Whiplash is a term most commonly used when describing a car accident. The effects of whiplash and mechanism of injury, however, are not just reserved for the road.
Whiplash is a descriptive term used to describe the sudden snapping of the unsupported head. In a car accident, the seat belt will hold the body in place while the head is forced into hyperflexion and extension. This motion is also seen in many contact sports such as football and hockey.
When a quarterback is getting ready to make a throw and a 300 lb lineman hits him hard from the back, the head again is forced into hyperextension just as in a car accident. This is also seen in hockey when a player gets hit from behind. In both sports, the athletes have chest protectors to absorb the impact on the body and helmets to protect the head, but there is nothing to stop the movement of the head on the neck.
Whiplash is a serious injury that can occur in many different ways, but the effects are usually similar and can be chronic and intense if not properly cared for.
Whiplash is present in another serious form in infants, and is better known as shaken baby syndrome. This causes serious neurocognitive dysfunction and in some cases death.
Lateral whiplash injuries to the outer portion of the neck can also happen, usually from a blow to the side of the body as in sports or a car accident.
Photo source: whiplash sports injury
The technical name for a whiplash is a cervical acceleration/deceleration injury, or CAD. There are several structures involved in a CAD.
In the neck we have the ligaments, musculature, nerves, intervertebral disc, arteries, vessels, and boney structures. Given the complexity of the neck, there are many different types of injuries that are possible that are considered whiplash. We will highlight a few of these in this article.
At Mountain View Pain Center in Denver, Colorado we see whiplash injuries almost daily, and the speed of the impact often has little correlation to the pain and symptoms. Often after a small impact in the car or on the field, a player will feel fine and then the symptoms will show the next morning.
Those of you who are athletes can relate. One day you take a minor hit, continue playing with no problem, and wake up the next day feeling as if you were in a car accident.
Causes of Whiplash Injuries During Sports
Image source: Hyperextension/Hyperflexion
During a forced hyperextension, bending the head backwards can cause a multitude of neck injuries. The muscles of the front of the neck that are usually strained are the anterior scalenes and the SCM (sternocleiomastoid).
The SCM is the v-shaped muscle on the front of your neck that moves your head forward and side-to-side. Injuring these muscles makes it very painful to move the head, especially in rotation. A
long with the muscle injury there is also ligament damage. The anterior longitudinal ligament runs over the anterior portion of the vertebrae (the front of the vertabrae, deep inside the neck). Whiplash can cause a sprain of this ligament or an avulsion fracture (tearing away of the bone, where the ligament tears off a small portion of the front of the vertebrae).
In between the vertebrae are discs that can rupture or herniate during the whiplash injury. At the rear of the neck we have the capsular ligaments (ligaments supporting the spinal joints), which can be injured form the compressive forces. A compressive force can also damage the facet joints. These joints allow the vertebrae to move in relation to one another. Extreme hyperextension can cause crushing of the posterior portions of the vertebrae.
Hyperflexion injuries such as taking a hit straight to the chest may tear the ligament at the back of the neck (nuchal ligament), which runs from the base of the skull along the tips of the vertabre (spinous process) to the base of the neck. Hyperflexion injuries can also cause disruption to the capsular ligaments or even dislocate the facet joints.
The image on the left demonstrates stretching of the nuchal ligament
and the image on the right demonstrates the stretching of the SCM muscle.
Source: Whiplash Associated Disorder
There can also be neurological damage from whiplash injuries. The force of the brain’s impact on the inside of the skull can damage the cortex or cerebellum. When the head is forced into hyperflexion the sudden force causes pressure on the brain, which causes a concussion. Concussion symptoms are very common in sports related neck injuries.
Even if you have no symptoms after a whiplash injury it is important to see your doctor to assess the level of possible damage. In many cases after a whiplash injury, a patient will show no objective symptoms nor will they show signs of physical damage on X-ray. Oftentimes, patients may not show symptoms until three months after the initial injury and there can be a fluctuation of symptomatology for up to two years. It is in your best interest to get checked out if you have taken a questionable hit.
If you decide to make the trip to your doctor after getting a whiplash injury be sure to fully describe how you were hit and all symptoms even if you feel they may be unrelated. Be sure to note if the head was rotated to the side, if your head struck the ground, if you lost consciousness, or anything else that may help your doctor set up an appropriate treatment plan.
Common Whiplash Injury Symptoms
Image source: whiplash injury symptoms
After an injury the two most common types of whiplash symptoms are pain and limited motion of the cervical spine (the neck). The pain can be described as a dull ache to a sharp stabbing pain. It is also common to have radiating pain or numbness into the extremities. Many patients describe intense pain in the upper and lower back. Headaches are also a very common symptom after a whiplash injury.
Patients most commonly experience pain from the facet joints in the cervical spine. These joints align the top of one cervical vertebra to the bottom of the vertebra above it. Their biomechanical function is to allow motion in the neck, and when injured, this results in a lack of motion, pain, and an increased chance of degeneration in the future.
