What Is Whiplash?
Whiplash refers to injury to the cervical spine caused by rapid acceleration-deceleration. This type of injury is most commonly associated with road traffic accidents, most often rear-end collisions. However this can also occur from sports, particularly contact sports such as rugby and football, or accidents during other activities such as skiing. The rapid change in forces on the body causes the neck to get “whipped” back and then aggressively forward which can produce direct injury to the tissues in the cervical spine. In addition to direct tissue injury there can also often be longer term neurological issues that may mimic concussion type symptoms. Concussions and whiplash can occur as part of the same injury in some cases.
How Whiplash Affects the Cervical Spine
During a whiplash injury there will be uneven loading through the structures in the cervical spine, this affects the segmental levels in different ways. The mid-lower cervicals (C3-C7) will go through hyperextension followed by hyperflexion; this increases the likelihood of injury to the discs and facet joints. The upper cervicals (C1-C2) have a higher degree of mobility since there is no disc between them, this leaves them vulnerable to shear forces which can produce ligament injuries and misalignment of the joints at the cranio-cervical junction.
Ligament Injuries and Cervical Instability
The most common ligaments affected by whiplash are the anterior longitudinal ligament, alar ligaments and transverse ligament. This can lead to micro-instability depending on the level of damage to the ligaments. In extreme cases where the degree of force from the whiplash is very high, ligaments can rupture which can cause cranio-cervical instability (CCI). CCI is less common than other clinical presentations but the symptoms can be similar to or the same as that of a fixed misalignment. Symptom onset from the ligaments may be delayed depending on how the muscles of the neck have been affected.
Muscle Imbalances Following Whiplash
Following a whiplash it is common for the superficial muscles such as the SCM, upper trapezius, and levator scapulae to become overactive. This will often produce pain or stiffness for days-weeks following the whiplash injury. In addition to this the deep neck flexors are often inhibited, which can exacerbate instability and postural distortion.
Facet Joint Injury and Chronic Neck Pain
One of the biggest contributors to neck pain following a whiplash is injury to the facet joints. The chronic neck pain from the facet joint injury is often worse when looking up or rotating the neck, or with prolonged sitting. Pain can also refer to the head, shoulders, or between the shoulder blades. Commonly there will be strain to the joint capsules, which then results in altered proprioception.
Neurological Symptoms and Delayed-Onset Complications
This is a big contributor to longer term complications such as delayed onset of dizziness or imbalance, this may not show up until weeks or months after the initial injury. These issues stem from disruption to the cervical spine’s position sense system, this means the brain no longer gets proper information about where the neck and head are in space. Symptoms can also include poor balance, visual disturbances, brainfog, difficulty concentrating, motion sensitivity. These neurological effects can be present even in patients with normal scan results.
Disc Injuries and Degenerative Changes After Whiplash
Following a whiplash, if symptoms persist, patients will often be referred for an MRI scan to assess the cervical spine. A common finding is injury to the discs, most often at C4, C5, C6, C7. Usually disc injuries will accelerate degeneration, resulting in loss of disc height. This can then lead to other issues such as irritation of nerve roots which can cause numbness, tingling, or weakness in the arms.
Long-Term Postural and Spinal Effects
These effects are not always immediate and will sometimes show up years after a whiplash due to the degenerative changes to the spinal discs and facet joints over time. These issues can cause, and be further exacerbated by, long term postural compensation such as forward head posture, loss of cervical lordosis (military neck), and altered thoracic spine mechanics, often causing chronic neck pain, back pain, shoulder pain.
Why Whiplash Should Not Be Ignored
Whiplash should not be ignored, not only because of the short term effects, but because of the long term consequences. Many patients that we see have often had a whiplash type injury at some point in their life. Often if it seems minor at the time it gets ignored and forgotten about once the initial pain subsides. However, whiplash has the potential to cause lasting damage to the spine which can have long term consequences to the functioning of the nervous system, contributing to other conditions which develop months or years later.
Assessment and Chiropractic Care for Whiplash
If you have suffered a recent whiplash regardless of the intensity, but particularly in more intense injuries, you should consider being assessed by an upper cervical chiropractor. The examination will include both structural and neurological testing, to evaluate the level of injury and the structures involved. CBCT imaging (3D x-ray) is highly recommended as it is the current gold-standard for assessing the bony structures in the cervical spine in a weight-bearing position. Upper cervical chiropractic is designed as a precision approach to restore proper spinal biomechanics, and preserve normal nervous system function. This is a specific and non-invasive approach to helping recover from whiplash.
