Introduction to Whiplash Injuries
We’ve all heard the term ‘whiplash’. Maybe you have even experienced it yourself. Whiplash is a common neck injury that can be sustained in a car accident.
Unfortunately, whiplash is often denigrated on television shows and in the media, thus giving the injury a reputation of being more of a psychological condition than a real physical injury. But that is far from the truth.
Medical experts who are well versed in neck injury know that whiplash is a genuine medical condition that results from a sudden forward and backward jerking of an individual’s head and neck. This can occur during a motor vehicle accident. It is often triggered when a stationary vehicle is hit from behind (i.e., rear-ended).(1)
Whiplash often is misdiagnosed, ignored or treated in such a way that symptoms become exacerbated because proper medical treatment is delayed. In this article, we are going to look at the symptoms of whiplash and the ways a medical professional can determine if whiplash has occurred so the proper treatment can begin.
But first, we’re going to take a look at the structure as well as the normal function of the neck.
The Anatomy of the Neck
Having a quick overview of the neck’s anatomy will be helpful as we explore the types of injuries that are often sustained due to whiplash. The neck region is often referred to as the cervical spine, as it is technically an extension of the spine.
The underpinning of the neck is the vertebrae of the cervical spine. These 7 vertebrae protect the underlying nerves as well as the spinal cord, and begin at the base of the skull. They are labeled C1 through C7.(2)
These vertebrae are smaller than vertebrae that are found in the lower spine. Stacked on top of each other, these vertebrae function to allow the neck great flexibility while also providing the strength to hold up the human head.
The Intervertebral Discs
Between each vertebra you find intervertebral discs, which serve as shock absorbers for the movement of the neck. In the cervical spine, you will find 6 of these discs.
These discs are tough. The outer layer of each disc is called the annulus. This exterior is made of collagen fibers. They protect the inner core, which is a soft jelly-like material called the nucleus pulposus. This interior core is comprised of fibrous material floating in gel. The material that the discs are made of allows for the discs to absorb shock and pressure that is exerted on the head and neck under normal circumstances.(3)
In the back of the neck vertebra you find facet joints that enable the neck to move smoothly backwards, forwards and in rotation. These joints prevent excessive motion, however, as they are serving a valuable purpose in protecting the cervical spine and all of its constructs.
Soft Tissue Structures
Surrounding the spinal column are muscles, ligaments and joints that stabilize everything. These soft tissues often sustain injury from an incident of whiplash, as the muscles and ligaments end up strained or even torn from the sudden impact and back-and-forth motion that occurs when a vehicle is rear-ended.
There are several main muscles that support the vertebrae of the cervical spine. But the longus colli muscle, which works to move and stabilize the neck, is the muscle that is most often injured when whiplash occurs in a rear-end collision.(4)
The sternocleidomastoid muscles, located on each side of the neck, work to rotate the head from side to side. They also work to flex the head up and down. These muscles can be strained when whiplash occurs as well.
The Cervical Nerves
Within the cervical spine you find 8 different nerve roots. These branch out from the spinal cord. These amazing nerve bundles control major motor function as well as sensory ability for various parts of the human body. For example, the first cervical nerves, called C1, C2 and C3, control movement of both head and neck. They also impact breathing and sensory feelings in the face. The mid to lower cervical nerves travel from the neck into the arms and hands. If these nerve bundles are compromised, as can be the case following a whiplash injury, pain and loss of function can result.
Quick Fact: In labeling the nerve roots, each nerve root is named for the lower of the 2 vertebrae that the nerve runs in between. For example, C2 runs between the C3 vertebra and the C2 vertebra.
Now that we’ve done a general summary of the basic anatomy of the neck, let’s look at how a normal neck functions. This will aid us in understanding how injury to the various structures of the neck can greatly affect the normal function thereof.
The Function of the Neck
A normally functioning neck is able to move smoothly in various directions. It can extend upwards when necessary, and it can contract when undergoing pressure. The neck can bend forward towards the chest and also bend backwards towards the upper back. It can bend to the side, towards the right as well as the left shoulder. The neck can also rotate from side to side. It can even roll, to some extent.