Each facet joint has a specific pain pattern that is common in patients suffering from a whiplash injury. These patterns can cause pain in the back of the head, the shoulder and all the way down to the mid back. The most common area of the cervical spine to be injured is C5/C6 and C2/C3.
Pain referral for facet joints
If you have injured your… then you will feel pain in your…
C2/C3 — middle of the neck to base of the skull
C4 — middle of the neck
C5 — middle of the neck to the shoulder, commonly following the trapezius muscle
C6 – across the shoulders down to the shoulder blade
Image source: pain referral for facet joints in whiplash injuries
Other symptoms related to whiplash include:
- Impaired neck movement
- Radiating pain into the arms, hands, and fingers
- Low back pain
- Ringing in the ears
- Jaw pain
- Pain between the shoulder blades
- Disc herniations
- Loss of proper motion to the cervical spine
Whiplash Injury Recovery
Whiplash injury symptoms often do not show up for three months or more and can last as long as three years; therefore, the sooner you begin treatment for your whiplash injury, the quicker the healing process can begin.
Whiplash Injury Recovery Phase 1 – Inflammation Process
This begins immediately following the whiplash injury and generally lasts up to 72 hours and in some cases up to five days.
It is common for there to be little to no pain after the hit. After a few hours or even the next morning after, the inflammation phase has begun. The muscle will begin to spasm, swell, become tight, painful, and look for range of motion to decrease. The decreased range of motion comes from the body trying to immobilize the tissue to prevent further injury.
During this time at Mountain View Pain Center our goal is to reduce pain and swelling and help control the inflammation process.
Whiplash Injury Recovery Phase 2 – The Repair Phase
This phase generally lasts from three days to three weeks. The importance of this stage of healing is the wound edges will begin to pull together to affectively reduce re-injury.
Whiplash Injury Recovery Phase 3 – Remodeling Phase
This phase lasts three weeks to two years. During this phase collagen begins to form and lies down to strengthen the wounded area. This is what is referred to as scar tissue, which is only about 80% as strong as normal tissue.
The importance of whiplash injury treatment in this phase is to allow the collagen to lay down in the correct area, and reduce scar tissue build up which can create decreased range of motion and lead to instability and pain in the future.
Image source: whiplash injury recovery
After the injury, go to your doctor for an examination. Make sure to fully explain the injury and whether this happened in the car or on the field.
Your doctor will run a series of orthopedic tests to reveal if there has been any damage to the soft tissue or joint function. Your doctor should also run a series of neurological tests to determine if there is any underlying damage. These tests should be repeated as you progress in your treatment so that your doctor can adjust his treatment plan according to your symptoms and progress.
After these tests your doctor may take X-rays or an MRI if he suspects there may be soft tissue damage or the possibility of impingement to the spinal cord or nerves. Often after an injury to the cervical spine, your doctor will take X-rays with your neck in flexion and extension to determine if there is any instability in the spine.
Image source: whiplash injury treatment
After an injury to the neck many people feel they should be put in a neck brace and avoid any manipulation to the spine. Research has shown that wearing neck braces can be detrimental to your whiplash injury recovery. This does not mean, however, that if your doctor recommends a collar not to wear it. If there is any fracture or instability it may be in your best interest. However, long-term immobilization is not recommended.
After the whiplash injury one of the first symptoms is decreased range of motion to the cervical spine. If this is not restored, then there is a list of future injuries you may experience.
With the lack of motion in the lower cervical spine, the upper cervical segments will begin to overcompensate, causing early degeneration, loss of proper posture, and pain. Once the lower segments have begun to lose their motion, the head will begin to drift forward, due to tightening of spastic flexor muscles. As this occurs the muscle on the back of the neck, the extensor muscles, will become stretched and torn.
A good way to check if your own extensors are becoming weak is to have a friend check your posture. A good rule of thumb is to have the ears over the shoulders. If your head has begun to drift forward, press lightly on the trap muscle, if there is tenderness there, then you have weakened stretched muscles that are becoming tender from lack of oxygen and calcium deposition. This leads to further problems such as tenderness, pain, and can lead to shoulder and upper extremity dysfunction.
The reason that a lack of motion in the neck causes pain is because the spine has little sensors called mechanoreceptors which react to movement. If there is decreased motion, the mechanoreceptors receive less information, which increase the proprioceptors (pain receptors). In English this means with lack of motion you are more susceptible to pain.
This is a compelling reason to see your chiropractor or osteopath for cervical manipulation. Early manipulation to the cervical spine will restore motion, decrease pain, and increase the speed of recovery. The early manipulation will also decrease the buildup of scar tissue and future chronic pain syndromes.
Early manipulation does not mean to start stretching your neck and cracking it yourself. If you do this, you will probably cause more damage. Manipulation should not be performed without determining the stability of the cervical spine after such an injury. If you are popping your own neck, then you are moving the already hypermobile segments, or the areas compensating for the restricted ones. This can cause more pain, injury, and increase the degenerative process of the cervical spine. Seek out a professional, and let them treat you.
