Whiplash and Accident
Long term damage to the spine and head is
especially common in auto accidents. Doctors of chiropractic
have for years recognized the need for neuro-structural integrity
in these areas and that most victims of automobile injuries
do not fully recover under medical care; they may continue
to have problems for years after the accident. This is especially
the case of those who have whiplash and concussion injuries.
This of course underscores the need for chiropractic care
for accident victims. New medical terms acknowledging the
chronicity and incomplete healing of accident victims have
recently arisen. The terms used are: Postconcussion Syndrome
(PCS), Whiplash Syndrome (WS), Post Whiplash Syndrome (PWS),
Mild Traumatic Brain Injuries (MTBI), and mild head injury
(MHI).
The chiropractic profession owes a debt to Arthur Croft,
DC of San Diego, California who taught of, and researched
the need for the caring of patients who had the above conditions
years before these conditions were acknowledged in the medical
literature.
The detection and management of pediatric whiplash
injuries. Ben Eliyahhu, DJ Proceedings of the National Conference
on Chiropractic & Pediatrics, Octo 1993, Palm Springs,
CA, November 1993, Palm Beach, Florida.
This paper presents
case studies on the detection and management of pediatric whiplash
injuries.
Case study one.
A six-year-old female was involved in a rear
end collision while sitting in the front seat. She and her
mother were taken to the hospital where the mother was examined,
x-rayed, collared and released. The child was briefly examined,
the mother was told that the child was okay and was discharged.
The child complained to the mother of headaches and neck
stiffness, was taken to the pediatrician who said the child
was fine. The complaints persisted and the mother brought
the child to the chiropractor. Infrared thermography scan
disclosed abnormalities of the head, neck and upper extremities.
Radiographs revealed ligamentous instability, cervical subluxations
and myospasm. The mother said that the child began to experience “black-outs” and
a neurologist diagnosed Petit Mal seizures. The child improved
under medical and chiropractic care and often said that the
adjustment gave her the greatest relief and she would often
ask her mother to bring her to the chiropractor.
Case study
two
An eight year-old boy was involved in an auto accident and
complained that his leg and head hurt. Doctors in the emergency
room said he was fine. Infrared thermography scans of the
child revealed abnormalities due to vertebral subluxations
and spinal biomechanical insult. Post adjustment scans showed
a return to normal and correlated to the child’s symptomatic
improvement.
A symptomatic classification of whiplash injury
and the implications for treatment. Khan S, Cook J, Gargan
M. Bannister G The Journal of Orthopaedic Medicine 21[1]
1999.
The goal of this paper was “to determine which patients
with chronic whiplash will benefit from chiropractic treatment.” 93
patients were interviewed in “structured telephone
interviews.”
From the conclusion: “Whiplash injuries
are common. Chiropractic is the only proven effective treatment
in chronic cases.”
A multiple parameter assessment of
whiplash injury patients undergoing subluxation based chiropractic
care: a retrospective study. McCoy HG and McCoy M. Journal
of Vertebral Subluxation Research Vol 1, No 3, 1997 Pp. 51-61.
From
the Abstract:
A retrospective study was conducted of 57 subjects
who had experienced an acceleration/deceleration (whiplash)
injury….
With subluxation-based chiropractic care, the subject population
showed significant increases in cervical flexion and extension,
muscle strength, and a decrease in the neck pain disability
index. Atlas/axis and Jackson’s angles varied inversely
from presentation to MCI (maximum chiropractic improvement)…longer
durations of care were correlated with the lower ratios (fewer
adjustments/week), while shorter durations of care to reach
MCI were correlated to higher ratios (average adjustments/week).
Post
whiplash syndrome. Bogduk, N. Australian Family Physician
Vol. 23, No. 12 December 1994 Pp. 2303-2307.
This article, from
one of the world’s leading anatomists
and cervical spine researchers is an excellent paper for
the study of whiplash. His observation of the limitations
of the medical approach to whiplash: “The treatment
of whiplash is based on fashion and faith” (p.2306)
underlies the importance of using chiropractic first before
resorting to drugs and surgery. In discussing the “core
of patients who do not recover”, Professor Bogduk describes
medicine’s failure to help these people as the fault
of a “system that denies the problem, discourages research
and puts the blame for the problem on the patients.” (P.
2307).
From the introduction:
Whiplash is a poorly understood problem
that attracts accusations of malingering and compensation neurosis.
Recent research has revealed a variety of occult lesions that
can be responsible for the chronic pain and suffering after
whiplash; however, appropriate diagnostic techniques are still
either lacking or not widely used. While there are reasonable
options for acute management there is no proven therapy for
the chronic situation.
Course of attention and memory after
common whiplash: a two-year prospective study with age, education
and gender pair-matched patients. Di Stefano G and Radanov
BP Acta Neurol Scand 1995; 91: 346-352).
Comment: Some studies
have documented attention deficits in symptomatic whiplash
patients as well as memory loss while other studies have not.
This paper reviews the value of the studies done by others
in this field and found them to have designs that were “insufficient.” The chiropractic
interest in this subject is more than that of the neuromusculoskeletal
condition of whiplash, but of the brain function that is
affected by presumed subluxations of the cervical spine.
