What is a Personal Injury?
You have been injured and another personal was involved in a negligent action to cause your injury (i.e. a vehicle negligently crashed into yours and was at fault for the collision.).
The Most Common Injury in a Personal Injury?
What is Whiplash?
“According to the National Institutes of Health “Whiplash, a soft injury to the neck, is also called neck sprain or neck strain. It is characterized by a collection of symptoms that occur following damage to the neck, usually because of sudden extension and flexion.” (61)
Approximately two-thirds of people involved in motor vehicle accidents develop symptoms of whiplash. The symptoms usually do not develop until two to 48 hours after the injury. Whiplash can also occur from falls, sports injuries, work injuries and other incidents.
Patients with whiplash injury may complain of pain and stiffness in the neck, extending into the shoulders and arms, upper back and even the upper chest. Two-thirds of patients suffer with headaches, especially at the base of the skull. Patients may also experience dizziness, difficulty swallowing, nausea and even blurred vision after injury, but these symptoms tend to resolve quickly.
According to Marshall, 45 percent to 85 percent of people who suffer a whiplash injury have the symptoms five years after the accident, and 82 percent had a straightening or reversal of their cervical curvature.(62) "Many authors regard a straightening or reversal of the normally lordotic curvature to be one of the most significant changes of a whiplash injury.” (63)
“The initial injury is due to damage of cervical muscles, ligaments, disks, blood vessels and nerves. The actual injury to soft tissues happens so rapidly that normal protective muscle reflexes cannot respond in time to decrease or prevent the injury,” according to a 2006 case report in the Journal of the American Chiropractic Association.3”” (64)
Is Whiplash a Real Condition?
Nearly Half of the orthopedic surgeons surveyed believed that chronic whiplash pain was psychogenic (i.e., all in the head). (65) In fact, whiplash injuries are one of the biggest pandemic problems of our age and the problem is getting worse. Galako et al.
(68) reported that in 1982, in the U.K., seat belt legislation was introduced and the next
year the prevalence of whiplash rose 268% (This is not implying that you should not wear seat belts. It is one of the single most protective devices in your car, but it does increase the likelihood of whiplash (69).) The National Highway Traffic Safety Administration (NHTSA) has estimated that for the year 2000, the total economic cost of motor vehicle crashes (MVCs) in the U.S. was $230.6 billion. (66) “This represents
$1210 for every living American. By comparison, $43billion is approximately what we spend on diabetes a year.” (67)
Could you have a Brain Injury?
Whiplash may be the biggest pandemic of our age; however, another “silent epidemic” is traumatic brain injuries (TBIs). The mortality from head injury in the last 12 years has exceeded the cumulative number of Americans killed in all wars since the founding of this country. (67) Nonfatal TBIs are conservatively more then 2 million a year with an overall economic societal cost of 25 billion each year. (70) NHTSA reported the annual number of brain injuries at 7 million for 1989. That is one injury for every 40 citizens.
- 25-30% of persons suffering an acute Mild Traumatic Brain Injury (MTBI) will report unrelenting complaints 3-6 months later. (71) If symptoms are persistent after 6 months, they are likely to be permanent. From a medical perspective this is one of the most under-diagnosed problems of all time. (67)
- Female sex 1-14.
- Females weighing less than 130 lb in frontal crashes 15.
- History of neck injury 2,16.
- Head restraint below head’s center of gravity (males and females); large topset 11.
- History of CAD injury 17.
- Poor head restraint geometry/tall occupant (e.g., 80th percentile male) 18,19.
- Rear vs. other vector impacts 1,5,6,10,12,20-26.
- Use of seat belts/shoulder harness (i.e., standard three-point restraints) 5-7,26-30.
- Body mass index/head neck index (i.e., decreased risk with increasing mass and neck size) 4,31.
- Out-of-position occupant (e.g., leaning forward/slumped) 32-35.
- Non-failure of seat back 20.
- Having the head turned at impact 36-38.
- Non-awareness of impending impact 2.
- Increasing age (i.e., middle age and beyond) 7,39.
- Front vs. rear seat position 40.
Why Have You Been Hurt While Someone Else Wasn’t?
