Why Whiplash is a Sneaky Bastard (The Physics & Damage)

There's a few important things at risk, (like your brain stem, no big deal.)

The research on the physics of how whiplash happens is slightly terrifying. With speeds as low as 8mph the sudden force of being hit may only be 2G, but with appropriate calculations, your neck ultimately absorbs a whip-like force of 5G for .25 of a second. (1) This is called 'magnification of acceleration' and unfortunately most people in a low speed accident will write-off any symptoms as non-related simply because they associate injury with higher speeds. 

Our clinic notices how many cases in which we treat neck pain, and more often than we'd like to admit, there's a low speed rear-ending accident in that patient's past that was never assessed. We hate to see patients spend money out of their own pocket to treat these issues when it should have been covered by PIP under your car insurance. But the longer anyone waits to submit that claim, the higher the risk of it being rejected. 

(1) Shapiro, A.; Teasell, R.; Steenhuis, R.: Mild Traumatic Brain Injury Following Whiplash. In: Spine: State of the Art Reviews. Vol. 7, No. 3. September 1993. pp. 455-469 

Spinal Cord Canal Narrowing During Whiplash

(A review of the latest studies by Dr. George Cluen) 

The upper cervical spine is exposed to tremendous forces during rear end collision, even when speeds are under 10 miles an hour. Research shows that ligaments can be stretched or torn, the muscles can be strained, and a new study from Yale shows that the nerves and spinal canal may also be at risk.

In this study, the author studied the biomechanics of a cadaver's cervical spine during a simulated whiplash motion. The spine was subjected to three types of tests: A crash of 7 mph with no head restraint, an active head restraint, and a modern whiplash protection system (like that of the Mercedes Benz M class models 2005 and newer.) The cervical canal houses the spinal cord, this area and the foraminal space was computed during each impact while researchers looked for evidence of spinal canal narrowing.

The study found that "Average peak canal and foramen narrowing could not be statistically differentiated" between the three types of tests.

The study concludes:

"While lower cervical spine cord compression during a rear crash is unlikely, our results demonstrated foraminal kinematics sufficient to compress spinal ganglia and nerve roots. Future anti-whiplash systems designed to reduce cervical injury may reduce radicular symptoms in whiplash patients."

Non-Scientist Translation: 

7 mph is enough to compromise the space around the spinal cord and the connecting nerves momentarily, damage can be done.

This study shows that further seat design developments are needed and even with advanced head restraint technology, injury from rear end collisions is still possible.



Ivanic PC. Cervical neural space narrowing during simulated rear crashes with anti-whiplash systems. European Spine Journal 2012; January 24; Epub before print.

Physical Therapy VS. Self Care for Whiplash

(A review of the latest studies from Dr. George Cluen.)

Up to half of all whiplash patients are plagued with chronic symptoms, and ongoing research seeks to identify affordable, effective methods of preventing chronic pain. The standard treatment for whiplash often includes comprenhensive, long term physical therapy. While these treatments have been shown to be beneficial, researchers from the University of Australia wondered if patients could get some of the same benefits with more minimal visits and an at-home exercise program.

What they discovered was, patient education coupled with at-home exercise programs, can be equally as effective as longer, more intensive physical therapy treatments are needed. The results showed that healthcare costs could potentially be reduced and those in chronic pain could reduce their appointment load.

The study included 172 patients suffering from whiplash after an auto accident who were randomly assigned to either a physiotherapy or an advice-only group. The patients in a professional treatment path were given 20 one-hour physical therapy sessions over the course of 12 weeks. The second group received a single 30 minute session of patient education and physiotherapy, along with the at-home exercise program. After 14 weeks of care, there were no clinically significant differences between the two groups. (Note that emotional burden or any other adaptive benefits were not measured. Let's not completely discount in person physical therapy.)

What we see a lot of within our industry that patients reflect back to us within initial appointments, is that a path of drugging and physical therapy typically sums up the corrective steps before a surgery is recommended. At Auto and Work Injury Center, we educate patients about the full spectrum of alternatives and how they compliment each other. Research shows that when you combine chiropractic with physiotherapy, recovery takes on a new momentum. Chiropractic can reduce symptoms for 93% of whiplash patients, and research also shows that patients receiving chiropractic adjustments for neck pain have lower medical costs and speedier recovery compared to patients seeing only a physician or physiotherapist alone. 



References

MichaleffZA, et al. Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomized controlled trial. The Lancet 2014; pii S0140-6736(14)60457-8. doi:10.1016/S0140-6736(14)60457-8.http://www.ncbi.nlm.nih.gov/pubmed/24703832

Woodward MN, Cook JCH, Gargan MF, Bannister GC, Chiropractic Treatment of chronic 'whiplash' injuries. Injury: International Journal of Care of the Injured 1996;27(9):643-645

Korthals-de Bos IB, et al. Cost Effectiveness of physiotherapy, manual therapy, and general practitioner. British Medical Journal 2003. doi: http://dx.doi.org/10.1136/bmj.326.7395.911. 

PTSD Tied to Chronic Pain After Auto Injury

 (A review of the latest studies from Dr. George Cluen)

Post traumatic stress disorder, although typically conjuring images of soldiers in shell shock, is becoming an increasingly documented concern after auto accidents. Unfortunately, it doesn't take a major car crash to forever alter a patient's psychological health. Research shows that even patients with mild injuries can show signs of PTSD. Now, a new study from the journal of Rheumatology indicates that PTSD is the biggest predictor of poor quality of life after an auto collision.

Prior to adjusting for socio-demographic characteristics, these results showed that 56% of whiplash patients reported non-recovery one year after the accident, compared to 43% of patients with other mild injuries. Whiplash patients were also more likely to report their symptoms negatively impacted their occupation status (31% versus 23%). These differences were not considered significant however after adjusting for socio-demographics such as gender, family, age, and education level.

What did hold true after adjusting for other stress factors, was the effect PTSD has on chronic pain. Patients with PTSD reported a two-fold increase in residual pain 12 months after the accident and a subsequent reduced quality of life.

These findings demonstrate that identifying and treating PTSD in auto injury patients is vital for preventing persistent pain. Finding healthcare providers that are both sensitive to the emotional needs as much as the physical needs is imperative for relief. At Auto & Work Injury Center we strive to educate our patients about approaching healing in way that addresses all three planes of the injury (the physical, emotional and energetic plane) and we offer supportive programs for this.



Reference

Hours M, et al. One Year After Mild Injury: Comparison of Health Status and Quality of Life between Patients with Whiplash Versus Other Injuries. Journal of Rheumatology 2013.10.3899/jrheum.130406