Whiplash is an extremely common in injury to the neck (cervical spine) that we see and treat at Vital-Balance. It can be classified generally as a cervical spine sprain/strain. Most of us think of this injury as a consequence of a car accident, as many times it is. It also includes any trauma (usually sports or falls) or accident that whips the head in any direction causing injury to the soft tissues surrounding the cervical spine. The tissues being muscles, tendons, ligaments and possibly, the discs in the neck. If not addressed properly in the beginning, it can cause chronic pain and disability.

The symptom pattern for this injury can be anything from pain in the neck to low back pain (there is a mechanical relationship between the neck and low back). Below are the common symptoms:

  • Increased irritability, fatigue, difficulty sleeping and difficulty concentrating
  • Numbness in arm or hand
  • Neck stiffness or decreased range of motion
  • Tingling or weakness in the arms and/or hands
  • Increased irritability, fatigue, difficulty sleeping and difficulty concentrating
  • Numbness in arm or hand
  • Neck stiffness or decreased range of motion
  • Tingling or weakness in the arms and/or hands

Below is a chart that shows the referral pattern for the spinal level that is most injured. We call this the “sclerotogenous referral” patterns.

After a trauma of this kind, patients are often given a collar to wear around their neck. At Vital-Balance, we do not recommend this to patients unless they are in extreme pain without it or if they are not able to hold their head up. Other than those circumstances, it is best to avoid using a collar. The reasoning is that studies have shown the use of collars actually weakens (atrophies) the muscles of the neck. In the short term it actually impedes the healing process and raises the chance of long-term pain and disability related to the injury. We begin addressing this condition with a physical examination (orthopedic and neurologic) by a health care professional and to have some imaging (preferably X-ray with dynamic studies or MRI) to access the extent of the injury.

If there is no major instability (ligament damage) or peripheral symptoms (such as pain, numbness or weakness in the arms and hands) then the management of the injury can begin without further evaluation. Vital-Balance recommends the initial stage of pain and inflammation should be managed with cryotherapy (ice) and Deep Oscillation Therapy for the first three days. This should be done by applying the ice (wrapped in something to prevent an ice burn) to the area for 20 minutes every 2-3 hours each day and seeing a physiotherapist that utilizes Deep Oscillation once a day for those three days. Wrapping the neck with ice, being very aware of not going past 20 minutes and being disciplined about the application are the keys to cryotherapy home care. It’s important to keep in mind that going past 20 minutes can cause more inflammation.

After the initial 3 days, cryotherapy can be decreased in frequency and deep oscillation should be reduced to 4-5 times a week for 4 weeks. Therapy can begin that includes, but is not limited to:

  • Mild range of motion exercises and stretching to patient tolerance.
  • Chiropractic adjusting above and below the primary injury area, starting with an instrument and progressing to manual.
  • Use of a spinal orthotic in the proper area of the neck to reinforce spinal structural integrity and facilitation of proper ligament healing.
  • Follow-up x-ray to access proper healing and healthy spinal structure.

4 weeks of the above therapy we typically see the symptoms improve by between 75-90%. At this point a physical re-evaluation and follow-up imaging should be performed to access the objective improvement of the patients’ condition. If the spine is deemed to be structurally stable and the healing process has improved the symptoms to 75-90%, then strengthening exercises can begin. If the structure is still compromised, it would be recommended to fully correct it so that neck degeneration does not accumulate over time. What usually happens is that when the symptoms dissipate and the structure is still compromised, people think their neck is now healthy and recovered. It is not. The structural compromise will lead to the slow degeneration of the neck and will lead to long-term pain and disability.

There have been countless times in my 15 years of practice when patients have come in with major cervical spine degeneration. 90% of these patients had a Whiplash trauma to their neck that was not properly diagnosed or rehabilitated. Then years down the line they developed insidious onset of pain and disability. Because this process happens gradually, they did not think it was serious. By the time they usually look for help, major degeneration has manifested. This makes rehabilitation harder and more expensive because it takes more time and effort. Look at it in the context of dental tooth decay. When there is the beginning to tooth decay present and nothing is done to address it, over time, more damage accumulates. The same thing happens in the spine when the structure is compromised and not treated. Remember, spinal health is a great indicator of overall health. Therefore, fully rehabilitating the spine when there has been a Whiplash injury to the neck it is very important for overall and future health.

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