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ACUTE CERVICAL SPINE INJURIES

Common causes of Whiplash, Resulting Injuries, Complications

What to do if you have a whiplash injury

This Information has been prepared specifically for on WHAT IS A WHIPLASH NECK INJURY?

A whiplash neck injury is the involuntary thrust of the head and neck in any direction, and the resulting elastic recoil of the head and neck in the opposite direction, with injury to the surrounding and supporting tissues. Although the proper term for this type of injury is a cervical sprain or strain, the term whiplash will be used in this brochure as it has become so familiar.

1. COMMON CAUSES OF WHIPLASH Common causes are automobile collision, a sudden jerk on one or both arms, a violent blow to the head or chin, a reflex jerking of the head due to fright or sudden noise, and any kind of fall that causes sudden forceful movement of the head and neck.

2. THE INJURY The force causing the whiplash may result in concussion, confusion or lacerations to the soft tissues and may produce sprains, strains, subluxations and dislocations. Joint injuries and fractures to the bones are common

Whiplash injuries may involve the nerves, arteries, spinal discs, spinal cord, ligaments, muscles, tendons, cartilages, sympathetic nerves, parasympathetic nerves, nerve ganglia, nerve plexes, and the brain. 3. DEGREE OF INJURY The degree of injury depends mostly on the forces and direction involved. For example- a car weighing 3000 pounds traveling only 25 miles per hour creates a force equal to 3,450 pounds. This means that several tons of force is exerted on the victim's neck at the moment of impact. The research crash council of the USAF demonstrated that the normal neck can withstand a forward snapping acceleration of 50 times the force of gravity before producing major injury, whereas a

backward snapping acceleration of only 5 times the force of gravity can be tolerated. Other factors affecting the degree of injury and disability are the length of the neck, weight of the head, age, gender, congenital anomalies and pathology. NECK - The longer the neck the greater the possibility of injury. HEAD - The heavier the head the more likelihood of injury. AGE - The elasticity of the neck structures decreases with advancing age. The same injury tends to be more serious in the adult patient than in the spine of children or teenagers. In general - the older the victim the more likelihood of injury and disability. GENDER - The gender of the victim is important since the female autonomic nervous system (supply to glands, blood vessels and internal organs) is more complex and sensitive than in the male.

ANOMALIES - A congenital anomaly (abnormal formation) usually results in a weak back. Naturally a whiplash superimposed upon a weak back causes more disability than the same injury on a normal back. Examples of abnormal formation existing from birth (anomalies) are congenital fusion of the vertebra (grown together), an incompletely developed vertebra exposing the spinal cord (spina bifida), cervical ribs, and extra ribs.
PATHOLOGY - Disease and aging processes affect the degree of injury. For instance, a whiplash type of injury is a pre-existent arthritis in the neck would tend to be more serious than the same injury imposed on a normal neck.