There are whole textbooks devoted to how and why you are injured in motor vehicle crashes. It does have to do with many variables. I’ll give you two charts that outline variables that increase your risk for immediate, or acute, whiplash and long term, or chronic, whiplash injuries. Both were documented with references by Dr. Croft in his textbook “Whiplash and Mild Traumatic Brain Injuries”. (67)
Arthur C. Croft, PhD, D.C., M.Sc., M.P.H., F.A.C.O. firstname.lastname@example.org
Risk for acute injury:
1) Female sex 1-14.
2) Females weighing less than 130 lb in frontal crashes 15.
3) History of neck injury 2,16.
4) Head restraint below head’s center of gravity (males and females); large topset 11.
5) History of CAD injury 17.
6) Poor head restraint geometry/tall occupant (e.g., 80th percentile male) 18,19.
7) Rear vs. other vector impacts 1,5,6,10,12,20-26.
8) Use of seat belts/shoulder harness (i.e., standard three-point restraints) 5-7,26-30.
9) Body mass index/head neck index (i.e., decreased risk with increasing mass and neck size) 4,31.
10) Out-of-position occupant (e.g., leaning forward/slumped) 32-35.
11) Non-failure of seat back 20.
12) Having the head turned at impact 36-38.
13) Non-awareness of impending impact 2.
14) Increasing age (i.e., middle age and beyond) 7,39.
15) Front vs. rear seat position 40.
16) Impact by a vehicle of greater mass (i.e. 25% greater)
17) Crash speed under 10 mph 20.
18) For rear struck occupant, when the bullet vehicle has a motor that is longitudinally mounted 25.
19) Being the driver vs. front seat passenger 12.
Risk for late whiplash:
- Body mass index in females only 31.
- Immediate/early onset of symptoms (i.e., within 12 hours) and/or more severe initial symptoms 7,39,43-47.
- Initial back pain 46.
- Initial decreased cervical spine ROM (females only) 48,49.
- Initial upper back pain 50.
- Initial upper extremity numbness or weakness 48-50 or pain 47.
- Greater subjective cognitive impairment 44,45.
- Greater number of initial symptoms 45,50,51.
- Greater severity or frequency of initial symptoms 50.
- High initial pain intensity 51.
- Use of seat belt shoulder harness 6. For neck (not back) pain 31; non-use had a protective effect.
- Initial physical findings of limited range of motion 51,52.
- Neck pain on palpation 53.
- Muscle pain 53.
- Disturbed vision 50.
- Initial sleep disturbance or fatigue 50.
- Initial neurological symptoms; radiating pain into upper extremities 49,53.
- Past history of neck pain 43 or headache 45.
- Headache 53.
- Initial degenerative changes seen on radiographs 43,48,49,54.
- Foraminal stenosis (cervical) 48.
- Front seat position 51; driver seat vs. passenger seat for females 55.
- Rear seat position 56.
- Occupants of vehicles manufactured in the late 1980s to early 1990s (OR=2.7 vs those in early 1980s vehicles) 25,57. This is relevant for rear impact crashes only. Other data suggest this relationship holds for all 1990s vehicles.
- Initial generalized sensory hyperalgesia 58.
- Head rotation at impact 49; both frontal and rear 48.
- Non-awareness of impending impact 59,60.
What Should I do for Treatment?
What should you do for treatment? It is preferable that you go to the ER for treatment directly after a crash to check for life threatening injuries. Once cleared of these injuries, you should come into our office, Advanced Spinal Care, for a consult as soon as possible. Chiropractic care is very beneficial and effective for treated whiplash. This is demonstrated in a retroactive study by Woodard et al., published in Injury, were 26 out of 28 (or 93%) patients suffering from chronic whiplash benefited from chiropractic care (Chiropractic care in this study included spinal manipulation, proprioceptive neuromuscular facilitation stretching and cryotherapy (icing)). (72) Your body is in a state of plastic change and either can be directed in a direction of correction, or pulled by the trauma, in a direction of pain. First, we work with light manipulations of the body, ice and several light muscle therapies to reduce the pain from your crash. Second, once your pain levels are manageable we introduce exercises, stretches, postural reeducation, proprioceptive and movement pattern retraining. Lastly, we teach you patient specific exercises and stretches to take care of yourself in the future with regular maintenance visits until you are stable. On occasion, we reach out to other specialties (orthopedist, neurologist, general medical, osteopath, psychologist) and send you for special imaging (Digital Motion X-Ray(DMX), CT, MRI) depending on conditions and condition severity. We then work jointly we them to make sure we reach our goal for you not to have any long-term consequences from your crash.
