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Resolving Neck Pain – Whiplash Injuries

Whiplash injuries are very interesting, but frustrating, subjects to talk about. There have been more than 10,000 research articles written about this subject. Yet, insurance companies, lawyers, and some physicians still question the validity of this syndrome. I have spent enough time in court as an expert witness to realize that opinions often have more to do with who will have to pay out money, than with the importance of addressing a condition that often leads to years of chronic pain. Pain which could have been addressed with an understanding of basic biomechanics, the right treatment methodology, and exercise.

Symptoms of Whiplash injuries

Whiplash injuries can present with a broad variety of symptoms, with the most predominant being:

Neck pain is the most common symptom.
Headaches are the second most common symptom, usually occurring on one side of the head, beginning at the base of the skull (occiput) and often radiating to the top of the head and frontal regions.
Arm pain caused by nerve compression or referred pain from the facet joint or disc.
Facial pain (either direct or referred).
Jaw Pain such as TMJ issues are common.
Nerve entrapment syndromes.
Shoulder blade pain (interscapular pain).
Shoulder pain (rotator cuff).

Whiplash injuries may also cause:

Balance problems (often related to upper cervical issues).
Difficulty sleeping.
Dizziness (often related to upper cervical issues).
Fatigue (this can be severe).
Low back pain.
Poor concentration.
Loss of memory.
Psychological changes, such as depression.
Tinnitus (ringing, buzzing, whistling, or other noises heard in one or both ears).
Visual disturbances (sensitivity to light – this can be stress induced, or due to adrenal stress).
Weakness.

(Chronic whiplash and whiplash-associated disorders: An evidence-based approach Journal of the American Academy of Orthopedic Surgeons October 2007;15(10):596-606 Schofferman J, Bogduk N, Slosar P.)

Understanding Whiplash Injuries – Biomechanics & Anatomy

Many factors come into play in any type of whiplash accidents. A typical rear-end collision that results in whiplash has several phases that need to be understood before beginning treatments.

Whiplash injuries are complex, involving much more than just one set of structures. This type of injury often involves; joints, muscles, ligaments, tendons, connective tissue, and a wide array of neurological structures. Besides the immediate pain and suffering felt from the initial incident, this type of injury can often lead to degenerative osteoarthritis ten or twenty years later. This is extremely well-documented in the scientific literature.

Click each of the following tabs for a quick overview of these factors and how they affect your body.

Whiplash Biomechanics

The first factor to consider is that Whiplash Injuries (hyper-extension – hyper-flexion injuries) occur within an extremely short period of time.

Most of these injuries occur in about one-quarter of a second. This means that the occupants of a vehicle (which was struck from behind) do not have time to react to the accident. Keep this time-frame in mind as we cover some of the actions that occur.

Vehicle Impact Phase

Let us start with the onset of a standard rear-end collision and consider what happens from the perspective of the driver of the vehicle that was rear-ended.

Upon initial impact (where the vehicle in the rear hits the car in front):

The force of impact begins to move the front vehicle forward.
Since the seat of the car is attached to the car’s frame, the driver’s seat moves forward with the car.
But the driver is not attached to the frame of the car, and he/she continues to remain in a fixed position; this is due to inertia. Physics defines inertia as “the tendency of a body to resist acceleration.” Keep in mind, all of this is occurring within milliseconds.

Then, within a faction of a second, the car seat is pushed into the driver’s lower and mid-back. This rapid forward acceleration also pushes the lower part of the driver’s neck (lower cervical spine) forward. This has the effect of straightening out both the normal curve in the driver’s neck (the natural lordotic curve) as well as the curve in the driver’s mid-back (the kypotic curve). This then creates an abnormal S-shaped curve in the driver’s cervical spine (neck).

A considerable amount of damage can be done during this phase (vehicle impact).

