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  • Dr. Cameron Bearder
    • Nov 1, 2020

What is Whiplash?

"WHIPLASH" is a term that is being used more and more within the healthcare arena, and for good reason. Once thought to be “non-existent,” the mechanisms and symptoms of whiplash are now much more understood by those who study and treat it. While there is still MUCH more research to be done, I’ll save that for another blog. Today, I’ll focus on the following:

  1. What is the definition of Whiplash?

  2. How do you get Whiplash injury?

  3. What are the most common Whiplash symptoms?

  4. How long does Whiplash last?

  5. What is the best Whiplash treatment?

 

What is the definition of Whiplash?


According to the MAYO Clinic, whiplash is defined as “a neck injury due to forceful, rapid back-and-forth movement of the neck, like the cracking of a whip.” There are several phases to the actual mechanism of whiplash:

In reality, the hyperflexion/extension phases can happen several times, depending on the mechanism of the whiplash itself, but the phase that is most overlooked is the "Impact Phase." As impact occurs, there is a SHEARING force that takes place in the spine. Shearing is not good, not good at all. Let's do a little visualization … Imagine placing an Oreo in the palm of your left hand. Now, gently place your right hand on top of the Oreo. Quickly and violently, push the Oreo together and then rapidly move your left hand backward and your right hand forward. The filling is going to collapse and the cookie(s) are going to crumble. That's about what's happening to your spinal segments and discs during a whiplash event.

 

How do you get a Whiplash Injury?


Most whiplash injuries are going to occur from some sort of collision. Statistically, it's going to happen with a car crash. Contact sports, like football, lacrosse, soccer, rugby, etc. are coming in second place, with things like bicycle accidents, horseback riding, and roller-coaster rounding out third. Lastly, and not talked about near enough, are forceful blows to the head and neck, usually from some form of physical abuse.


Now, these events do not have to be all-out traumatic for a whiplash injury to occur. In fact, it can be quite the opposite, and frustratingly so. Current research data has revealed that a whiplash injury to the neck can create symptoms and spinal damage at speeds as low as 5-10 miles per hour. This is NOT that fast!!!

Even minor "fender benders" (do fenders even bend anymore?) can create lasting and lingering issues, depending on the person and other variables involved in the collision. For example, in a motor vehicle collision, the weight of the person, rotational position of the head during impact, and whether they anticipated the impending collision happening all play a part in the potential severity of the damage to the spine. There's actually a research documented LIST of factors and variables.


A growing awareness, as well as body of research, is indicating that contact sports injuries and collisions can create a whiplash event, with similar symptoms to a motor vehicle accident. Some folks might argue that a car collision can be more serious. I'd reply to that and say that its context dependent. Pretty much every car built after 2010 is going to have some pretty amazing safety features that activate when a collision occurs. There are no safety features in when someone gets SLAMMED and tackled in a soccer, basketball, lacrosse, or football game. Sorry, helmets don't count in my opinion. Don't believe me? Hop on over to YouTube and search sports injuries. Still not convinced? Next time you're watching a sports game on the ESPN, pay attention to the replay when a player gets injured. You'll see that neck get cranked around like one of those inflatable thingies at a used car dealer. The same discussion can be had with bicycles. If a rider goes over the handlebars, that neck is in for a wild ride. I take care of plenty of weekend warriors and athletes that have had some serious crashes happen, wreaking havoc on their neck. You better believe that there was some whiplashing happening. Less common occurrences of whiplash, but still very relevant, might come from horseback riding and roller coasters. If you can't visualize it, YouTube is chock-full of examples. Less commonly talked about is injury from abuse. This is a difficult subject to talk about, but let me assure you, it is a very real occurrence.

 

What are the most common Whiplash symptoms?

Most whiplash symptoms are going to be contained to the head, neck, and shoulders. Low back pain from whiplash events is a very real possibility and happens more often than you might think, however, I'm going to stay in the lane that I focus on, the head and neck.


Soft tissue injuries are going to create the most common whiplash symptoms, ranging from headaches, jaw pain, neck pain, shoulder pain, etc. Muscle strain and ligament sprain are most likely to blame for these. If we dive a bit deeper, some of the more serious symptoms can actually be from bone and/or nerve tissue injury. This is your radiating pain, "pinched nerve" pain, and numbness/tingling-type issues. These can happen from direct injury to the bone or nerve, AND as a consequence of a soft tissue ligament injury. You see, if the ligaments that hold the spine stable become weak, or lax, this can allow for the spinal segments to move a bit more than they should. This changes how the brain interprets stability with regards to spinal structure. Eventually, chemical signals from the brain to bone will turn on the arthritis process by actually creating MORE bone for stability. This process takes time to manifest, and I'll explain this more in just a bit. As arthritis builds up around existing bone, there's a chance (and probably a good one) that it's going to build up mainly around where the segments rest on the spinal disc, as well as where the spinal nerves exit between the bones (intervertebral foramen, for the nerds). THIS can directly irritate the nerves, as well as activate pain receptors in the discs (nociceptors, again, for the nerds). Full transparency and honestly, the research on "arthritis" does NOT point to all arthritis creating pain. To simply state that JUST because you have arthritis, you will be in pain, is simply not true. Hopefully, your doctor is willing to be a detective clinician and determine what is actually going on. I'll explain this more in depth in a future post, so more on this later.

