Whiplash is a term we’ve likely all heard. Many of us may even reach for our neck when we think about the idea. We know pain is associated with it. But do we really understand it and why certain approaches to treatment do or don’t work as well? Today, let’s explore this often misunderstood injury and gain insights into its intricacies.
While it’s commonly associated with car accidents, where sudden impacts propel the head into a backward and then forward motion, it’s not exclusive to vehicular incidents. Sports activities can also be culprits; a slip-and-fall or a collision on the soccer field, for instance, can subject your neck to the abrupt movements characteristic of whiplash.
To begin with, whiplash is not generally well understood, but it typically involves injury to the muscles, tendons, ligaments, nerves, and discs in your neck. These structures undergo a series of rapid and forceful movements forward and backward which can result in various degrees of damage.
Soft-tissue Injuries (Muscles, Tendons, and Ligaments):
The sudden, forceful motion of the head being thrown backward then forward during whiplash can cause these structures to stretch beyond their normal range. This overextension can lead to anywhere from microscopic tears in the fibers to higher grade injuries considered “partial” or “full” tears. As a note on medical lingo, tensile injuries are called “strains” for the muscle-tendon structures and “sprains” for the ligaments. The pain of these injuries often begins in the first 24-48 hours, depending on when the body gets out of shock.
The job of ligaments is to stabilize joints, so these injuries often mean the neck or cervical spine is left unstable. The muscle-tendon structures often undergo a stretch response where they lock down and restrict movement. This is usually made even worse because of all the ligament sprains. As a response to all this trauma, the body’s natural response is to send extra blood flow to the area to help get nutrients there for healing. More is moving in than can typically move out, and the result is inflammation
Disc Injuries:
Discs are the soft, cushion-like structures that sit between the vertebrae. The sudden movements in whiplash can compress and distort the discs, potentially causing them to bulge or herniation. These injuries do not inherently cause pain long-term; it depends on whether they press on any nearby nerves. In the near-term, however, there is plenty of pain. That is because in order for a bulge or herniation to happen, the outer layers of fibers to the disc (the annular fibers) stretch and tear. This can result in the release of inflammatory chemicals which can contribute to pain. The onset of disc-related pain can range from immediate to weeks after the injury.
Vertebral Injuries:
Vertebrae are connected at locations called zygapophyseal joints (there’s a $10 word, right?!). For the sake of not sounding too alien to our patients, we sometimes refer to those by their joint type- facet joints. If you’re into niche industry drama, have fun diving into that argument! Regardless of what you call them, these joints can become injured and have swelling which can be quite painful.
It helps to know that we are supposed to have a slight C-curve in our necks, because it is common in whiplash cases for the vertebrae in the neck to shift and become misaligned in such a way that the C-curve disappears, and makes a straight line, or even a reverse C-curve. In rare cases, the vertebrae can even fracture. Like disc injuries, the pain onset of vertebral injuries may be delayed.
Nerve & Spinal Cord Injuries:
All of the injuries described above can cause compression and irritation to the nerves in the surrounding area. This can lead to pain in the local area or pain in areas farther away from the injury, called radicular pain. In whiplash injuries, radicular pain is most likely to show up in the arms, shoulders, or upper back.
In some cases, the vertebrae can shift so badly that they protrude into the spinal cord space. These severe injuries must be approached with extreme caution.
It is all well and good to understand what’s happening at the time of the injury, but what might you consider preparing for in the future? Whiplash injuries can create changes that leave areas vulnerable to long-term issues. Understanding these implications can help you better advocate for yourself in treating the injury.
Structural Changes
Structurally, the distortion of the neck’s natural curve during whiplash means the joints can no longer function the way they are designed to. The body’s natural inclination to compensate is helpful in the short run but can create chronic pain issues in the long run. Locally, this alteration in neck function can lead to reduced Range of Motion (ROM), an increased susceptibility to tension-type headaches, and the onset of chronic pain in the neck. Local nerve compression can create pain issues further away, typically down the arms. Finally, cervical spine influence on the entire spine as well as the jaw can lead to chronic mid and low back pain as well as distorted jaw function, eventually leading to TMJD.
In our experience, we find these structural changes are often perpetuated by deep neck muscles that may remain locked in a shortened position post-injury. While some cases respond well to traditional Physical Therapy (PT) and chiropractic methods alone, more persistent issues may benefit from a combined approach involving advanced massage techniques with chiropractic care for a more complete recovery.
Psychological Implications
At the time of writing this article, we can only find studies linking chronic neck pain to higher instances of anxiety and depression. In these studies, the root causes of the neck pain were not isolated. The following is based on our experiences within our clinic as well as our understanding of the human body (so, please forgive us for being a little extra technical here!):
It is our observation that patients with a reduced cervical curve may have an increased tendency towards anxiety and depression. This could involve many potential contributing factors, but we are most qualified to share our thoughts on the anatomical changes that may be partly or completely responsible. When our body compensates for the curvature changes, our posture often changes as well. Most importantly, we note a forward head with shortened musculature from the neck to the pubic bone. This forces a very important change in how we breathe! Instead of using our diaphragm, we use the muscles in the front of our neck and overuse the little muscles between our ribs. This is technically a hyperventilation, and most people won’t even realize it! (Concerned this is you? We have assessments and would be happy to evaluate you.)
The changes in the neck curvature and breathing are also often associated with fixations at the top and bottom of your spine (the occiput and the sacrum). This affects the ability for your parasympathetic nervous system to activate (more on that HERE). Between the fixations and the poor breathing, we notice patients experiencing more frequent anxiety, even when they are addressing the emotional factors with mental health support. In our experience, they are able to make more progress in their outside therapies once we’ve addressed these physical components.
Degenerative Changes
Joints that undergo a trauma such as whiplash often see accelerated degenerative changes. In the neck, we most commonly see an earlier onset of disc degeneration as well as earlier developments of osteoarthritis and stenosis. Ongoing maintenance care can help to delay these outcomes, as well as manage pain symptoms and slow progression once they’ve started.
Keep in mind, the severity and duration of long-term implications can vary widely among individuals. Factors such as the nature of the injury, the effectiveness of early treatment, pre-existing health conditions, and individual differences all play a role in determining the outcome.
So, there you have it – a deeper understanding of whiplash and the effects it can have both in the short-term and the long-term. Accidents are, unfortunately, a part of life, but being informed can help you advocate for more complete treatment. Speaking of treatments for whiplash, we discuss those HERE (isn’t this blog long enough already?!)
Stay safe, prioritize your well-being, and continue being the exceptional individual you are. Until next time, take care!