Normally, neck motion is the result of movement throught multiple vertebral joints, each of which contribute only a few degrees of motion to an action. Therefore movements like neck extension are made up of the summation of multiple vertebra, each adding small degrees of motion to produce the total action.
When the neck is in this abnormal S-shaped position, the joints of the neck (facet joints) are forced past the limits of what is considered to be their normal physiological range-of-motion.
This excessive motion causes damage to the area around the spinal joints (facet joints). This damage can include: facet capsule ligament tearing, bony impingements, and intra-articular (within the joint) hemorrhages. The degree of joint damage depends on the severity of collision.

(Chronic whiplash and whiplash-associated disorders: An evidence-based approach; Journal of the American Academy of Orthopedic Surgeons October 2007;15(10):596-606 Schofferman J, Bogduk N, Slosar P.)

Hyper Extension Phase

The next high-speed, forward-motion, jerks the driver’s head back.

In many cases, the head moves right back over the headrest. This frequently occurs since most people keep their headrest too low to be an effective stop.

It can also occur due to poor headrest design. If the impact of the accident is severe enough, a considerable amount of soft-tissue and joint damage can occur in the front of the neck as the head is thrown back.

Hyper Flexion Phase

Next, the car seat springs forward, causing the driver’s whole torso to move forward at a high velocity. Physics defines velocity as “rapidity or speed of motion; swiftness.” Keep in mind, as your seat moves forward, your head is still moving back. This action is similar to the final moment before a spring releases.

Then, almost instantaneously, your torso and head are flung forward. This forward motion is so strong that if the driver does not have a seat belt on, the driver could be thrown right out of their seat into the steering wheel, or even through the window.

This strong forward action causes the driver’s whole spine to flex forward, often past its physiological limits. This action can cause a considerable amount of posterior neck, mid-back, shoulder, and even low-back damage.

Effective Treatment for Whiplash

Treatments for whiplash vary based on the symptoms presented, and the severity of the injury. Whiplash injuries are complex, involving much more than just one set of structures.

This type of injury often involves; joints, muscles, ligaments, tendons, connective tissue, and a wide array of neurological structures. Besides the immediate pain and suffering felt from the initial incident, this type of injury can often lead to degenerative osteoarthritis ten or twenty years later.

Click on each of the following tabs to better understand our treatment process.

Icing for Initial Self-Treatment

Treatment can begin after major injuries such as fractures have been ruled out.

For the first 72 hours ice should be used to reduce pain, inflammation, and swelling

Rest – Avoid putting additional stress on the neck.
Ice – Apply ice to the neck and shoulder for 20-30 minutes, every 2-3 hours, until the swelling is reduced.

In addition, non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed to control pain and inflammation during this initial phase.

After completing this initial acute stage, implementation of ART treatments should begin as soon as possible.

Scar Tissue Forms Fast

The formation of scar tissue, both on the surface, and within your body, is part of your body’s natural healing process, and is required for the initial healing of your damaged tissues.

These microfibers form strong meshes over damaged areas and act to help support those structures while your body is healing itself.

However, excessive scar tissue formation can cause layers of tissues to bind together (forming adhesions) and result in restricted ability to move, nerve compression, and a variety of other problems.

An Example of the Impact of Scar Tissue on Your Body

When one considers just how quickly fibrotic tissue (scar tissue) forms within damaged tissue (7 days), it becomes clear that early soft-tissue intervention is essential.

For example, let us look at just one structure – The Anterior Scalene.

The anterior scalene extends from the vertebra of the neck to the second rib (TP’s C3-C6 to scalene tubercle first rib, anterior surface second rib).
Research has shown that after a hyper-extension/hyper-flexion injury, the anterior scalene often becomes fibrotic.
When this muscle becomes fibrotic it can cause compression on a network of nerves known as the brachial plexus.
Compression of the nerves in the brachial plexus can create the neurogenic thoracic outlet syndrome (NTOS) which causes neck pain, headaches, altered sensation (paresthesias), and weakness in the shoulders, arms, wrists, and hands.
Some studies (4) have shown that NTOS causes a decrease in quality of life equivalent to that of those suffering from Chronic Heart Failure.

