Welcome to the first installment of our comprehensive three-part series on Whiplash Associated Disorder (WAD), a condition often misunderstood but all too common following vehicular accidents.
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At our clinic, we've honed a definitive process that delivers a success rate of over 90% in treating WAD injuries. With over 30 years of experience and a track record of successfully treating more than 25,000 patients, we bring both expertise and precision to every case.
In this series, we'll guide you through everything from basic information to cutting-edge diagnostic techniques, innovative treatment processes, and functional exercise programs. Our meticulous approach extends beyond clinical care—we provide concise and thorough documentation, including medical-legal reports, and bring our extensive experience as expert witnesses to the table.
Whether you're dealing with the immediate aftermath of an accident or navigating the complexities of long-term recovery, we're here to help you achieve the best possible outcome.
Article Index:
The Rapid Dynamics of Whiplash Injury
We’ll begin our discussion by exploring the complex motions involved in whiplash injuries. At the heart of whiplash biomechanics is a rapid, almost seesaw-like movement between hyper-extension and hyper-flexion. This violent motion unfolds in a mere 250 milliseconds—so quickly that those involved in a rear-end collision have no time to react or brace for impact.
To better understand the dynamics at play, we can break down the whiplash sequence into three distinct stages: The Initial Impact, The Neck’s Over-Extension, and The Neck’s Flexion. Each stage contributes to the potential for injury, setting the stage for the challenges that follow.
Stage 1: The Initial Impact
Picture a rear-end collision, the common trigger for whiplash. As the trailing vehicle slams into the one ahead, a sudden force propels the front car forward. The car seat, firmly attached to the vehicle, moves with it, but the driver, due to inertia, initially remains stationary.
In a split second, the seat drives into the driver’s lower and mid-back, thrusting the lower neck forward. This abrupt motion disrupts the natural curves of the neck (lordotic) and mid-back (kyphotic), forcing the cervical spine into an unnatural S-shape.
This stage is where significant damage can occur. The neck, contorted into this abnormal posture, causes the small neck joints, or facet joints, to hyperextend. This excessive movement can tear the facet capsule ligaments, create bone-on-bone contact, and lead to internal joint bleeding. The extent of joint damage often depends on the collision’s severity.
Stage 2: The Neck's Over-Extension
In this stage, the sudden forward momentum of the car violently whips the driver’s head backward, sometimes even beyond the headrest—particularly if it’s poorly positioned or designed. This powerful motion places immense strain on the soft tissues and joints at the front of the neck as they struggle to absorb the force of the head’s backward launch.
Stage 1, Stage 2 - The Damage
The initial impact and subsequent over-extension can wreak havoc on various parts of the body. Multiple structures are at risk during these critical moments of a collision, including:
Facet Joints & Capsules
The facet joints in the neck are small but vital, responsible for bearing weight and controlling movement. In a whiplash event, these joints and their protective sheaths, known as facet capsules, are often injured, leading to long-term neck pain.
Ligament Injuries
The Anterior Longitudinal Ligament (ALL) runs along the front of the vertebrae and prevents excessive backward movement of the head. Damage to this ligament during whiplash can destabilize the neck, potentially causing ongoing pain and instability.
Longus Colli Muscle
This deep neck muscle, extending from the top vertebra (C1) to the mid-upper chest (T3), is commonly injured in whiplash incidents. Injury to the Longus Colli can disrupt motor control, muscle tone, and posture, contributing to the challenges of recovery.
Platysma Muscle & Facial Nerve
The Platysma muscle, which lies over the sternocleidomastoid (SCM), stretches from the neck and upper chest to the shoulders and collarbone. Damage to this muscle, controlled by the Facial Nerve, can lead to tingling sensations across the face and upper chest.
Scalene Muscles
The Scalene muscles, located on the sides of the neck, are crucial because they surround the brachial plexus—a network of nerves—and the subclavian artery. Injury to this area can cause Thoracic Outlet Syndrome (TOS), leading to nerve or blood flow issues that extend down to the wrist and fingers.
Sternocleidomastoid Muscle (SCM)
The SCM is vital for neck movement, including flexion and rotation. It is vulnerable to compression injuries, which can cause occipital neuralgia—a condition marked by chronic pain in the upper neck, back of the head, and around the eyes. Damage to the Spinal Accessory Nerve, which controls the SCM and Trapezius muscles, can also weaken the neck and shoulder.
Stage 3 - Hyper-Flexion
In this final stage, the neck experiences a violent forward bending known as hyper-flexion, as the driver’s seat springs back, propelling the driver forward with intense force. Imagine this moment as a tightly wound spring releasing its energy. While the seat thrusts forward, the head, still moving backward, is suddenly whipped forward.
In an instant, both the torso and head are flung forward with such force that, without seatbelts, occupants could be thrown into the steering wheel or even ejected through the window, depending on the severity of the collision.