In the treatment process for whiplash injuries, the first stage should always be decrease pain and inflammation. How long you let this condition go without treatment can have a big impact on your recovery time. If this has become a chronic condition, don’t expect to be cured in one visit. You will have to take an active role in your own treatment by performing the exercises your doctor prescribes. It is important to remember that just because you are out of pain, you must continue the rehab to fix the underlying problems and help strengthen the area to avoid chronic pain or problems in the future.
At Mountain View Pain Center, we provide a series of treatments to assist in the recovery from a whiplash injury. As mentioned above, first order of business is to relieve pain and inflammation. This is done with cervical spine adjustments, electrotherapy, and soft tissue mobilization. At this time we ask our patients to be patient, take a break from physical activity, and allow the body to rest. There are many patients who decide they know best and continue with sports and workouts, which is your choice, just understand you will prolong your treatment process and heal at a slower rate.
Whiplash Injury Rehab Exercises
Once we have the pain under control we begin with the rehab portion of the treatment, which includes a variety of upper extremity and neck exercises. Do not push yourself. If the exercise causes pain then don’t do it. “No pain, No gain” is not the method here. If you are having difficulty performing simple exercise, then listen to your body, continue with treatment and slowly advance as the body allows.
The series of treatments will be customized to you, depending on your specific injury. For example, if a quarterback visits our office that was struck in the back with his head turned, he may have different injuries than a hockey player hit in the back looking straight forward.
You can begin your own treatment at home by icing 20 minutes per hour on the cervical musculature. Do not use ice cubes directly on the skin as you can cause a burn. You may also find relief from rolling up a towel and placing underneath the neck while lying on your back. This will help relax some of the muscles in spasm.
The rehab portion will focus on the overstretched ligaments and tendons as well as the spastic muscles. Our goal is to release the spasm and lengthen the shortened muscles, and at the same time strengthen the weakened and stretched muscles. The reason we perform both is to stabilize the body, and prevent further injuries. If we just address the spasm, then over time the weak muscles will not be able to hold their resistance, and we will be back at square one.
Along with exercise, at Mountain View Pain Center we also install a stretching program. The stretches are provided to allow the body to elongate the muscle to their natural length, and decrease the buildup of scar tissue that will decrease the range of motion. Make sure you follow the instructions from your doctor.
If you have a spasm in the flexor muscle on the anterior portion of the neck, then we want to stretch that area, and not perform resistance exercises here. If the weakness is in the extensors, then you do not want to stretch an already stretched and weakened muscle. This may provide relief while you are doing it from the release of endorphins, however you will be causing more damage. By improving the range of motion and muscle strength to the neck we can restore normal posture and biomechanical function of the cervical spine.
Some exercises are too painful to perform so we begin with isometric exercises. Isometric exercises allow for contraction of the muscle without movement of the head. In most cases we are working on the lateral flexors or extensor muscle groups. An example of an isometric exercise for the extensors is to stand with your back against the wall, and press your head slowly into the wall and contract the muscles at the back of your neck, and hold for about 5 seconds. You can place a towel in between your head and the wall for comfort. As we progress you will be able to build up the movements and perform exercise with body weight and then resistance. We also add a series of exercises with the upper extremities as well as a few hand eye coordination and balance programs.
After a whiplash injury, avoid sleeping on your stomach. Your doctor may provide a cervical pillow, as sleeping on your side or stomach may cause you to curl up into a flexed position for comfort. This holds the muscles we are trying to stretch in a shortened position for hours, which we need to avoid.
Whiplash injuries, whether in sports or in the car, can lead to serious complications, so your best bet after receiving such an injury is to go see your doctor to be on the safe side.
Supplements or vitamins that aid in diminishing muscle spasms and inflammation
My personal favorite is a Vitamin called Inflammatone. I prefer this as it is a combination of several herbs that benefit in decreasing inflammation and speeding up the healing process, which cuts down the amount of pills you have to take, which is always an added benefit. If you are browsing your local store or whole foods, keep your eyes peeled for ginger, boswellia, and tumeric, as these are great at decreasing inflammation, and are all ingredients in Inflammatone.
I would recommend avoiding cheap brands from your local grocery stores, as these are either synthetic or significantly lower dosages. The name brands are generally only a few dollars more, and when it comes to vitamins you get what you pay for.
Your best bet is to try to get these from your doctor. In many cases physical therapists and chiropractors will sell vitamins out of their own office, the brands they use are generally lab tested and have been researched extensively. Many doctors will sell these relatively cheaply to provide the extra benefit for their patients. If you know a good naturopathic doctor, they are great resources for brand or specific vitamin advice. Fish oils also work well to control inflammation, and are also good for your body’s overall health.
This article contains the opinions and examples of treatment plans for whiplash injuries from Mountain View Pain Center in Centennial, CO, and is not intended as a substitute for specific medical advice from a doctor regarding your individual injury or condition. If you have any further questions or concerns feel free to contact our office or leave a comment below.
The Trainer’s Room is written exclusively for Midwest Sports Fans by Centennial, CO chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy of the Mountain View Pain Center in Centennial, CO. You can contact them by leaving a comment below or sending an email to [email protected].
Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.
He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.
Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.
Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.