4. THE GOLDEN PERIOD The first three weeks after the injury is called "The Golden Period of Treatment". If the treating physician does not fully understand the whiplash type of injury, serious consequences may follow. Unfortunately, ordinary doctors seldom understand the special threat that whiplash holds for the victim. Too often he/she only treats the victim for muscle spasm. Whiplash is the type of injury that requires special knowledge and experience, and requires more of a doctor's time than other types of injuries. Without proper care and understanding, severe and permanent injury may result. However, recent developments in manipulative practice show that uncared for cases may still obtain a great deal of benefit even years after the injury. TREATMENT The careful management of this combination of conditions has proven to be very effective in restoring normal function to the injured areas. Consistent and complete compliance is the key. Treatment is in three phases: 1) the inflammatory phase during which a variety of symptoms come and go and which usually lasts about 3-6 weeks when treated properly. Treatment frequency during this period can be daily for 4-12 days and then three times a week for 3-12 weeks or more depending on complicating conditions or aggravations. 2) the restorative phase during which the relative positioning of the bones is accomplished and the ligamentous and other soft tissues are allowed to heal. Scar tissue may be minimized if this phase is treated properly. This may last for another 3-6 months and may overlap phase three. 3) The rehabilitation phase during which time the muscular coordination and compensatory mechanisms of the spine are restored to normal function. Treatment here is largely comprised of structured exercises and periodic spinal correction. Treatment frequency is usually daily for 3-7 days and then three times a week for 3-6 weeks. After that, realignment of the vertebra must be performed to prevent eventual return of this condition. It can be accomplished in 30-60 days of reduced frequency management. Often once a week treatment is sufficient at that point to restore alignment. Thereafter, this condition can be reasonably avoided with monthly correction of spinal alignment. After the first few days of treatment, you will be given a sheet of stretching exercises to do at home. This is to help reduce the treatment time and speed healing. It is very important for you to do these daily as prescribed. If you have any questions about them or difficulty or pain on performing them, please tell the doctor right away. Several days following the initiation of treatment, more aggressive exercise routines will be proscribed for you. You will be taken to the rehabilitation center and instructed on how to use the computer monitored exercise routines specifically designed for this condition. The routines are monitored for completion and graduated in difficulty after certain numbers of routines have been completed. You will be expected to perform these routines after treatment during the initial part of the restorative phase and throughout the rehabilitative phase of your treatment. Our goal is to help you get well and stay well. We know from experience that most mechanical conditions return gradually over a period of months and become more advanced each time. The only way this can be prevented is with exercise. We expect you to be successful. We offer treatment of these conditions at various levels for all patients. We expect that you will follow this treatment plan through to its logical conclusion of restoration of complete function and rehabilitation. Our management system is designed to help you remember all of your appointments and to be fully compliant with all of our recommendations. At any time, should you decide to discontinue the process, please just let us know so that we don't become a bother.

COMPLICATIONS

5. STRAINS, SPRAINS & FRACTURES Ligaments are both flexible and elastic. allowing freedom of movement. However, if stretched beyond their elastic limits injury occurs. If the muscles only are involved, the condition is a strain. If the ligaments itself does not tear but the bone to which it is attached tears, an avulsion fracture occurs. These conditions are very different and require different methods of treatment. The healing time for each condition varies accordingly. Injured
joint ligaments heal with scar tissue, in which the elasticity is lost, resulting in loosened spinal joint. This loose joint becomes unstable and may result in traumatic arthritis. Immediate disability follows injury to ligaments. Healing from the functional viewpoint is seldom perfect. 6. TRAUMATIC ARTHRITIS Any injury that stretches into a joint usually threatens the joint with traumatic arthritis. The cartilage the touching surface of the joints may be torn by any violent twisting motion or impact. The cartilaginous surfaces may become devitalized, disappear, or become incongruous as a result of the severe backward and forward snapping movements of the whiplash. The incongruity or loss of apposition of a neck joint is very painful and is known as traumatic arthritis. Thus, a sprain or strain of surrounding soft tissue of the joints can cause a relaxed or loose joint, resulting in degenerative (arthritic) changes at a later date.
	7. MUSCLE SPASM Muscles can be bruised or torn or over-stretched by a whiplash. This results in muscle spasm, loss of normal neck curve, and limitation of motion. Hemorrhages within the muscle may occur, and usually dissolve spontaneously. Muscle injury should improve within several weeks. If it continues beyond a normal period then myofascitis sets in, which is an inflammation of the muscle and the adjacent covering (called fascia, which is an inelastic binding tissue). This
causes a thickening of the fascia and additional limitation of movement. The injured muscle and surrounding ligaments may be replaced by scar tissue - a condition that is called myofibrositis. The inter-relationship of injuries should be realized. When muscle damage occurs such as hemorrhage, swelling, sprain, or strain, almost always the nerve supply is affected. Likewise, if there is a compression of the spinal nerve root as it emerges from between the vertebrae there may be interference either with the motor or sensory function of the muscle. So you can see that muscle injury may cause nerve damage. and nerve injury may cause muscle damage.

8. RUPTURED DISC The violent movements of a whiplash may result in a ruptured disc. Conservative health care should be pursued extensively before the victim undergoes surgery for a ruptured disc in the neck. The reason being that the closer one approaches the brain, the more dangerous the operation. Approximately 70 to 80 percent of ruptured disc cases respond to chiropractic care. Twelve to 18 months is the average disability.

