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.