It is interesting to note that many compression injuries to the brachial plexus do not show up for 7 to 37 days after the injury. By applying manual therapy procedures (such as Active Release Techniques) early in the healing process, it is possible to avoid the formation of excessive scar tissue in these structures, and thereby reduce the impact of conditions such as NTOS.

(1. Diagnosis of thoracic outlet syndrome Journal of Vascular Surgery Volume 46, Issue 3, September 2007, Pages 601-604. Richard J. Sanders MD, Sharon L. Hammond MD and Neal M. Rao BA 2. Biomechanical and histological evaluation of muscle after controlled strain injury Am J Sports Med 1987 15: 9 Pantelis K. Nikolaou, Beth L. Macdonald, Richard R. Glisson, Anthony V. Seaber and William E. Garrett, JR 3. Symptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries J Bone Joint Surg (Br) 2001 Mar;83(2):226-9 Ide M, Ide J, Yamaga M, Takagi K 4. Surgical intervention for thoracic outlet syndrome improves patient’s quality of life. Chang, D.C., Rotellini-Coltvet L.A., Mukherjee D, et al.,J Vasc Surg, 2009. 49(3): p. 630–5;discussion 635–7.)

Using ART to Treat Whiplash Injuries

Active Release Techniques is one of the most effective techniques available for treating whiplash injuries, even whiplash injuries that occurred sometime in the past.

Early implementation of ART treatment procedures can prevent acute injuries from becoming chronic problems.

In the case of whiplash injuries research has shown that 15% to 40% of individuals who have had these injuries develop chronic neck pain.(1) Early intervention can help you avoid becoming one of these statistics.

(1. Chronic whiplash and whiplash-associated disorders: An evidence-based approach Journal of the American Academy of Orthopedic Surgeons October 2007;15(10):596-606 Schofferman J, Bogduk N, Slosar P.)

Take Care of the Entire Kinetic Chain

Although early intervention is important, it is equally important to have the practitioner consider all the areas that are, or could be, damaged in a hyper-extension, hyper-flexion injury.

The practitioner must look for damage in more than just the neck, and review possible injuries to the patient’s jaw, shoulders, arms, wrists, upper-back, lower-back, hips, and sometimes even the lower extremities. Areas that have been injured often do not show symptoms for several weeks.

This is often the case with jaw problems caused by whiplash injuries. With whiplash injuries, one in three people who have been in a hyper-extension hyper-flexion accident will develop delayed TMJ problems.(1)

(1. Delayed temporomandibular joint pain and dysfunction induced by whiplash trauma: a controlled prospective study Journal of the American Dental Association August 2007;138(8):pp. 1084-91 Salé H, Isberg A.)

From a kinetic chain perspective, jaw motion and neck motion are directly linked to each other. Activation of neck and jaw muscles occurs simultaneously, with synchronized movements of the TMJ, cervical spine, and the atlanto-occipital joints (The Atlanto-occipital joint lies between the base of the skull (occiput) and the C1 vertebra (atlas))(2).

(2. Deranged jaw–neck motor control in whiplash-associated disorders European Journal of Oral Sciences, February, 2004; 112: 25–32. Per-Olof Eriksson, Hamayun Zafar, Birgitta Haggman-Henrikson)

Thus any injury to muscles of the neck can directly affect jaw function. It becomes much easier to resolve Whiplash Injuries when your Active Release practitioner takes into account this type of kinetic chain relationship. Which leads me to an important point, you need to find an ART practitioner who is certified in biomechanics, as that could make a huge difference in resolving your condition. Practitioners with a strong biomechanics training will have a better understanding of kinetic chain relationships can more easily identify structures that are involved in the injury. See Find an ART Practitioner to find a qualified practitioner in your area.

