Whiplash basics

April 11, 2013

Mitchell A. Cohn

The term "˜whiplash' actually represents several types of injuries. All the injuries, however, have a common mechanism "“ "whipping" of the head in one direction with a rebound in the opposite direction.

Let's assume your car is stopped, but the car behind you doesn't stop. Hit from behind, your head and neck are rapidly driven backward. This can stretch and even tear ligaments of the anterior spine and other soft tissues of the head, neck, and chest. These injuries tended to be more extensive prior to the advent of the modern headrest, which limits backward motion of the head.

After impact, however, your head rebounds forward. With a seatbelt restraining your chest, this forward whipping (unless adequately blocked by an airbag) strains and tears the tissues at the skull base, back of the neck, and many muscles and tissues attached to the spine and ribs. This can also result in displacement of ribs and upper back and neck vertebrae and disc injuries. Pain, stiffness, and swelling can result.

Luckily, many such injuries heal with little treatment. Sometimes, manipulation (osteopathic or chiropractic) and/or physical therapy can help significantly accelerate the healing process.

Unfortunately, many cases of whiplash have some ill effects that continue well beyond the normal healing phase. Many people complain of pain years after a whiplash injury. These people can have headaches, neck pain, dizziness, upper back pain, and sharp pains in the chest exacerbated by things such as coughing or deep breathing. In many of these cases, standard medical care has had little to no effect. In others, manipulation, such as chiropractic, has had benefit, but which lasts only hours to weeks; then the pain returns.

In most of these cases, x-rays, MRIs, CT scans, and nerve studies can look completely normal, failing to explain the symptoms. Narcotics or other specialized pain medications often also fail to provide significant, sustained relief.

A good hands-on physical examination, however, can often reveal the cause(s), which cannot be visualized with technological tests. Ligaments or tendons with relatively minor damage can still be the source of great pain. Connective tissues, which are twisted, injured, impinged, and impede blood or lymphatic flow can also lead to chronic swelling and sustained pain. Chronically spasmed muscles "“ which cannot be imaged by technological means "“ can be a primary source of continuous pain or can even "pinch" nerves, providing another source of pain.

For such chronic pain, examination by an osteopathic manipulative medicine specialist may prove fruitful. These doctors are trained, like chiropractors, to find boney malalignments, but unlike most chiropractors, also emphasize the diagnosis and treatment of more subtle soft-tissue injuries. As a full-fledged physician, just like your MD, however, these specially trained doctors of osteopathic medicine (D.O.s) also have other treatments and tools available to them, which your chiropractor may not have.

If nothing else has worked for you, or if you would rather not wait and wade through the morass of standard medical and chiropractic care, consider seeing a properly trained osteopathic manipulative medicine doctor.

Dr. Cohn is employed at the Born Preventive Health Clinic in Grand Rapids, Michigan, where he is focused on treating acute/chronic pain and injury via osteopathic manipulation and prolotherapy. Dr. Cohn regularly blogs on medical issues and other issues of global and personal interest.

Originally published Apr 11, 2013 10:00:53 AM.