Symptoms - The Iceberg Model

Most people are familiar with the image on the top. An image of a lowly iceberg. It looks so simple to simply steer around and bypass it on the way to smoother seas.

But if our past was a good teacher, then we know that by only paying attention to the surface, we can miss a dangerous obstacle in the depths.

Our bodies are equipped with an incredible array of signals to let us know that something is wrong. Sometimes it comes in the form of a pain in the back, draining fatigue, or chest pain. The purpose of these signals is to tell us that something is wrong, but it’s up to us to look within to identify the cause.

As long as we continue to exist in a healthcare system that only seeks to reduce symptoms, then we will continue to get the same results as those who only saw the tip of the iceberg.

Unless we look towards the body’s healing capacity, and why it’s not operating at 100% full function, then we are missing the boat on the health challenges of millions of people. And there’s no amount of drugs, natural medicine, surgery, or insurance money that can save that ship from sinking.

What a 10 mph car accident does to the neck?

Pain after a car accident can be very strange and confusing. Take a look at these examples and tell me if this reminds you of a situation that you or someone you know.

Person A: Healthy and fit 37-year-old man in a car and gets hit at 45 mph+. The impact drives his car into the car in front causing extensive damage.

Person B: Healthy and fit 29-year old woman. Sitting in line in a parking lot when another car runs into the back of her at 10 mph or less. Minimal damage to the car and wore a seat belt.

Which one do you think had a worse whiplash injury and had pain immediately and which do you think just had soreness that they wanted to get checked out?

Both had substantial biomechanical changes on their x-ray and MRI, but only one had a significant amount of pain immediately after the incident.

If you guessed that Person B with the parking lot bumper tap had the most pain, then you win! Congratulations!

The Deceptive Nature of Pain

Pain is one of medicine’s greatest tricksters. To this day, researchers and scientists don’t have a strong grasp on the nature pain disorders.

Why is it tricky? Because the pain someone feels isn’t necessarily related to the amount of damage in the body. Patients with fibromyalgia have crippling pain despite not having any visible damage to their bodies.
Pain is the most important factor to a patient, but it can be the most deceptive factor to a clinician. When it comes to taking care of people after an accident, we have to measure a patient’s function regardless of their pain status.

What Happens to the Neck After an Accident?

Insurance companies will only consider it an accident-related whiplash injury if you see a doctor within 14 days of the accident. So if you have no pain after the accident or the pain wasn’t bad enough to drive you to a physician until day 15, then you didn’t have a whiplash (I know how silly it sounds).

But going back to the previous example, we know that both Patients A and B had biomechanical flaws as a result from trauma to the spine. Despite the fact that there were 2 very different accidents and 2 different pain statuses, there are similarities in what can happen to the neck even after the smallest collisions. Take a look at the video below which simulates an accident less than 10 mph.

 

What Happens to the Neck in an Accident?

After watching the video, you can get the impression that a collision at just 5-7 mph causes rapid movement of the head and neck.

Despite the fact that your body is encased by a 2 ton metal box, it’s easy to see that even though the vehicle stops moving, there is still a transfer of energy into the body. When you’re wearing your seat belt, it causes a rapid deceleration of your body, but your head will continue to move forward and backward very rapidly.

In fact, a large enough force to the neck can actually produce a concussion even if there’s not direct contact to the head! These accidents would need somewhere around 90 G’s of force to the head.

While that would cease to be a small accident, the smaller 10 mph accidents can produce 3-5 G’s of force which is enough to damage the tissues of the neck. The way your head accelerates and decelerates can put 3-6 G’s of force into the cervical spine. This force gets transferred into the ligaments, muscles, discs, and joints of the neck more than any other piece of anatomy.

While the body can tolerate large amounts of force in brief periods, a large amount of force applied to a small region of anatomy as seen in a car accident can damage the tissues of the neck.

Ligament Injury

Ligaments are like the rubber bands of the spine. They can be stretched, but once they stretch too far, they can’t go back to normal again. As ligaments are damaged, scar tissue is used as a patch, but it’s not as functional as the stuff you were built with.

Just like when you sprained your ankle as a kid and that ankle never worked the same, damage to ligaments of your neck can happen the same way. Fortunately, true sprains of the neck take a lot of force and don’t happen with most accidents.

Muscle Strains

When muscle works beyond its capacity, or gets stretched beyond its end range, it forms small tears within the muscle belly. That’s why there’s no consensus as to whether you’re better off knowing about a coming accident and bracing, or if you’re better off being surprised.

Either way, damage to the muscle tissue can happen depending on the nature of the collision.

Muscle strains can be painful, but they can and do heal with time. Strain to muscle tissue is one of the most common sources of pain from whiplash injuries and resolve well with chiropractic and exercise.

Disc Damage

Accidents are one of the most common ways that people under 30 can suffer herniated discs in the spine. When the force of an accident overcomes the resistance of the disc material, small tears in the disc can result in the inner fluid spilling into the spinal canal.

Sometimes this results in a pinched nerve, but most of the time it does not. A disc problem doesn’t have to be a big problem. Many people have disc damage and have no idea because it’s not symptomatic.

Structural Shifting

The muscles, ligaments, discs, and nerves of the neck help dictate the Structural Positioning of the spine. The force of an accident can deform one or all of these tissues leading to abnormal positioning of the head and neck.