- Bylund PO, Bjornstig U. Sick leave and disability pension among passenger car occupants injured in urban traffic. Spine 1998;23:1023-8.
- Dolinis J. Risk factors for 'whiplash' in drivers: a cohort study of rear-end traffic crashes.
- Brault JR, Wheeler JB, Siegmund GP, et al. Clinical response of human subjects to rear- end automobile collisions. Arch Phys Med Rehabil 1998;79:72-80.
- van den Kroonenberg A, Phillipens H, Cappon J, et al. Human head-neck response during low-speed rear end impacts. Proceedings of the 42nd Stapp Car Crash Conference, 1998:207-21.
- Morris A, Thomas P. Neck injuries in the UK co-operative crash study. 1996;SAE 962433:317-29.
- Borchgrevink GE, Lereim I, Royneland L, et al. National health insurance consumption and chronic symptoms following mild neck sprain injuries in car collisions. Scand J Soc Med 1996;24:264-71.
- Satoh S, Naito S, Konishi T, et al. An examination of reasons for prolonged treatment in Japanese patients with whiplash injuries. J Musculoskel Pain 1997;5:71-84.
- Mayou R, Bryant B. Outcome of 'whiplash' neck injury. Injury 1996;27:617-23.
- Giguere JF, St-Vil D, Turmel A, et al. Airbags and children: a spectrum of C-spine injuries. J Pediatr Surg 1998;33:811-6.
- Temming J, Zobel R. Frequency and risk of cervical spine distortion injuries in passenger car accidents: significance of human factors data. International IRCOBI Conference on the Biomechanics of Impact. Göteborg, Sweden, 1998:219-33.
- Chapline JF, Ferguson SA, Lillis RP, et al. Neck pain and head restraint position relative to the driver's head in rear-end collisions. Accid Anal Prev 2000;32:287-97.
- Berglund A, Alfredsson L, Jensen I, et al. Occupant- and crash-related factors associated with the risk of whiplash injury. Ann Epidemiol 2003;13:66-72.
- Hell W, Hopfl F, Langweider K, et al. Cervical spine distortion injuries in various car collision directions and injury incidence of different car types in rear-end collisions. International IRCOBI Conference on the Biomechanics of Impact. Lisbon, Portugal, 2003:193-206.
- Cappon H, van Ratingen M, Wismans J, et al. Whiplash injuries, not only a problem in rear-end impact. . Proceedings 18th International Technical Conference on the Enhanced Safety of Vehicles (ESV). Nagoya, Japan, 2003.
- Banks R, Martini J, Smith H, et al. Alignment of the lumbar vertebrae in a driving posture. J Crash Prevention and Injury Control 2000;2:123-30.
- Jakobsson L, Norin H, Isaksson-Hellman I. Parameters influencing the risk of AIS 1 neck injuries in frontal and side impacts. Proceedings. International Research Council on the Biomechanics of Impact (IRCOBI) Conference. Montpellier, France, 2000.
- Khan S, Bannister G, Gargan M, et al. Prognosis following a second whiplash injury.
- Viano D. Head restraint position during normal driving: implication to neck injury risk in rear crashes Accid Anal and Prev 1996;28:665-74.
- Ono K, Kanno M. Influences of the physical parameters on the risk to neck injuries in low impact speed rear-end collisions. Accid Anal Prev 1996;28:493-9.
- Foret-Bruno J, Dauvilliers F, Tarriere C. Influence of the seat and head rest stiffness on the risk of cervical injuries. 13th International Technical Conference on Experimental Safety Vehicles, S-8-W-19, 1991:968-74.
- Bourbeau R, Desjardins D, Maag U, et al. Neck injuries among belted and unbelted occupants of the front seat of cars. J Trauma 1993;35:794-9.
- Magnusson T. Extracervical symptoms after whiplash trauma. Cephalalgia 1994;14:223- 7; discussion 181-2.
- Serra LL, Gallicchio B, Serra FP, et al. BAEP and E.M.G. changes from whiplash injuries. Acta Neurol (Napoli) 1994;16:262-70.
- Borchgrevink GE, Stiles TC, Borchgrevink PC, et al. Personality profile among symptomatic and recovered patients with neck sprain injury, measured by MCMI-I acutely and 6 months after car accidents. J Psychosom Res 1997;42:357-67.
