Whiplash: 12 Things you should know

1. Significant injuries occur at low-speeds.

2. Women suffer greater injuries than men because they have less strength in their neck muscles.

3. Early mobilization is critical. Use of a cervical collar actually gives worse results than no treatment at all. Immobilization following injury causes muscle wasting and loss of strength that significantly delays recovery. Corticosteroids damage articular cartilage & decrease collagen strength & repair. Early mobilization improves healing & repair of bone, cartilage, ligaments, & tendons. It also improves joint proprioception, which helps to prevent early joint degeneration. 

4. Most whiplash injuries are occult and cannot be identified on conventional imaging such as x-ray, MRI, or CT scans.

5. The peak inflammation associated with whiplash is located around the C2 vertebra and is the most common origination of headache symptoms. The C2/C3 facet joint in particular is the cause of cervicogenic headache 53% of the time.

6. The severity of vehicle damage is not predictive of injury or outcome. Stiffer vehicles actually increase the probability of long-term consequences because the forces get focused on the head & neck. A more accurate predictor of outcome is if the injured person experiences acute neck pain within the same day of injury. These people are 3x more likely to report chronic neck pain 7 years later. Also of note, younger people generally have a better prognosis & require less treatment.

7. Upper Cervical spine is most injured when head & neck are in flexed & rotated position at time of impact (e.g. looking at cell phone or child in back seat).

8. Whiplash patients are 5x more likely to suffer from chronic neck pain compared to control population.

9. Whiplash patients are at a significantly increased risk for premature disc degeneration. Most common site of disc injury is C5/C6.

10. Cervical range of motion is the most important indicator of physical impairment. It has proven to be 90% accurate in diagnosing people with whiplash symptoms. Flexion and extension are usually the most impaired movements.

11. Over 90% of whiplash patients under chiropractic care showed notable improvement over a 6 month period of care. Chiropractic treatment has been shown to be 5x more effective than Celebrex or Vioxx within 9 weeks of treatment. Chiropractic care has also been shown to have a 2x greater success rate than standard medical care, and a significantly higher success rate than Physical Therapy. Some measured markers include less work absences and less reliance on pain medications. Passive joint motion is superior to active exercise therapy.

12. In order to get the best therapeutic outcome, treatment must be initiated within the first 3 months following whiplash injury. Recommended guidelines for acute or sub-acute recovery with treatment ranges from 2 months to 2 years, with a mean of 7 months. An appropriate initial treatment frequency is 2-3 x per week for the initial 10 weeks of care.

Do Kids Get Structural Problems?

“My kids are way too young for spinal problems…”

During my years in practice, people have often asked why we check so many kids in the office. Most people are under the impression that children are way too young to have a structural problem in the spine. For the most part, you would be absolutely correct. About 60% of the kids we check in the office have no structural problems at all, and thank goodness for that.

However, statistics from the Center for Disease Control show some alarming numbers. Each year, over 1 million children between the ages of 0-5 will be hospitalized due to a fall. Another 700,000 will be hospitalized from an accidental trauma. That’s not even including the number of kids who will suffer a trauma to the spine, but are never taken to the ER!

Now think about this, most people will never even know or think about taking their kids to a chiropractor following a fall or trauma. The great news is that kids are extraordinarily resilient to injury. They bounce back up, and their ability to heal is just much better than that of an average adult. However, structural problems in the spine don’t necessarily cause neck pain and back pain, especially in children. What they can do is create other secondary conditions. Whenever there is pressure in the nerves at the base of the brain from a structural misalignment at the top of the neck, many kids can show conditions like: 

• Asthma
• Allergies
• Immune problems
• Ear infections
• ADHD
• Torticollis

These are just some of the common conditions that parents bring their kids to chiropractors for. While it’s not a chiropractor’s job to treat these symptoms, they are signs that the nerve supply from a child’s spine is compromised. On many kids, this can be tied to a difficult or traumatic birth process.

The best part of all is how much kids love getting gentle adjustments. It’s often times a parent’s worst nightmare to take their kids to a doctor. The screaming and tantrums on display at a pediatrician or a dentist can unnerve even the strongest parent. A child and infant adjustment is very different than adults, and you’ll usually see kids jumping on to my tables excited to be checked!

But the most important reason that kids should be checked early is just because it makes sense. When most of us adults develop some bad secondary conditions, x-rays usually show that a problem has been growing in the spine for 15+ years. Why let kids develop the same problems that us adults have had. Just like we take our kids for a dental check-up to ensure that they are free of cavities, our kids deserve a structural check-up to prevent the damage of a developing spine.