The neck is not allowed to rotate or move past certain points, due to structural processes that are in place to prevent undue movement. These constraints prevent the neck from rolling around too loosely. The neck is protecting vital structures and functions of the body, so it serves a variety of purposes.
The cervical spine serves several major functions.
- It houses and protects the spinal cord.
- It supports the weight of the head, which weighs 10 to 13 pounds.
- It enhances the flexibility of the head and neck, allowing the head to rotate, roll forward and backwards, and bend from side to side. (5)
Quick Fact: Your neck can move your head to allow 90 degrees of forward movement, 90 degrees of backward motion, and 180 degrees of sideward motion!(6)
The 7 vertebrae that lie within the neck are stacked on top of each other (separated by the discs). They are labeled C1 through C7. C1 is the smallest of the cervical vertebrae, and lies closest to the body’s skull. The rest of the vertebrae get larger as they approach the top of the thoracic (upper back) vertebrae. This is because the lower vertebrae actually bear more of the load than the vertebrae at the top of the cervical spine.
These vertebrae work in tangent with soft tissue structures like muscles, tendons, and ligaments to allow for the free action of the neck and head. These constructs allow for necessary support and structure, as well as flexibility, of the neck.(7)
The cervical spine is designed to be an extremely flexible part of the body, but this flexibility is due in great part to the fact that the vertebrae in the neck are very small. Strong unexpected movement, such as the sudden snapping motion that occurs during a rear-end collision, can easily create severe injury. These vertebrae can experience fractures or even break. More reason why anyone involved in a rear-end collision should pay careful attention to any pain or tenderness they may experience in the hours and days after the collision.
Now let’s look at how typical whiplash injuries from a rear-end collision damage different parts of the neck. This will help us in determining what injuries may occur as a result of whiplash.
Whiplash Injuries to the Neck
When you experience whiplash, there are several different types of injuries that can be sustained. These include soft tissue injury, injury to discs in your back, nerve damage and even fractures.
Soft Tissue Injury
When an individual is involved in a rear-end collision, the sudden motion that is experienced in the neck as the neck whips forward and backward often results in a neck strain. This means that the soft tissue found in the neck is injured. The muscles and supporting ligaments found in the neck as well as the upper back can be stretched or extended more than their normal range. It can take several days for the injured party to begin feeling pain in the soft tissues of the neck and back.(8)
Remember our discussion about the discs that are located between the vertebrae of the neck and spine? These flexible discs act as shock absorbers. But in a whiplash-type car accident, these discs can be stretched beyond the norm, resulting in disc that bulges outside normal parameters. They can even rupture.
When the outer wall of a disc is torn, it can heal on its own. There are certain situations, however, when it does not repair itself. When this happens, the disc weakens and the nerve endings in the outer wall, also called the annulus, become tender and painful. Additionally, after disc herniations, the gel-like center can place pressure on the associated nerves.
If the disc herniates, the material in the center of the disc compresses. This causes the disc itself to press on sensitive nerves or even the spine itself. This results in nerve pain that can extend into the neck or even the arm.
If the whiplash causes damage to joints or discs, there can be resulting nerve symptoms. This results when the damaged bodies exert pressure on spinal nerve roots. (9)
In some instances of whiplash, the injured party may actually sustain fractures. The vertebrae that can be fractured are located in the neck or even the upper spine.
Fractures of the vertebrae caused by a whiplash injury sometimes evade immediate diagnosis. It is important for medical professionals to carefully examine injured parties to determine if there are signs of fracture, as treatment needs to begin quickly in order to prevent serious injury to the spinal cord itself.
Anyone who experiences pain beyond very minor aches and pains following a rear-end collision should pay a visit to their personal care physician for an evaluation. As outlined above, some of these symptoms indicate severe injury that requires immediate medical treatment.
Evaluating the Neck for Injuries
Health professionals who are presented with a patient who endured a rear-end collision will carefully evaluate the patient for common whiplash injuries. Here are some of the tests and evaluations you can expect if you visit your physician or other medical professional for whiplash symptoms.
Careful Examination and Interview
You can expect to recite a full medical history at the outset of your examination. Then your provider will carefully question you about the facts surrounding the motor vehicle accident itself, in order to get a general idea of how hard your vehicle was hit in the accident. This can help him or her determine the likely extent of injuries you may have sustained.