Exercises for Whiplash Injuries

Appropriate exercise plays a critical role in the rehabilitation plan of any whiplash injury. Initially, exercises should be performed within a range-of-motion that is pain-free, or causes very minimal pain. Staying in this range will help to ensure:

That no abnormal neurological motor responses are being created.
Time enough to allow for complete tissue repair of the injured area.

It is very important to remember that injured tissue needs time to remodel, but without the right exercise, the possibility of re-injury is very high. See our Blog about “Exercise and Tissue Remodeling”.

Release Your Kinetic Chain: Exercises for the Jaw to Shoulder

If you are looking for a series of exercises specifically designed to rehabilitate the neck after a whiplash injury, then you should check out our Release Your Kinetic Chain series of exercise books. We have achieved great results in the treatment of whiplash injury patients by using the exercises in the Exercises for the Jaw to Shoulder book. This book covers several of the main areas commonly injured in a hyper-extension hyper-flexion injury.

Release Your Pain: 2nd Edition

Dr.Abelson’s international best-seller – Release Your Pain – can help you better understand the causes of neck and back pain, its effects upon the structures of your neck, and provides exercises to help you remodel your tissues after an injury..

Visit our website at www.releaseyourbody.com to purchase your eBook or hard-copy.

Nerve Flossing Exercises and Videos

When nerves are entrapped, your body will go to great lengths to protect these nerves. Muscle function is often reduced, including reducing the amount of force that certain muscles can generate. This creates muscle imbalances and abnormal neuromuscular responses, and can impact other structures in the kinetic chain as they attempt to compensate for these weaknesses.

Appropriate nerve flossing exercises can help to restore normal neuromuscular patterns, increase strength, range-of-motion and restore normal motion patterns. Flossing a nerve is like flossing your teeth, except that your nerve is the floss that is moving through the restricted tissues.

In addition to the Active Release protocols that a certified ART practitioner will use, there is also several simple nerve flossing exercises that can be performed at home to help reinforce these treatments.

Watch the following videos for examples of nerve flossing videos that we use at our clinic. Click the left and right arrows to scroll through the videos.

Nerve Flossing – Spinal Cord and Sciatic Nerve: Nerve Flossing – Spinal Cord and Sciatic Nerve

Releasing both the spinal cord and sciatic nerve. This nerve flossing video gives you several ways to mobilize entrapped nerve roots and the sciatic nerve.

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Nerve Flossing – Spinal Accessory Nerve: Nerve Flossing – Spinal Accessory Nerve

In this video we discuss the Spinal Accessory Nerve and show you a nerve gluiding exercise you can use.

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Nerve Flossing – Axillary Nerve: Nerve Flossing – Axillary Nerve

In this video we discuss the Axillary Nerve and show you a nerve gluiding exercise you can use.

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Nerve Flossing – Suprascapular Nerve: Nerve Flossing – Suprascapular Nerve

In this video we discuss the Suprascapular Nerve and show you a nerve gluiding exercise you can use.

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Exercise Blogs for Whiplash

Click on the following blog articles for additional information on Whiplash Injuries.

Understanding Whiplash Injuries – Bio-mechanics & Anatomy

The first factor to consider is that Whiplash injuries (hyper-extension, hyper-flexion injuries) occur in an extremely short period of time. Most of these injuries occur in about one-quarter of a second. This means that the occupants of a vehicle which is struck from behind do not have time to react to the accident. Keep this time-frame in mind as we cover some of the actions that occur.

Resolving Whiplash Injuries with Active Release – Part 1

After major injuries such as fractures have been ruled out, treatment can begin. For the first 72 hours ice should be used to reduce pain, inflammation, and swelling. See our section on the correct procedures for icing. After this initial acute stage, implementation of ART procedures should begin as soon as possible.

Neurological Impact of the Neck’s Kinetic Chain

Whenever an injury occurs in your neck (such as a sprain/strain), it damages not only the ligaments, tendons, and muscle fibres, but also their embedded neurological structures (Golgi tendon organs, muscle spindles, and joint receptors). These neurological structures play an essential role in postural control.