TMJ and the Neck – What’s the Connection?

One of the most common and troublesome problems is a condition known as Temporomandibular joint dysfuction, or TMD for short. In fact, many of you may have heard someone talk about their TMJ or having TMD, but didn’t quite know what it was.

TMD involves the joint that connects your jaw to your head. Proper movement of this joint is critical to proper function. It has a profound affect on people because dysfunction of that joint can cause a variety of problems including:

• Sharp/stabbing jaw pain
• Inability to open the jaw properly
• Headaches
• Neck pain
• Painful clicking
• Teeth grinding
• Clenching
• and much more...

It has rapidly become one of the more common reasons for visits to a neurologist and pain clinics, because of the dramatic impact that this sensitive piece of anatomy has on a person’s quality of life. Many times, this condition is treated with medications. In some cases, muscle relaxers or injections to the joint.

What does this have to do with the neck?

A search of PubMed will show numerous references for increased incidence of TMD in conjunction with a whiplash injury, or head/neck trauma. A systematic review of these papers show that people with whiplash/head injury actually have more severe pain and more pronounced dysfunction of the joint.

Another review showed that just treating the TMJ in these whiplash related cases poor outcomes suggesting that the cause of the problem may be outside the joint itself. The whiplash associated cases showed just a 48% improvement compared to the non-whiplash cases which improved 75% of the time. That leaves a huge amount of people who are still in pain and suffering because the primary insult to the body was not addressed properly.

TMD usually comes in 2 varieties:

1. Muscular dysfunction – the muscles of the jaw (pterygoids, masseter, temporalis) become hypertonic and dysfunctional creating painful musculature and sloppy movement.

2. Articular dysfunction – the joint itself can have problems. Dislodging of the disc, arthritic degeneration, and inflammation can irritate the very sensitive nerve endings that cover the joint.

Not much can be done about arthritic breakdown of a joint. However, this is a less common cause of TMD. The most common causes of TMJ problems stem from muscular imbalance and dislodging of the articular disc. In a way, these two problems are intimately related. When you have bad jaw muscles moving the jaw abnormally, then it leaves more room for the articular disc to shift out of place.

So what can make these jaw muscles dysfunctional? To know that, we have to know what controls the muscle. Every muscle in your body is controlled by a nerve. Whether it be a big bulky bicep, an achy sore back muscle, the blood pumping heart muscle, and the food digesting stomach.

For the jaw muscles, a special nerve called the Trigeminal Nerve emanates from the skull and provides innervation for the face, jaw muscles, teeth, brain, and other important structures. (as seen in the above image)

The trigeminal nerve is one of twelve specialized nerves called Cranial Nerves. The unique thing about Cranial Nerves is that they do not exit out of the spine. They actually begin come out of the brain and the brainstem, and exit out of the skull. Therefore, a problem with one of the cranial nerves is usually indicative of a problem at the brain stem.

Cervical Displacement, Whiplash, and the Brain Stem

One of the reasons that our office gets referrals is because of how Cervical Displacement impacts the health and function of the brain stem. While the top of the neck doesn’t apply direct pressure to the brain stem, the movement and function of the neck has large implications for this important piece of anatomy.

When someone has an episode of whiplash, there can be substantial damage and injury to the neck, but the more concerning portion is what happens to the nervous system. A phenomenon known as Central Sensitization occurs. This problem happens when the brain stem fires inappropriately to the limbic system (controls the basic emotions (fear, pleasure, anger) and drives (hunger, sex, dominance, care of offspring)) and reticular activating system (the places where pain is interpreted in the brain). When this happens, even the slightest touch or movement can trigger a pain sensation in the brain.

This is why many doctors can find no physical damage to the body, but people will suffer with chronic pain issues like fibromyalgia. People recognize this quickly when the pain is stemming from the neck, shoulders or back, but the reality is that this same thing is happening in the jaw muscles.

To get to the root of someone’s problems, we have to evaluate this critical, but under studied part of the nervous system. 

How does Structural Chiropractic address this?

1. Restore healthy biomechanics to the spine – create a state of Normal Structure in the neck so that the proper signals get to the brain.

2. Increase circulation through the brain – proper alignment ensures that blood to and from the brain stem properly. Proper blood flow means better nerve firing.

3. Restore health biomechanics to the jaw – Once the neck alignment is restored, most of the time the jaw will reset on it’s own. However, sometimes gentle jaw adjustments may be necessary.