Your medical professional will ask questions regarding your symptoms: where you are currently experiencing pain and when the pain began. He or she will ask about the severity of pain you are feeling, and if you are feeling spasms, dull pain, or shooting pain in any place in your body. Even if you are feeling pain in an area you may not think was affected by the impact, this is important information your doctor to know. For example, since there are nerves in your neck and upper back that impact the function of your limbs, feeling numbness in your fingertips may be expositive of a nerve injury. You may also be given a physical exam to check range of motion.(10)
If your provider suspects possible fractures somewhere in your neck or upper spine, you will be given an x-ray. The x-ray can reveal images of bones and even internal tissue for your doctor to review.
CT Scans and/or MRI
If your provider suspects you may have soft tissue or nerve damage, a CT scan or MRI may be ordered. A CT scan (computed tomography scan) can take horizontal images of your neck and upper back. This can reveal unusual changes in the structure of bone and muscle.
An MRI (magnetic resonance imaging) takes very detailed images of the soft tissue in your neck and upper back.(11)
Sometimes your medical professional may wait a week or so before ordering a CT scan or an MRI. This may occur if you are experiencing different symptoms in the weeks following the accident. In that case, an MRI scan that is able to visualize instability in the soft tissues found in the neck would be very helpful in planning your treatment plan.(12)
Once the medical professional has determined the extent of injury, it is time to create a treatment plan that will effectively treat pain and prevent further injury. The plan will also determine a course of treatment to follow to ensure that the patient receives the best results.
Symptoms of Whiplash
The symptoms of whiplash can occur almost instantly, but often can take 24 hours to appear. In some instances, symptoms take several days to develop, due in part to inflammation that may prevent an individual from realizing that there is pain or tenderness present in a particular area of the neck or back.
Common symptoms include:
A whiplash type injury can cause general pain and tenderness throughout the neck and upper back. A dull aching pain is typical; however, if the individual is suffering severe, sharp pain or pain that comes and goes over the course of several days, it is time to consult a medical professional.
Numbness and Tingling
Another symptom of whiplash injury is numbness and tingling in the extremities. Individuals experiencing these symptoms may be suffering from nerve damage and should consult a medical professional immediately.
Weakness in the limbs is another serious symptom of whiplash injury requiring medical attention. This can be due to pressure being placed on the delicate nerves that supply the muscles.
Dizziness is often a symptom of a head injury or other severe complication of whiplash, and again, requires medical attention. Report incidents of dizziness to your doctor for evaluation.
Headaches are often associated with whiplash. These should be reported to medical professionals as well.
There are other symptoms associated with whiplash injury that should be reported to your medical team. These include:
- Memory loss and issues with concentrating
- Ringing ears
- Severe pain in arms, shoulders, neck or back
- Bladder or bowel problems (13)
Anyone experiencing the symptoms above requires immediate medical attention, as they could be indicative of severe injury.
Treatment of Whiplash Injury
It is important to understand that treatment for whiplash injuries is both important and varies, based upon the type of injuries. Those who are injured in an acceleration/deceleration injury (whiplash) should always seek evaluation from a trusted provider.
Chiropractic Care For Whiplash
Following a whiplash injury, a trusted chiropractor can be a great asset to your recovery. They are well versed in the evaluation and appropriate treatment of these types of injuries.
Acute Injury Treatment
After an acute injury (an injury that recently occurred) treatment often involves the process of alleviating pain, reducing inflammation and improving range of motion of the area.
Chronic Injury Treatment
In the longer term, treatment continues to include pain control, but also includes flexibility and strength as well. The ultimate goal is to relieve your pain and return you to a normal functioning life.
Whiplash is a serious medical condition experienced by an estimated 2 million people each year.(14) Whiplash can occur as a result of a rear-end car collision, and the resulting forward-and-backward motion of the head and neck can create injury throughout the head, neck and body of each individual in the vehicle. For some individuals, the injuries are mild, but for many others, the damage sustained may be permanent.
If you believe you have a case of whiplash, you should speak to your personal care physician as soon as possible. You will want to get an evaluation done of your injuries so your medical professional can determine how to proceed with treatment. If you develop severe symptoms as discussed above, you may be at risk for medical complications that could impact your life on a chronic basis.