Whiplash
See John Cartmell's comments following article
By the SpineCare Medical Group
http://www.spinecare.com/treatments/whiplash.html
Whiplash
Pain in the neck, shoulders, head or the base of the skull that occurs after a
motor vehicle accident is often called “whiplash.” Most patients with whiplash
recover in a few weeks or at most, a few months, but 15 to 20% of people develop
chronic pain. Whiplash is not a trivial problem, because
once it has occurred, only 70% have recovered completely by one year and only
82% have recovered completely by two years. In
addition to neck pain, there are many symptoms associated with the whiplash
syndrome and include sleep problems, poor concentration and memory, blurry
vision, ringing in the ears, fatigue, and weakness.
The treatment for whiplash syndromes depends on the stage and degree of the
problem and which structures have been injured. In addition to soft tissue
injury, pain that persists after four to six months is usually due to injury to
the facet joints, one or more discs, or both. The diagnosis can usually be made
by injections, MRI, and X-rays. Treatment is usually
successful, but requires physical therapy, injections, and occasionally surgery.
The term, whiplash, is confusing because it is both a mechanism of injury and
the symptoms caused by a car accident. It is due to a traumatic event that
causes the head to move suddenly (“whip”) in one direction and then recoil in
the other direction. The most common cause of whiplash is a motor vehicle
accident in which one vehicle is struck from behind by another. However, it can
occur when a car stops abruptly after striking a pole, a wall, or another car,
and can also occur after a side impact.
Significant damage to ligaments, discs, and joints can
occur even if the swings of extension and flexion are not excessive, but
often the neck is forced to the extreme ends of normal range or beyond. Because
the trauma is usually sudden, occupants of the car are not prepared for the
impact. The muscles are relaxed, which allows more forces on the discs,
ligaments and joints. Perhaps the most important fact about whiplash is that
significant pain and structural damage can occur at crashes of low velocity.
Whiplash: Causes of Pain
It is the patient with persistent pain without any other specific findings on
examination or specialized tests that presents the most problems for the patient
himself or herself, the doctors, and the legal system. In the first few weeks to
months after motor vehicle accident, it is often impossible to determine the
exact cause or causes of the pain. The symptoms and signs are not sufficiently
specific. In almost every instance, the muscles and ligaments have been strained
and may be inflamed, painful, and tender. However after about 3 months, primary
muscle or other soft tissue injuries usually have healed.
The most common causes of persistent pain in whiplash are
the facet joints and the discs. There is a poor correlation between the
radiographic appearance of the joints and whether they are painful. Some joints
which look bad are painless while other joints that look normal can be proven to
be a source of pain. Only facet injections can determine whether the joint is
painful.
In a research study by Drs. Bogduk and April, in 23% of patients, facet joints
alone were the cause of pain, in 20% of patients the discs alone were the cause
of pain, and in 41% of patients both the facet joints and
discs were contributing. They were not able to identify the source of the
pain in only 17% of their patients.
Whiplash: Associated Symptoms
Many whiplash patients have symptoms which seem unexplainable, such as
headaches, pain in the shoulders, between the shoulder blades, or in one or both
arms.
There may be fatigue, dizziness, problems with vision,
ringing in the ears, heaviness in the arms, and low back pain. There can be poor
concentration or memory, change in emotions with irritability, depression or
short temper, and sleep disturbance. Dizziness occurs in one-quarter to
one-half of people with whiplash injury. Again, researchers are not sure of the
cause. The most likely explanation is an injury to the part of the inner ear
that regulates balance. Problems with memory and concentration can be due to the
pain itself, depression, medications, or trauma to the brain. Visual
disturbances occur in 10 to 30% of whiplash patients and blurred vision is the
most common.
Long-term Outcome
Fortunately, most people who suffer neck pain after a whiplash injury will
recover by six months. However, a small percentage of people continue to have
pain.
Most patients destined to recover completely will have done so by three to four
months, after which the rate of recovery slows markedly. By two years,
essentially all patients have reached their individual maximum improvement.
About 18% continued to have significant pain two years
after the accident! Patients who did not get well tended to be older, had
pain which began sooner after the accident, and/or had their head rotated to
either side at the time of impact. They also found that patients who, before the
accident, had a history of neck pain, arthritis of the neck, or headaches did
not do as well.
Neck Pain, Whiplash and the Legal System
In our litigious society, it is fairly likely if a person develops neck pain due
to a whiplash injury in a motor vehicle accident there will be a lawsuit. Common
sense would tell us the greater the pain and impairment, the larger the legal
settlement or award might be. Rarely, patients may exaggerate their symptoms or
be faking. However, a bigger question is whether the potential for money from a
legal settlement can unconsciously prolong or worsen the pain. This is called
“secondary gain” and it is unconscious, not fraudulent.
The Effects of Lawsuits and the Outcome of Whiplash Syndromes
The science shows that personal injury litigation does not adversely affect
outcome. In 1983, Drs. Norris and Watt reviewed 61 patients who were treated for
whiplash injuries, 41 of whom had personal injury lawsuits. They found no change
in symptoms after claims were settled. About ten years later, long after
litigation had settled, only 12% had completely recovered, and 48% had pain
which interfered with normal daily life.
In another study from 1993, Drs. Parinar and Raymakers re-evaluated patients
they had seen previously for legal opinions, not for treatment, 8 years after
the initial consultation. They concluded that lawsuits did not influence the
timing or degree of recovery.
Several years ago we carefully analyzed a group of patients who were referred
for treatment by their attorneys because they were not getting better. The
patients were treated with strengthening exercises, body mechanics training,
medications, spinal injections and occasionally psychotherapy. No patient needed
surgery. Most of the patients did well with significant improvements in pain and
function. Although most patients still had mild pain at the end of treatment, it
was not enough to interfere with their daily lives. These very favorable results
occurred although none of the lawsuits had been settled.
Copyright © 1997–2006 by
SpineCare Medical Group.
John Cartmell comments:
Symptoms typically associated with whiplash --- back and neck pain, poor concentration and memory, blurred vision, ringing in the ears, fatigue and weakness, dizziness, heaviness in the arms, irritability, depression, and sleep disturbances --- can all be made worse if the nutrition is insufficient to support healing of damaged tissues and the restoration of health. This is particularly true in older adults who, in spite of an adequate diet, are at increased risk of malnutrition due to age-related decreases in digestion and assimilation of nutrients.
The need for certain nutrients increases significantly after trauma injury in order to support new tissue growth and healing of damaged ligaments, muscles, discs and joints. Treatments like physical therapy, drugs for pain or inflammation, or surgery, cannot address or correct for this increased need for nutrients.
Nutritional concerns are often overlooked during rehabilitation after trauma injury. This might explain why 10 years after whiplash, only 12% of patients have completely recovered, while 48% still have pain problems sufficient to interfere with normal life activities.
John W. Cartmell, MS
www.dietadvisor.com
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