Car accidents|blunt trauma|whiplash of the spine

Rear-ended car accidents are common and the incidence of whiplash injuries is in the range of one million annually in the United States1. Due to the backward movement of the head upon the neck followed by a forward movement of the head, a whiplash injury often results in nerve related myofascial pain.
Patients may suffer from neck, mid-back, and lower back pain and pain down the upper and lower limbs in various combinations. Often, these patients with whiplash injuries sure to car accidents and other trauma also suffer from muscle contraction headaches, temporomandibular joint pain and a clicking noise in the jaw joint with jaw movements, dizziness, unsteadiness, tingling and numbness and coldness in the fingers. Patients can also suffer from post-traumatic fibromyalgia resulting in total body pain. Soft tissue trauma to the neck can result in an increased incidence of fibromyalgia compared with other injuries. There may also be a post-concussion syndrome leading to memory deficits and concentration problems.

Although symptoms may dissipate within three months of the car accident, 30% of the patients may continue with chronic neck symptoms and 10% of the patients may have chronic headaches. 6% of the patients may not be able to return to work even after one year post car accident.

Although patients may complain of pain predominantly on one side, careful neuromusculoskeletal examination will reveal tenderness in many muscles on both sides of the spine, and in both upper and lower limbs with accompanied restriction in range of motion in many joints. Sluggish tendon reflexes may be present.

The most motion in a whiplash injury from a car accident occurs at the C5-C6 vertebra level following 5g acceleration but force is also distributed to the C4-C5 to C7-T1 levels depending on the intensity of acceleration2. Cervical spine x-rays may show straightening of the cervical spine due to paraspinal spasm. CAT scan and MRI scan are often performed to rule out presence of herniated cervical disk and nerve root impingement. Commonly the facet joints are involved. These tests may be normal since in a whiplash, the injury is to multiple level bilateral spinal nerve roots.

The nerve roots in trauma induced whiplash injuries become irritated from being stretched, distorted, kinked or transiently compressed against bone either at the level of the disc or more outward away from the center of the spinal canal in the region of the foramen through where the nerve roots exit. Whiplash type injuries of the nerve roots can occur also with falls, sudden recoil type movements from lifting injuries or with any sudden jerky and forceful movements to the head, neck and lower back.
Quantitative electrodiagnostic studies which reveal the extent of the nerve damage is most useful for determining the outcome for recovery. The prognosis for recovery is dependent on the number and extent of nerve roots involved, presence of nerve root impingement, age of the patient, associated degree of underlying degenerative spine disease, multiplicity and diffuseness of symptoms and the initial high pain levels on presentation, etc. These nerve related factors are more important than the speed or severity of collision or the extent of damage to the vehicle but these factors do contribute to the amount of nerve damage induced.

Routine treatments include physical therapy with use of cold modalities in the acute condition and heat modalities such as hot packs after the first 24-48 hours. Medications will include anti-inflammatory medications, pain pills and muscle relaxants. Mobilization of the tissues using massage, TENS unit and gentle active range of motion can be useful. If cervical collars are used, the narrow portion of the collar must be kept in the front. As a general principle, the use of the cervical collar should be limited to two hours on and two hours off. A good cervical pillow that supports the neck well during sleep is essential. Patients must lie on their back to sleep. They must not sleep on their sides or on the abdomen. They must not place pressure on their arms and must avoid sleeping with their arms under the pillow or head.
Acute nerve related muscle pain is most responsive to eToims Twitch Relief Method with treatment directed towards muscles supplied C2 through C8 nerve roots with emphasis on muscles supplied by the C6 and C7 nerve roots and the trapezius muscles supplied by the C4 nerve root. The entire spine from neck to the lower back needs to be treated. After controlling the neck pain, treatments also have to be directed to the muscles supplied by the lumbosacral nerve roots.

1. Evans RW. Some observations on whiplash injuries. Neurologic Clinics. 10(4):975-97, 1992 Nov.
2. Ito S. Ivancic PC. Panjabi MM. Cunningham BW. Soft tissue injury threshold during simulated whiplash: a biomechanical investigation. Spine. 29(9):979-87, 2004
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