This leads to abnormal neurological input to the brain and what manifests as poor posture (slouching, head tilt, antalgic lean). While poor posture is not the problem that needs to be treated, it’s an objective sign of a nervous system is operating at less than its full capacity.

Remember That It’s Not About Pain

Remember at the beginning of the article we talked about how pain can be deceptive. The reason I wanted to point that out is because you can experience damage to all of the above structures and not feel an immediate onset of pain. Pain is just tricky like that.

Whether you feel immediate pain or not, your neck should always be evaluated even after minor accidents because it gives the earliest and best opportunity to correct a silent problem.

Whiplash Associated Disorders – What are the Facts?

In my experience, I’ve found that whiplash is a commonly misunderstood diagnosis among the patient population. Many people self-diagnose the pain in the neck following a bad roller coaster ride or car accident as a whiplash injury. While they may or may not be correct, the truth is that whiplash is a type of injury with serious implications, and is frequently mismanaged by unscrupulous folks with a big stake in the business of personal injury.

Whiplash is a common name for a group of neck disorders known as cervical acceleration-deceleration injury or cervical sprain/strain injury. It occurs when the head and neck are placed in motion and suddenly forced to a stop causing a hyperflexion or hyperextension motion. 

 

This irregular movement of the neck causes the ligaments of the spine to sprain and the muscles to splint the unstable structure. This type of injury is also known to cause the discs of the spine to bulge and herniate, thus complicating matters even further.

It’s easy to see how whiplash can be a real pain in the neck (pun intended), but most people treat it like a sprained ankle and hope that the pain goes away in a few weeks. However, there can be long term consequences; even for people who don’t have pain symptoms immediately. Research has shown that whiplash associated disorders are related to inflammatory and endocrine problems like those seen in chronic fatigue syndrome or fibromyalgia¹. Whiplash is also associated with chronic pain by making your brain more sensitive to pain signals, which explains why so many people can suffer without any evidence of physical damage². Additionally, people who report whiplash injuries after a rear-end accident are likely to show complaints of headaches, TMJ, back pain, fatigue, and sleep problems even 7 years later³! Whiplash has even been associated with chronic inflammation by making the body’s own immune system overly responsive to normal stimuli^4,5.

Though the focus of my practice has never been on auto-accidents cases, the truth is that most drivers will be involved in a collision no matter how good a driver they may be. Most will probably not experience pain immediately after a collision, especially if you’re in your teens or early 20’s. However, the impact of a vehicle traveling at speeds as low as 15 mph can show visible signs of structural damage to the neck. These include s-shaped curves in the neck, anterior ligament instability, atlas displacement, and Anterior Head Syndrome. A recent study has found that this type of trauma to the spine can cause parts of the brain and brain stem to slip further into the neck creating a condition called Chiari Malformation⁶. While they may not be painful in their early stages, these structural changes can pre-dispose the spine to early degeneration and arthritis if left uncorrected over the course of several years.

 Normal Neck X-Ray

S-shape X-ray Characteristic of Whiplash

As a chiropractor focused on Structural Correction, I see patients everyday with Secondary Conditions like headaches and TMJ related to accidents that took place many years earlier. While some of these patients suffered painful injuries and received treatment following an accident, most people will walk in and say they didn’t have any symptoms until years later. When someone asks why their pain seemed to come out of nowhere, I can usually look at their x-ray and see that the structure of the neck fits the familiar S-shape of a previous rear end collision.

Here are your take home messages:

• First, problems can grow in the body in the absence of symptoms. Much like cancer and heart disease don’t happen overnight, people with chronic pain usually under go slow physiologic changes in their brain and hormonal systems for years before they have a condition that won’t go away.

• Second, if you have a physical/structural problem, then you must go beyond treating the pain symptoms to help get full resolution of the problem. Whiplash injuries cause distinct structural problems in the spine. While pain relief is important, making the pain go away while leaving the structure in bad shape is like taking the battery out of a smoke detector when a fire is burning in the house.

Whiplash associated disorders can be a complicated problem that requires a comprehensive solution. When selecting a team of doctors, make sure that you have someone in your corner that can look at you from a functional standpoint rather than sheer pathology, that addresses the structure of your spine in 3-dimensions, and understands the nature of traumatic injuries.

References:

 
1. Banic B, Peterson-Felix S, Anderson OK et al. Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia. Pain. January 2004. 7-15. 

2. Berglund A, Afredsson L, Jensen I, Cassidy JD, Nygren Ake. The association between exposure to a rear-end collision and future health complaints. J of Clinical Epidemiology. Aug 2001 (54): 851-856. 

3. Kivioja J, Rinaldi L, Ozenci V et al. Chemokines and their receptors in whiplash injury: elevated RANTES and CCR-5. J Clin Immunol. Jul 2001; 21(4): 272-7 

4. Kivioja J, Ozenci V, Rinaldi L. Systemic response 

5. Gaab J, Baumann S, Budnoik A et al. Reduced reactivity and enhanced negative feedback sensitivity of the hypothalamus-pituitary-adrenal axis in chronic whiplash associated disorder. Pain. December 2005. 119(1). 219-224. 

6. Freeman MD, Rosa S, Harshfield D et al. A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash). Brain Inj. 2010; 24(7-8): 988-94.
  
If you have experienced this kind of injury, call our office today and book your consultation. 248-287-8700