9. NERVE ROOT COMPRESSION Impingement or compression of the nerve root is one of the most common complications in whiplash. Nerve root pain is different from other types of pain. It is felt in the entire area that is serviced by the particular spinal nerve. It is known a "radiculitis" or radiating pain. Almost all whiplash cases involve nerve root compression. Nerve root irritation may also be caused by arthritic spurs digging into the nerves when the neck vertebrae are misaligned from whiplash, and the resulting muscle spasms. Other factors causing nerve root compression are fractures, swelling of the capsular structures and misalignment of the vertebral arteries.

10. NERVE INJURIES There are two types of nerve stretching injuries that result from whiplash. The first is that of an overstretching which does not interrupt the pathway of the nerve, but may cause interruption of the nerve impulses. This type of injury will recover quickly. The second type of nerve injury is where the actual nerve fibers are overstretched to the point of tearing. This may require as long as a year to heal, and the nerve seldom recovers completely.

11. BRAIN and SPINAL CORD INJURY Whiplash may cause concussion, confusion or laceration of the brain, and brain injury should be suspected in all cases where the victim is unconscious following the accident. Damage to the spinal cord within the spinal canal results in injury to the body only below the point of damage. Concussion to the cord causes a transitory disturbance to the spinal cord function, with no permanent or local signs. The spinal cord may be injured by a contusion - in this instance residual signs remain, ranging from slight motor signs to complete loss of brain function.

12. INSURANCE Conservative care is recognized as the treatment of choice for whiplash by more than 500 insurance companies. These include automobile liability, medical pay, and on the job injuries by workman's compensation.

WHAT TO DO If you are a victim of a whiplash injury consult a conservative health care practitioner as quickly as possible. He/she is a specialist in structural and spinal disorders. He/she will advise you frankly, sincerely, and honestly. Follow his/her directions to obtain maximum results at the lowest cost. Should your case require radical care, you chiropractic physician will so inform you and arrange for consultation with specialists as needed.

SYMPTOMS OF WHIPLASH CHIROPRACTIC and MEDICAL RESEARCH now link symptoms as listed below with whiplash type injuries. One or more of these symptoms often occur immediately. However, others may not develop until hours, weeks or sometimes even years following the injury. Many patients having these symptoms are unaware or have forgotten about their accident.

• Headache (One Or Both Sides)
• Head And Neck Pains
• Tension Muscle Spasms
• Stiff Neck
• Restriction Of Neck Motion
• Blackouts
• Fatigue (Tiredness)
• Extreme Nervousness
• Mental Dullness
• Muscle Swelling
• Heaviness Of Head Neck & Shoulders
• Feel Tired
• Light Blindness
• Loss Of Balance
• Equilibrium Problems
• Loss Of Hearing
• Pinched Nerves
• Slipped Discs
• Muscle Tearing
• Neuralgia (Nerve Pain)
• Neuritis
• Ringing Of The Ears
• Nausea
• Gastro-Intestinal Symptoms
• Light Headedness
• Shortness Of Breath
• Low Back Pains
• Pain Between The Shoulders
• Cold Hands Or Feet
• Excessive Sweating
• Numbness Of Arms, Hands, Shoulders, Feet Or Legs
• Loss Of Normal Spine Contours
• Increased Reaction To Drugs
• Anxiety
• Irritability
• Poor Memory
• Inability To Concentrate
• Periods Of Depression
• Fractures
• Dislocations
• Palpitation
• Eye Strain
• Tremors
• Pallor
• Insomnia (Can't Sleep)
• Muscle Atrophy
• Rapid Heart Beating

Expectations We understand that you have come here for help. We have spent many years learning the best ways to solve the problems of mechanical back and neck pain. We expect you to comply with our recommendations and follow our treatment schedule completely regardless of the treatment plan you have. We expect you to set all of the recommended appointments at times convenient for you and we expect you to keep all of them. We expect you to respond favorably and know that your 100% compliance is the determining factor. We also expect you to attend our next class on Absolute Spinal Health. The staff can give you a schedule of the next class. Other Information at our class on Absolute Spinal Health, we discuss mechanical conditions of the back, neck and spine and teach you ways to prevent mechanical conditions from occurring. We also offer a wide variety of health information at our web site. www.piclilnic.com All patients are welcome to use our information to improve your life and maintenance your spinal health.