This rapid motion causes the spine to bend sharply forward, often exceeding its natural limits. This intense movement can result in significant injuries to the neck, mid-back, shoulders, and lower back.
Regions at Risk during Hyper-Flexion
During this hyper-flexion phase, various parts of the body—joints, soft tissues, muscles, and ligaments—are subjected to extreme stress, leading to potential injuries.
Joint Injury
Facet Joints: As previously mentioned, facet joints in the neck are particularly vulnerable during whiplash. They endure significant strain during both the hyper-extension and hyper-flexion phases, making them common sites of injury in whiplash incidents.
Soft Tissue Injury
Studies show that MRI scans frequently detect damage to the muscles at the back of the neck in whiplash cases. Patients with persistent neck pain often have MRI results revealing fat deposits within these rear neck muscles (cervical extensors). This fat infiltration is associated with sensory, motor, and physical impairments in those suffering from long-term whiplash-associated disorders (WAD).
The Suboccipital Triangle
Located at the base of the skull, the suboccipital triangle is defined by three critical muscles: Obliquus Capitis Superior, Obliquus Capitis Inferior, and Rectus Capitis Posterior. These muscles are rich in neurological receptors that play a vital role in maintaining posture.
Injuries to this area impact more than just the muscles, ligaments, and tendons; they also affect crucial neurological structures like Golgi tendon organs, muscle spindles, and joint receptors. These structures are essential for spinal stability, and damage to them can lead to persistent issues.
The suboccipital muscles, particularly, have a high density of muscle spindle fibers, which provide postural information to the central nervous system. For example, the Inferior Oblique muscle has 242 spindles per gram of muscle tissue—much higher than the 1.4 spindles found in the large Latissimus Dorsi. This high spindle density highlights the importance of the suboccipital region in posture and coordination.
When these structures are damaged, it can lead to coordination problems like gait disturbances and ataxia. In whiplash injuries, the suboccipital nerve, which innervates these muscles, is often compressed, particularly at the Superior Oblique muscle, contributing to these issues.
Semispinalis Muscle
The Semispinalis Muscle, particularly its capitis and cervicis components, plays a crucial role due to its location directly above the greater occipital nerve. Compression of this nerve is a common cause of cervicogenic headaches, frequently seen after a whiplash injury.
These headaches, known as occipital neuralgia, C2 neuralgia, or Arnold’s neuralgia, are marked by persistent pain in the upper neck, back of the head, and behind the eyes. Studies reveal that approximately 85% of whiplash patients develop trigger points in the semispinalis capitis muscle, highlighting its significant role in these injuries.
Splenius Muscle
The Splenius Muscle, which includes the capitis and cervicis portions, is essential for head extension, as well as lateral bending and rotation of the neck. Due to its key role in neck movements, it is highly susceptible to injury during whiplash incidents.
Injuries to the Splenius Muscle can significantly impact neck mobility and increase pain, making it crucial to accurately diagnose and treat these injuries following whiplash. Proper care is essential for optimal recovery and maintaining neck function.
Multifidus Muscle
The Multifidus Muscle, located deep within the spine’s posterior, is frequently injured in car accidents, with damage extending from the neck down to the lower lumbar region.
Recent research indicates that this muscle can increase the strain on the facet capsular ligaments during a collision. Since damage to these facet capsules is often linked to ongoing neck pain, injuries to the Multifidus Muscle in a car crash can contribute to long-term discomfort and chronic neck issues.
Trapezius Muscle and Nerve Impingement
When the upper fibers of the Trapezius muscle are injured, they can compress the third occipital nerve, which runs beneath the muscle and ends at the lower part of the head (occiput). This nerve compression can lead to occipital neuralgia, a type of chronic headache.
It's important to note that we've only covered some of the common anatomical injury sites. We haven't yet discussed injuries to the jaw, limbs (such as the elbow, wrist, hand, knee, ankle, and foot), or peripheral nerve entrapments that can occur in motor vehicle collisions.
In the third part of "Resolving Whiplash Injuries," we will delve into common symptoms, the process of physical examination, and the classification of Whiplash Associated Disorders (WAD).
Conclusion - Chapter 1
As we conclude this first installment of our three-part series on Whiplash Associated Disorder (WAD), we’ve explored the intricate biomechanics of whiplash and the extensive damage it can inflict on various neck structures. From the violent motions of hyper-extension and hyper-flexion to the significant impact on muscles, ligaments, and nerves, whiplash is a complex condition that requires precise diagnosis and expert care.
At our clinic, with over 30 years of experience and a success rate of over 90%, we have honed our approach to treating WAD effectively. Our comprehensive process addresses every aspect of these injuries, ensuring optimal recovery and the restoration of function.
Stay tuned for the next part of our series, where we’ll dive deeper into the symptoms, physical examination process, and classification of WAD. We’re committed to helping you navigate the path to recovery with the highest level of care and expertise.
Note: References at the end of Chapter 3
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 90%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
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