Whiplash - describes a range of injuries to the neck


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Whiplash describes a range of injuries to the neck caused by or related to a sudden distortion of the neck. The typical clinical picture in whiplash injury is that following the injury there is no obvious immediate pain.
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Whiplash - describes a range of injuries to the neck

  1. 1. WhiplashLuc Peeters, MSc.Ost. (University of Applied Sciences)Grégoire Lason, MSc.Ost. (University of Applied Sciences)The International Academy of Osteopathyhttp://www.osteopathy.euWhiplash describes a range of injuries to the neck caused by or related to a suddendistortion of the neck. The typical clinical picture in whiplash injury is that followingthe injury there is no obvious immediate pain.In severe cases there may be initial stiffness of the neck. Initially function is notimpaired either. The patient may proceed from the accident to continue with dailyactivities but begins to notice stiffness in the neck.The following night is often uncomfortable and the majority develop significant painand stiffness by the subsequent morning.This clinical picture varies considerably from patient to patient according to theseverity of the accident (trauma) and whether the patient has a vulnerable neck byreason of pre-existing degenerative changes which may give rise to symptoms afterinjury.The whiplash mechanism consists of the following possible problems: • Bending. • Shear. • Compression. • Combinations.Within a fraction of a second after impact from whiplash, adjacent vertebrae in theneck flex and extend at different rates.There appears to be a point at which the C5 and C6 vertebrae has a greater amountof extension than any other segment.This may excessively compress the facet joint and stretch the facet joint capsule. 1
  2. 2. Impact C5 Overstretch C6 Whiplash at level C5-6Shortly after impact, the cervical spine undergoes what is called an S-shaped curve.In this configuration, the cervical spine, rather than simply being curved in a normalC-shape, as it would normally be at rest, takes on an altered shape: the lower part ofthe cervical spine moves into extension and the upper part of the cervical spinemoves into flexion.Hydrodynamic theoryThe hydrodynamic theory involves the concept of pressure alterations inside thespinal canal secondary to extension–flexion changes in the spinal curvature due torear impact accelerations.The spinal canal lengthens and shortens in extension and flexion and this change inlength, which affects the pressure inside the canal, may traumatize the dorsal rootganglia leading to whiplash-associated disorders.Radiculopathy however is not the most common complaint in whiplash patients.Muscular involvementDuring the extension – flexion motion of the trauma, eccentric muscle contraction ofas well the anterior as posterior muscles can occur and cause muscular complaints.The hyperextension mechanism of the injury is mostly accompanied with rotation thatexceeds the normal range of motion. This can cause mechanical damage as well asdamage to the vertebral artery.The shear and compression hypothesisThe shear and compression hypothesis attributes neck pain to the stretch of the facetcapsule resulting from these two biomechanical variables.In a rear impact, shear forces occur in the cervical spine because the forward motionof the thorax occurs before the head motion. The shearing action imparts a relative 2
  3. 3. motion between adjacent vertebrae, and this motion is the highest in the lowercervical level because of the facet orientation.In addition, compressive forces are generated early in the acceleration phase due tothe straightening of the thoracic spine.In rear impacts, anterior shearing of the lower vertebra occurs, and its facet jointoffers little or no protection. This is in contrast to frontal impacts wherein the anteriorshearing of the upper vertebra occurs, and its contact with the facet joints providesprotection because of the anatomical orientation of these structures. Axialcompressive force does not