- Krafft M. A comparison of short- and long-term consequences of AIS 1 neck injuries, in rear impacts. International IRCOBI Conference on the Biomechanics of Impact. Goteborg, Sweden, 1998:235-48.
- Richter M, Otte D, Pohlemann T, et al. Whiplash-type neck distortion in restrained car drivers: frequency, causes and long-term results. Eur Spine J 2000;9:109-17.
- Kallieris D, Mattern R, Miltner E. Considerations for a neck injury criterion, SAE 912916. Proceedings of the 35th Stapp Car Crash Conference, Society of Automotive Engineers. Detroit, MI, 1991:401-15.
- Lange JE, Voas RB. Nightime observations of safety belt use: an evaluation of California's primary law. AJPH 1998;88:1718.
- Versteegen GJ, Kingma J, Meijler WJ, et al. Neck sprain in patients injured in car accidents: a retrospective study covering the period 1970-1994. Eur Spine J 1998;7:195- 200.
- Evans E. Safety-belt effectiveness: the influence of crash severity and selective recruitment. Accid Anal and Prev 1996;28:423-33.
- Freeman MD, Croft AC, Rossignol AM, et al. Chronic neck pain and whiplash: A case- control study of the relationship between acute whiplash injuries and chronic neck pain. Pain Res Manag 2006;11:79-83.
- Romilly D, Thomson R, Navin F, et al. Low speed rear impacts and the elastic properties of automobiles. Proceedings: 12th International Conference of Experimental Safety Vehicles. Gothenburg, 1989:1-14.
- Warner C, Strother C, James M. Occupant protection in rear end collisions: II. the role of seat back deformation in injury reduction. Proceedings of the 35th Stapp Car Crash Conference, Society of Automotive Engineers. Detroit, MI, 1991:379-89.
- Foret-Bruno J, Tarriere C, Le-Coz J-Y. Risk of cervical lesions in real-world and simulated collisions. 34th AAAM Conference Proceedings. Scottsdale, AZ, 1990:373.
- Olsson I, Bunketorp O, Carlsson G. An in-depth study of neck injuries in rear end collisions. 1990 International IRCOBI Conference. Bron, Lyon, France, 1990:1-15.
- Radanov BP, Sturzenegger M, Di Stefano G. Long-term outcome after whiplash injury. A 2-year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial findings. Medicine 1995;74:281-97.
- Winkelstein B, Nightingale R, Richardson W, et al. Cervical Facet Joint Mechanics: Its Application to Whiplash Injury. 43rd Stapp Car Crash Conference Proceedings 99SC15, 1999:243-52.
- Winkelstein BA, Nightingale RW, Richardson WJ, et al. The cervical facet capsule and its role in whiplash injury: a biomechanical investigation. Spine 2000;25:1238-46.
- Radanov BP, di Stefano G, Schnidrig A, et al. Role of psychosocial stress in recovery from common whiplash [see comment]. Lancet 1991;338:712-5.
- Carlsson G, Nilsson S, Nilsson-Ehle A. Neck injuries in rear-end car collisions: Biomechanical considerations to improve head restraints. Proceedings of the International IRCOBI/AAAM Conference on the Biomechanics of Impacts. Goteborg, Sweden, 1995:277-89.
- Kornhauser M. Delta-v thresholds for cervical spine injury. 1996;SAE Technical Paper Series 960093:1-13.
- Wood DP. Safety and the car size effect: a fundamental explanation. Accid Anal and Prev
- Parmar HV, Raymakers R. Neck injuries from rear impact road traffic accidents: prognosis in persons seeking compensation. Injury 1993;24:75-8.
- Radanov BP, Di Stefano G, Schnidrig A, et al. Cognitive functioning after common whiplash. A controlled follow-up study. Arch Neurol 1993;50:87-91.
- Radanov BP, Sturzenegger M, De Stefano G, et al. Relationship between early somatic, radiological, cognitive and psychosocial findings and outcome during a one-year follow- up in 117 patients suffering from common whiplash. Br J Rheumatol 1994;33:442-8.
- Radanov BP, Di Stefano G, Schnidrig A, et al. Psychosocial stress, cognitive performance and disability after common whiplash. J Psychosom Res 1993;37:1-10.
- Jakobsson L, Norin H, Bunketorp O. Whiplash-associated disorders in frontal impacts: influencing factors and consequences. Traffic Injury Prev 2003;4:153-61.
