Whiplash injuries have been noted since the start of our mechanized society. With the introduction of locomotives and travel by train medical personnel noted patients were complaining of headaches, neck pain, back pain and blurred vision. All of these patients have been passengers on a passenger car that had been hit sharply from behind by another railroad car as it was being coupled. At the turn of the 19th century, this phenomena was called “railway spine”
This same group of symptoms is now called “whiplash” that describes the mechanism of injury involved in rear end collisions. Rear end crashes at low speeds happen every day on our streets and the drivers and passengers of these cars experience the symptoms of whiplash. Crash studies have shown that the acceleration of is actually about two times the acceleration of the car after being hit from behind. This fact explains how injuries can occur with no apparent damage to the vehicle. This condition continues to worsen since car manufactures have built cars to withstand collisions up to 10 miles per hour without visible damage.
This entire phenomena has created a huge health problem since almost 10% of our adult population has now been affected with nearly 6 million collisions each year resulting in half being hurt in these accidents. Fortunately, may injured in these accidents can recover with proper treatment by trained professionals.
A Typical Rear End Crash
You are minding your own business while stopped at an intersection waiting for a green light when someone crashes into your rear fender. The other driver has been talking on his/her cell phone and does not stop in time before slamming into your car. After the initial shock, you look into the rear view mirror and decide to confront the person who hit you and check for damage to you car. You do not find any damage to either car, but you exchange insurance information and decide to call a policeman to report the accident. After arriving on the scene, the patrolman writes his report citing the other driver for failure to take due care and notes that there are no injuries reported and there is no apparent damage.
The above scenario occurs many times every day in a big city and more than 2 million such accidents are reported every year nationwide. Many more are never reported because people are in a hurry and they do not realize that these accidents cause real damage to the ligaments in the neck and the cervical spine. The pain symptoms are usually delayed and can start days, or even weeks later. People that do have pain symptoms are sent to the hospital to check for serious spinal injuries and released.
In the next few paragraphs, you will learn how injuries occur in low speed accidents with no apparent damage to your car.
The details presented are based on actual research and crash tests recorded with a high speed camera and technical instruments connected to the drivers. We monitor ongoing research produced by the Spinal Research Center of San Diego, which is an organization that specializes in whiplash and the resulting trauma. Crash tests are organized each year to train physicians.
Why Did You Get Hurt?
Most rear end accidents occur at speeds under 20 mph, so how can they be that dangerous? The reason is very simple. Detroit makes cars that are built to withstand crash tests that you see on television. Part of the design is to make bumpers withstand low speed crashes of 12 mph, yet the threshold of injury proven by research is only 5 mph. This means that if your car is stopped for traffic then is propelled to a speed of only 5 mph by another car, that is enough energy to produce a whiplash injury.
The accident takes place over the short period of only 300 milliseconds, or less than one-third of a second. The reaction of your torso and head can be described in four phases as follows:
(1) The initial phase starts with the torso moving backward into the seat back with the cervical and thoracic spines straightening. the head rises a few inches because of thee spine straightening and the foot pressure on the brake is probably relaxed.
(2) At this point in the sequence, the vehicle is at peak acceleration, which is 1.5 to 2 times the acceleration of the vehicle. The head has not yet begin to move forward and continues to move backward, and slack may develop in the shoulder harness. The head comes down on the headrest causing tension and shear in the neck, and worse possibly the chance for flexion injury.
(3) In the third phase, the head and neck are at peak acceleration and the vehicle acceleration has stopped. the brake pressure is probably reapplied, which accentuates the deceleration phase and increases the chance for a flexion injury.
(4) In the final phase, full flexion occurs against the restraint system and the occupant experiences high neck tension, torsion and compression. This is the most injurious phase of the whiplash.
FACTORS INFLUENCING SEVERITY OF INJURY
Relative Size of Vehicle behind You: Larger mass vehicles like trucks are extremely dangerous even at very low speeds. Avoid dodging in front of larger vehicles and keep a safe distance between vehicles.
Improper Head Restraint: Most drivers are unaware of the proper use of the head restraint. If the head restraint is too low, the head can easily go over the head rest and cause more serious injury. Adjust the restraint so it is level with your head, or even a little higher.
Awareness: The driver may reduce the impact of the whiplash if he/she can brace themselves before impact. Studies have shown that long term disability is 15 times more likely in unaware motorists. Push yourself all the way back in the seat and brace yourself!
Gender: Research shows that women are injured twice as often as men in low speed rear end collisions. Women also have long-term disability of more than 10% than men, and they generally have a more chronic course.
Head Position: Motorists that have their head rotated at the moment of impact are adversely affected because other ligaments can be torn during the whiplash trauma. Look straight ahead with head against head restraint.
Stature: Shorter drivers are generally at less risk than taller drivers because they are better protected by the seat back and head rest.
Age: Research suggests that children are at less risk than adults. Reports vary between 2/3 and 1/16 the risk. Older people usually require longer healing time, but studies are inconclusive.
MYTHS AND INFORMATION
More Myth and Misinformation Than Fact If you are involved in the legal process for any reason, you will note that most will interpret the facts to suit their own needs and appeal to common sense interpretations that are not based on research or real facts.
“No Crush, No Cash” One myth is that driver injury must be accompanied by vehicle damage. It has been shown that crash damage does not correlate with injury severity and outcome studies confirm this. Car bumpers are built to withstand 12 mph crashes.
Delayed Onset of Symptoms Reflects Badly Defense attorneys will claim that delays in seeking help imply that complaints are fabricated for the purpose of profit. The following points summarize the research on this issue:
- A delay in onset of symptoms is most common
- The highest intensity of pain is seen at 72 hours post-injury
- Shoulder problems develop in half of victims within months
- 50% of disc protrusions become symptomatic within 6 weeks
- Post concussion syndrome can become manifest hours to weeks after injury
- A second wave of symptoms may occur months later
Outcome In spite of overwhelming evidence to the contrary, may physicians believe that whiplash heals spontaneously and without residuals within a period of 6-12 weeks. One survey asking orthopedic surgeons, neurologists, neurosurgeons and family practitioners for their opinions about whiplash concluded that 25% of all groups believed that prolonged symptoms were psychogenic in origin. This is the best evidence that chiropractors are best equipped to deal with the whiplash phenomenon.
Range of Injuries Seen in Whiplash
- Dizziness and otoneurological disorders
- Ligament injuries in cervical spine
- Post traumatic stress disorder
- Visual disturbances
- Brain injuries
- Mentrual disorders
- Spinal cord injuries: Rim Lesions, Internal Disc Disruptions, Disc Protrusion, Hematoma, Scar Formation, Luigament Injury
WHY CHIROPRACTIC CARE?
DC’s have the most experience Chiropractors have the most experience in treating these cases and they provide the broadest range of care. The ongoing research in the area of whiplash is generated almost exclusively by the chiropractic profession.
DC’s have full diagnostic capability Chiropractors can be effective case managers because they can order imaging studies, laboratory tests and elector-diagnostic tests. We work with many specialists in the area to develop the proper diagnostics and treatment.
DC’s provide both spinal care and physical therapy modalities Chiropractors provide not only spinal adjustments, but also deep tissue therapy and physiotherapeutic interventions.
DC’s provide home care, nutrition, exercise instructions advice on daily living Chiropractors provide a full range of advice on how to treat injuries and instruct patients how to take charge of their own health.
Full med-legal cooperation Chiropractors provide assistance in the form of open channels of communication, timely and well written reports and expert testimony when required.