stability and lead to persistent issues.
Furthermore, the high number of muscle spindle fibers in these suboccipital muscles, which relay postural information to the central nervous system, emphasizes their significance. Injuries to these spindles can lead to coordination issues, such as disturbances in gait and ataxia (a condition that affects voluntary muscle movements).
Let's consider the concentration of muscle spindles per gram of muscle tissue in various parts of the body:
Spindle density per gram of muscle tissue:
Inferior Oblique (Upper Neck) – 242
Superior Oblique (Upper Neck) – 190
Rectus Capitis Posterior Major (Upper Neck) – 98
Rectus Capitis Posterior Minor (Upper Neck) – 98
Longus Colli (Front of Neck) – 48.6
Multifidus (Deep back muscle) – 24.3
Lateral Pterygoid (Jaw muscle) – 20.3
Opponens Pollicis (Hand Muscle) – 17.3
Trapezius (Shoulder muscle) – 2.2
Latissimus Dorsi (Large back muscle) – 1.4
The higher the spindle density per gram of muscle tissue, the greater the influence that particular region has over our posture. For instance, the inferior oblique muscle at the skull's base has 242 spindles per gram of muscle tissue, substantially higher than the 1.4 spindles found per gram of muscle tissue in the large latissimus dorsi (a key back muscle).
Damage to these structures within the suboccipital region has been shown in animal studies to cause gait disturbances and ataxia. The suboccipital nerve, which supplies these muscles, can be compressed during a car accident, especially at the superior oblique muscle. This compression is among the most frequent injuries in whiplash incidents.
Semispinalis Muscle
The Semispinalis Muscle, including the capitis and cervicis components, is of importance because of its location directly above the greater occipital nerve. Compression of this nerve is a frequent cause of cervicogenic headaches, often observed following a whiplash accident.
These headaches, characterized by persistent pain in the upper neck, back of the head, and behind the eyes, are also known as occipital neuralgia, C2 neuralgia, or Arnold’s neuralgia. Studies show that roughly 85% of whiplash patients have trigger points in the semispinalis capitis muscle, further underscoring the muscle's significance in these injuries.
Splenius Muscle
Splenius Muscle The Splenius Muscle, comprising the capitis and cervicis parts, plays a critical role in head extension. It also facilitates the neck's lateral bending and rotation. Given its heavy involvement in neck movements, it's not surprising that this muscle is prone to injuries during whiplash incidents.
Damage to this muscle affects all neck activities, potentially leading to limited mobility and heightened pain. This emphasizes the necessity of accurate diagnosis and treatment of injuries to the Splenius muscle following whiplash occurrences for the best recovery and preservation of neck function.
Multifidus Muscle
The Multifidus Muscle, situated deeply in the spine's posterior section, is often affected in car accidents, with injuries spanning from the neck down to the lower lumbar region.
New research suggests that this muscle can amplify the strain on the facet capsular ligaments caused by a collision. Damage to the facet capsules is commonly related to persistent neck pain. Hence, injuries to the Multifidus Muscle during a car crash can have long-term consequences, potentially leading to chronic neck discomfort.
Trapezius
When the upper fibers of the Trapezius muscle are compromised, it can impinge the third occipital nerve, which threads under the Trapezius muscle and ends in the lower region of the head or occiput. This nerve compression can result in occipital neuralgias, a form of chronic headache.
Remember, we have only touched upon some of the frequent anatomical injury sites. We haven't explored injuries to the jaw structures and limb injuries (like those to the elbow, wrist, hand, knee, ankle, and foot) including peripheral nerve entrapments, which can manifest from motor vehicle collisions.
In the third part of "Resolving Whiplash Injuries," we will delve into common symptoms, the process of physical examination, and the classification of Whiplash Associated Disorders (WAD).
Conclusion
In this initial segment on Whiplash Associated Disorder (WAD), we explored the mechanics of whiplash injury through its stages - initial impact, neck over-extension, and neck hyper-flexion. We highlighted key structures like facet joints, capsules, ligaments, and specific muscles, whose damage can result in chronic neck pain and neurological issues. We also touched on the significance of the Suboccipital Triangle and other muscles in causing symptoms like chronic headaches and restricted neck mobility. The upcoming segment will delve into common symptoms, physical examination procedures, and introduce the WAD classification system, aiming to simplify the complex nature of whiplash injuries.
Note: References at the end of Chapter 3
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.
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