- Bunketorp O, Jakobsson L, Norin H. Comparison of frontal and rear-end impacts for car occupants with whiplash-associated disorders: symptoms and clinical findings. Proceedings of the International IRCOBI Conference. Graz, Austria, 2004:245-56.
- Carlsson G, Bunketorp O, Jakobsson L, et al. Medical and car impact-related risk factors for the prognosis of WAD. . 47th Annual Proceedings, Association for the Advancement of Automotive Medicine, 2003:598-600.
- Hartling L, Pickett W, Brison RJ. Derivation of a clinical decision rule for whiplash associated disorders among individuals involved in rear-end collisions. Accid Anal Prev 2002;34:531-9.
- Scholten-Peeters GG, Verhagen AP, Bekkering GE, et al. Prognostic factors of whiplash- associated disorders: a systematic review of prospective cohort studies. Pain 2003;104:303-22.
- Svensson M, Aldman B, Bostrom O. Transient pressure gradients in the pig spinal canal during experimental whiplash motion causing membrane dysfunction in spinal ganglion nerve cells [German]. Orthopade 1998;27:820-6.
- Suissa S, Harder S, Veilleux M. The relation between initial symptoms and signs and the prognosis of whiplash. Eur Spine J 2001;10:44-9.
- Watkinson A, Gargan MF, Bannister GC. Prognostic factors in soft tissue injuries of the cervical spine. Injury 1991;22:307-9.
- Krafft M, Kullgren A, Lie A, et al. The risk of whiplash injury in the rear seat compared to the front seat in rear impacts International IRCOBI Conference on the Biomechanics of Impact. Munich, Germany, 2002:203-10.
- Krafft M, Kullgren A, Lie A, et al. The risk of whiplash injury in the rear seat compared to the front seat in rear impacts. Traffic Injury Prev 2003;4:136-40.
- Krafft M. When do AIS 1 neck injuries result in long-term consequences? Vehicle and human factors. Traffic Injury Prevention 2002;3:89-97.
- Sterling M, Jull G, Vicenzino B, et al. Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery. Pain 2003;104:509-17.
- Ryan GA, Taylor GW, Moore VM, et al. Neck strain in car occupants: injury status after 6 months and crash-related factors. Injury 1994;25:533-7.
- Sturzenegger M, DiStefano G, Radanov BP, et al. Presenting symptoms and signs after whiplash injury: the influence of accident mechanisms. Neurology 1994;44:688-93.
- Marshall D. Correlation of cervical lordosis measurement with incidence of motor vehicle accidents. ACO5.3 1996:79-85.
- Decarlo A. Rehabilitation Approach to Treatment of Whiplash- Associated Disorder. JACA Aug 2006.www.acatoday. org/JacaDisplay1.cfm?CID=1826&DisType=Text
- Donohue, A. (2016, Feb 04). Whiplash: More than Standard Neck Pain. Retrieved from: https://www.acatoday.org/News-Publications/ACA-News- Archive/ArtMID/5721/ArticleID/116
- Evans RW, Evans RI, Sharp MJ. The physician survey on the post-concussion and whiplash syndromes. Headache. 1994; 34(5):268-74.
- Owings RP. Government status report-United States, Proceedings 18th International Technical Conference on Enhanced Safety of Vehicles (ESV). Nagoya, Japan, 2003.
- Croft, A.C. (2009) Whiplash and Mild Traumatic Brain Injuries Coronado, C.A.: SRISD Press.
- Galasko CSB, Murray PA, Pitcher M. Prevalence and long-term disability following whiplash-associated disorder. Journal of Musculoskeletal Pain. 2000; 8:15-27.
- Richter M, Otte D, Pohlemann T, Krettek C, Blauth M. Whiplash-type neck distortion in seat-belted automobile drivers. Determination of the trauma mechanism and severity of injury. Orthopade. 1999 May; 28(5):414-23.
- Goldstein M. Traumatic brain injury: a silent epidemic. Ann Neurol. 1990;27(3):327.
- Duff MC, Proctor A, Haley K. Mild traumatic brain injury (MTBI): assessment and treatment procedures used by speech-language pathologists (SLPs). Brain Inj. 2002 Sep; 16 (9):773-87. Woodard MN, Cook JCH, Gargan MF, Bannister GC. Chiropractic treatment of chronic whiplash injuries. Injury 1996;