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Auto crashes can cause trauma to the neck area known as whiplash. Treatment can prevent long term problems.

Whiplash: Beyond Relief of Pain

By Rick Allen, DC

Crash! In an instant your life is turned upside down. You are hurt. You have been in an motor vehicle collision. You are suffering from cervical acceleration/deceleration (CAD) injury, commonly called a "whiplash." You want relief from pain! If you are smart and thinking long-term, you also want to go beyond just the relief of pain. You need to completely restore the healthy function of your injured neck and back. Dr. Allen has taken post-graduate courses in rehabilitation for accidents and spinal restoration and can help you achieve that goal. He is referenced on the Injury Resources web site, which has an outstanding review of the biomechanics and devastating effects of whiplash.

Whiplash diagram

Michael Melton of Injury Resources graciously supplied the illustration of the spine being whipped that is used on this web page. I have a copy of an excellent video they created this past year that highlights new information about the abnormal motion of the neck that takes place during whiplash.

I recommend you visit the web site at http://www.injuryresources.com/. I further recommend that, if you have been injured in a collision, you find a local chiropractor for treatment that includes comprehensive rehabilition of the muscles, joints, connective tissue, and nervous system of the neck and back, returning it to complete, healthy function.


Question:

I have been having back pain after a car accident and a friend suggested I go see a chiropractor. What can I expect from the initial visit, and what can a chiropractor do for me?

Answer:

Animated whiplash injury

Doctors of Chiropractic are trained to provide natural, hands-on, non-surgical, drug-free care. Our focus is usually on helping your muscles, joints, and nervous system operate at peak efficiency. This helps your body stay healthy and cope with day-to-day health challenges. In addition, many chiropractors are specially trained in the diagnosis, treatment, recovery and rehabilitation of the acceleration/deceleration (CAD) injuries you typically sustain a car crash: the strains and sprains of a "whiplash." A recent study (1) found that even in long-term, chronic cases, which are more difficult to treat than acute ones, 93% of whiplash patients improve with chiropractic care. When treatment begins within the first few days following the collision it is reasonable to expect even better results. Delay in getting professional chiropractic care may result in permanent scar tissue and aberrant movement patterns being laid down.

When you are hurt in a car crash your first desire is relief from pain! You may think that rest, ice, pain killers and muscle relaxant drugs are all you need. Wrong! If you are smart and thinking long-term, you also want to go beyond just the relief of pain. You need to completely restore the healthy function of your injured neck and back. Make sure the chiropractor that you select has taken courses in the rehabilitation of soft tissue injuries and the restoration of normal spinal curves.

On your first visit, your chiropractor should take a careful history of the collision and the injuries you sustained. Be sure your chiropractor listens and carefully notes what you say. Your chiropractor will perform a physical exam to find the cause of your problem. Because of the severity of whiplash trauma, your chiropractor will probably take x-rays of your neck and back. If there are unusually severe problems, such as unremitting pains shooting down the arms or legs or muscle weakness, your chiropractor may require additional imaging (MRI or CT scans) and, possibly, additional laboratory tests. Either on the first or second visit, your chiropractor will review the examination findings and outline a treatment program.

If your injury is acute and there are no contraindications, your chiropractor will start some immediate care to bring down swelling, probably using gentle massage and, if tolerated, adjustment, electrical stimulation, and ice. Your chiropractor may also give you anti-inflammatory herbs, such as white willow, and enzymes, such as bromelain. These have less side effects than ibuprofen, Advil, and other non-steroidal anti-inflammatory drugs (NSAIDs). You will be advised to ice the area about 10 minutes every hour for the first one to three days to help bring down any swelling. Extra rest, plenty of water (at least 6-8 glasses/day) and good nutrition are vital - be sure to give your body everything it needs to repair itself as quickly and thoroughly as possible.

The initial visit will typically last about 1 to 1 1/2 hours. Thereafter, visits are typically about 20 to 40 minutes long. Treatment may be daily during the first week of care for an acute injury and then drop down to 3 times per week for another weeks. Treatment during this next phase will focus on restoring proper soft tissue and joint motion. If the abnormal, traumatic forces of the whiplash have altered the curve of your neck, your chiropractor may also start you on a "neck pump" or traction system to return the curve to its normal shape.

As you progress, your chiropractor will be able to introduce progressively more strenuous stretches and exercises. To maintain the improvements, your chiropractor will recommend ongoing stretches, exercises, and, if necessary, continued use of a "neck pump" or traction system. As you progress, your chiropractor will also be able to reduce the frequency of care. Overall, care will probably last from 2 to 4 months, but could continue for up to a year, depending upon the severity of the injury, as the body completes the remodeling and strengthening phase. This is determined on an individual basis.

In addition, because whiplash is a complex issue involving many factors your chiropractor may choose to involve other specialists, such as medical doctors, psychologists, massage therapists, physical therapists, exercise trainers. One recent study (2) that focused on the cognitive and psychological factors made it clear that a multimodal approach to whiplash pain is most effective. When this is recognized, treatment progresses more rapidly.

References:

Web sites

An excellent reference on this topic is the Injury Resources web site, http://www.injuryresources.com/. It has an outstanding review of the biomechanics and devastating effects of whiplash, plus a search feature to help you locate a professional, including Doctors of Chiropractic. They have recently released an excellent video that highlights new information about the abnormal motion of the neck that takes place during whiplash. I make sure every patient sees this video. I highly recommend you visit this web site.

Another good resource is the web site of the Spine Research Institute of San Diego, http://www.srisd.com/. This web site is primarily for doctors wishing to learn more about the research and products available from Dr. Arthur Croft, who is a pioneer in the field of injuries resulting from low-speed crashes. Dr. Croft has also produced an excellent video, "Whiplash," that I also make sure my patients watch.

Lastly, our links page and articles and publications page have additional links on this topic.

Literature:

(1) Woodward MN, Cook JCH, Gargan MF, Bannister GC. "Chiropractic treatment of chronic 'whiplash' injuries." Injury: International Journal of the Care of the Injured 1996;27(9):643-645.

(2) Provinciali L, Baroni M, Illuminati L, Ceravolo MG. "Multimodal treatment to prevent the late whiplash syndrome." Scandinavian Journal of Rehabilitation Medicine 1996;28:105-111.

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