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. [email protected]
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.
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