Less common injuries would include concussion, post-concussion syndrome, and hormonal issues. If that pile of electrical mush we call a brain gets jumbled around enough, you're on track for a concussion. Research is kind of all over the map with regards to concussion, but as it builds, things are becoming clearer. However as it stands now, healthcare professionals don't really do much for concussion(s). In my practice we see quite a few post-concussion syndrome cases, with most of them coming from exactly the type of scenarios I'm describing in this post. I could, and will, write a lengthy post on concussion, so for the time being, we'll just settle on it being an overlooked, but very important part of whiplash.

 

How long does Whiplash last?


One of the more perplexing issues with whiplash associated disorders (WAD) is that it is compounded by the paradox that major injury can result in minor symptoms whereas minor trauma can result in severe, disabling symptoms. In other words, for the most part, there's no absolute determining factor with regards to predicting how long pain from a car accident will last, or how long it takes for whiplash pain to go away. To be very honest, we think we know SO much about the human body and how it works, when in reality, we don't. Every patient is unique and has to be treated as such.


Now, to get to the "million dollar question." The answer is, it depends. There are some guidelines with regards to whiplash-related pain and when to take it "more seriously." Most professionals will agree that pain that is not getting better and/or getting worse past 6-8 weeks is going to need some deeper attention. In my professional opinion, if it were my wife or parents, I would want them to be checked within several days of the whiplash event, with periodic check-ins over the next 12 weeks. Sometimes, symptoms don't initially appear immediately after the whiplash even. I've had patients report that their pain didn't start until a month after the event! That's 30 days that their body was actively repairing itself, potentially on an unstable spine. For reference, soft tissue repair stages begin in the body VERY soon after the injury. So let's say that you had pain that started to creep in 2 weeks after the whiplash event, and you shrugged it off with some Ibuprofen, which made it feel a little better, allowing you to "forget about it." Four to six months later, you wake up and realize that you've progressively felt like Mike Tyson's punching bag for longer than you'd care to admit. For that entire time, your body is trying to figure your life out on a potential unstable surface. This is what we call the beginnings of chronic pain from whiplash.


Can pain from whiplash "go away" without treatment? Well, yeah, sure. If you're one of the lucky ones and your ability to repair and adapt is higher than average, then you might only have a handful of days with some soreness. Now, this does NOT mean that everything is 100% ok. I'm not going try and "scare" folks, I'm just trying to inform, but I wouldn't ride that train of "I feel fine, therefore, I must be fine!"

 

What is the best Whiplash treatment?


The best whiplash treatment is the one that treats the PATIENT and not just the SYMPTOMS. That might be a little confusing, but for the other healthcare professionals that read our posts, I know you understand what I'm saying.


We can do all sorts of x-rays, MRIs, and exams. We can perform adjustments, recommend exercises, administer injections(Medical Doctors), or whatever it may be. BUT! If all we do is blindly follow a protocol and then refer them out when they don't get better, what type of healthcare is that? The best whiplash treatment is one that is a comprehensive, evidence-based approach, focused on the goals of the PATIENT. Has anyone ever asked you, "what are your goals with this treatment?" Obviously you want to reduce/eliminate the pain at hand, but have you as a patient ever asked the DOCTOR, "what's the actual goal of this treatment you're about to administer?" Our whiplash approach is multi-factorial:

  1. LISTEN to the patient and make sure that this is the correct approach for their goals

  2. THOROUGHLY examine the patient, using analytics that will guide us to the source of the problem

  3. Treat the PATIENT using the tools in our toolbox, combining Active and Supportive therapies

  4. Manage expectations and EMPOWER the patient about their own health


That being said, I'd say that at least 75% of our patients have been to other providers before they walk through our doors, and I can say that the majority of them have gotten limited, if any, relief or answers. Why? Typically, but not always, a critical piece of the puzzle has not yet been addressed …


At Keystone, one of our main areas of focus is to identify is the person in front of us has an Atlas Displacement. In a nutshell, when there's been some form of injury to the head and neck, more times than not, the area that goes un-examined is the upper cervical spine (the top part of your neck). Interestingly enough, there is overwhelming research indicating that THIS area is MOST VULNERABLE to injury, yet it is alarmingly overlooked and rarely treated. The majority of our focus at Keystone is to assess, gently reposition, and stabilize this critical area of the spine using an Upper Cervical Chiropractic approach. There is NO twisting, popping, or cracking of the neck, as the research tells us that this upper cervical area does NOT respond well to regular "manipulation." We then use supportive therapies to accelerate the healing process, drastically reducing the time needed to reach our goals.

 

Whiplash is a condition that we commonly treat here at Keystone. As it's part of our larger focus on head and neck conditions, it's right up our alley. Now, we've taken it a step further and sought out the BEST when it comes to everything there is to know about whiplash. That honor goes to Dr. Art Croft, at the Spine Research Institute in San Diego, CA. Without exception, Dr. Croft's work with whiplash and whiplash associated disorders is second-to-none, having pioneered the field and the landmark studies that have followed. I'm happy and honored to be able to state that our on-going continuing education includes graduating from SRISD Biomechanics and Traumatology program in 2017.

This blog is provided for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that we might see and do not describe the circumstances of a specific individual.


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