exist in the frontal mode.Let’s not forget that whiplash (rear, front or lateral) can cause damage to the brain.Bleeding can occur on the opposite side of the impact to the head.Psychological responses appeared to be within normal ranges soon after theaccident with the psychological distress seen later proposed to be as a consequenceof ongoing pain and disability.Classification of whiplash injury (Quebec Task Force): WAD (WhiplashAssociated Disorders): 0 No complaint about neck pain. No physical signs. I Neck complaint of pain, stiffness or tenderness only. No physical signs. II Neck complaint. Musculoskeletal signs including: Decreased range of movement. Point tenderness. III Neck complaint. Musculoskeletal signs. Neurological signs including: Decreased or absent deep tendon reflexes. Muscle weakness. Sensory deficits. IV Neck complaint and fracture or dislocation. 3
  4. 4. Summary of possible injuries: • Facet joint cartilage damage. • Disc tear, most often in the lower segments of the neck. • Nerve root impingement with radiation along the affected nerve. • Ligamentary tear (facet capsules, anterior and posterior longitudinal ligaments,…). • Muscle tear. • Cerebral hemorrhage. • Arterial dissection. • Medullar overstretch. • Dura overstretch. • Dislocation. • Fracture (rupture or impaction).Patients after whiplash must be immobilized as soon as possible (collar).From WAD stage III, X-ray is necessary.Osteopaths shouldn’t treat locally too soon after the trauma because of the abovementioned possibilities. Manipulations are contra-indicated and the major resultcomes from immobilization and rest.The structural damage of the whiplash can in a later stage of life cause chroniccervical pain (ligamentary rigidity or hyperlaxity, facet arthrosis, disc degeneration,cervical instability, arterial impairment).Differential diagnosis in the case of whiplash injury is very important. Multiplestructures can be affected. Therefore it is difficult to give standardized treatmentoptions for the osteopath. A general rule however is not to treat locally too soon afterthe accident. The injured tissues need time to heal by themselves and this can takeup to 3 weeks. Rest, eventually with collar is important in this perspective.Bibliography • Bogduk N. & Yoganandan N. (2001) Biomechanics of the cervical spine. Part 3: minor injuries. Clinical Biomechanics. 16(4):267-275. • Chang D.G., Tencer A.F., Ching R.P., Treece B., Senft D. & Anderson P.A. (1994) Geometric changes in the cervical spinal canal during impact. Spine. 19: 973–980. • Chen H.B., Yang K.H. & Wang Z.G. (2009) Biomechanics of whiplash injury. Chin J Traumatol. Oct; 12(5): 305-314. • Foreman S. M. & Croft, A.C. (2002) Whiplash injuries- The cervical acceleration/deceleration syndrome. Third Edition, Philadelphia: Lippincott Williams & Wilkins. • Jull G. A. (2000) Deep cervical neck flexor dysfunction in whiplash. Journal of musculoskeletal pain, 8 (1-2), 143-154. • Kaneoka K., Ono K., Inami S. & Hayashi K. (1999) Motion analysis of cervical vertebrae during whiplash loading. Spine. 1999. Vol. 24: 763-770. 4
  5. 5. • Niederer P., Walz F.H. & Schmitt K.U. (2004) Trauma Biomechanics: introduction to accidental injury – Medical.• Panjabi, M. M. & White, A. A. (2001) Biomechanics in the Musculoskeletal System. Churcill Livingston.• Yoganandan N., Pintar F.A. & Kleinberger M. (1999) Whiplash injury: biomechanical experimentation. Spine. 24:83–85.• Scher A.T. (1991) Catastrophic rugby injuries of the spinal cord: changing patterns of injury. Br J Sports Med.; 25: 57–60.• Swartz E.E., Floyd R.T. & Cendoma C. (2005) Cervical Spine Functional Anatomy and the Biomechanics of Injury Due to Compressive Loading. J. Athl. Train. Jul-Sep; 40(3): 155–161.• Siegmund G.P., Myers B.S., Davis M.B., Bohnet H.F. & Winkelstein B.A. (2001) Mechanical evidence of cervical facet capsule injury during whiplash: a cadaveric study using combined shear, compression, and extension loading. Spine. 26(19):2095-2101.• Torg J.S., Guille J.T. & Jaffe S. (2002) Injuries to the cervical spine in American football players. J. Bone Joint. Surg. Am.; 84: 112–122. 5