This work should be read in concert with Gorman’s and
Zhang’s papers in the Improved Brain Function section
of this report.
From the abstract:
Attentional functional and memory of common
whiplash patients were evaluated during the first two years
after experiencing injury....All (117) patients had a similar
socioeconomic background, all being injured in automobile accidents
and fully covered by insurance plans. Two years following initial
trauma, 21 patients remained symptomatic.
When compared with
matched controls, the 21 symptomatic patients had no memory
impairment but did have attention functional (difficult of
follow-up of tasks with divided attention).
Late outcome of
mild head injury: results from a controlled postal survey.
Bohnen N, Vanzutphen W, Twijnstra A et al. Brain Injury 8(8):
701-708, 1994.
In this study, a postal questionnaire was sent
to a population of (mild head injury) MHI patients 1 to 5 years
post accident and a control group to measure subjective and
psychological complaints, distresses and discomforts often
mentioned by MHI patients. Interestingly, the distresses and
symptoms of the MHI group were indistinguishable from the non-MHI,
however the MHI group’s symptoms were significantly
more severe.
Comment by Dr. Koren: One proposed mechanism of
action is that pre-existing subluxation patterns are exacerbated
as a result of trauma. In other words, the patients were
more “in
pattern” or their subluxations were more severe as
a result of their accident.]
The conclusion from the abstract
was interesting: “The
results support the hypothesis that MHI may not ever be completely
reversible.”
Post-traumatic headache. Journal of Neuropsychiatry
and Clinica. Neuroscience 6(3): 229-236, 1994.
From the abstract:
The authors review post-traumatic headache
(PTH). The most common symptom following head injury, PTH is
paradoxically most severe after mild head injury. Although
most cases resolve within 6-12 months, many patients have protracted
or even permanent headache. Because PTH generally has no objective
findings, it is often controversial whether the symptom is “real,” “psychogenic,” or “fabricated.” Despite
persisting beliefs by physicians, attorneys, and insurers
that PTH resolves upon legal settlement, recent studies have
shown that “permanent” PTH is usually present
several years after a legal settlement. Often PTH affects
family life, recreation, and employment. Patients require
education and support as well as appropriate evaluation and
treatment.
Visceral diseases as a sequela of brain damages.
Vestnik Rossiiskoi Akademii Meditsinskikh Nauk (1): 12-15,
1994.
From the abstract:
In the period following mild closed brain
injury, diseases of the viscera and the body’s systems
develop as a result of diffuse lesions in the brain regions.
Experimental studies have shown that this is associated with
impaired self-regulatory mechanisms responsible for energy
metabolic processes in the brain.
Comment by Dr. Koren: This
is a very “chiropractic” paper
in its approach and acknowledgment of the relationship between
visceral conditions and general health and self-regulatory
or homeostatic mechanisms. Of course, the authors did not
check their patients for the vertebral subluxation complex
either in the spine, cranium or pelvis.
The relationship between
whiplash injury and subsequent lower back complications. Neel
SS et al. Chiropractic Oct 1988;1(3):86-88.
It has been observed
that people who suffer from whiplash injuries develop low back
pain. This study interviewed 52 patients who had been involved
in a whiplash type injury and found that 85% of them reported
lower back pain after the whiplash.
The patients in this study
had no previous motor vehicle accidents, were wearing lap and
harness eat belts and had no previous low back pain.
Relationship
between early somatic, radiological, cognitive and psychosocial
findings and outcome during a one-year follow-up in 117 patients
suffering from common whiplash. Br J Rheumatol 1994; 33:442-8.
Initial
examinations of 117 whiplash patients was performed a few days
after the accident, and 3, 6 and 12 months afterwards. After
one year, 28 patients (24% of total) were symptomatic. Poor
improvements were associated with severity of injury, previous
history of head trauma and headache, sleep disturbance immediately
after accident, nervousness and reduced speed of information
processing.
Considerations in the rehabilitation of cervical
myofascial injury, Canadian Family Physician, Vol. 32, Sept.
1986.
About 10-15% of motor vehicle cervical injuries fail to
achieve a functional recovery 2-3 years after the accident.
Whiplash
injuries: their long-term prognosis and its relationship to
compensation Hodgson, S.P., Neuro-Orthopedics 7, 1989.
62% of
the people injured in a whiplash soft-tissue trauma will have
continued complaints between 10 and 15 years after the date
of the accident.
PET and SPECT in whiplash syndrome: a new approach
to a forgotten brain? Otte A, Ettlin TM, Nitzsche EU, Wachter
K, Hoegerle S, Simon GH, Fierz L, Moser E, Mueller-Brand
J. J Neurol Neurosurg Psychiatry 1997; 63:368-372.
From the abstract:
Whiplash associated disorders are a medicolegally
controversial condition becoming increasingly worrisome to
the western world. This study was designed to evaluate perfusion
and glucose metabolism in [the] whiplash brain.
Comment by Dr.
Koren: Whiplash patients have traditionally reported a number
of symptoms that are related to brain function – i.e.
loss of memory, vision changes, emotional changes. This study
involved six patients suffering from whiplash syndrome and
12 normal controls. They gave everyone chemicals that reveal
brain function when viewed by specialized equipment (PET
and SPECT) which is similar to a CAT scan for the brain.
In the patient group, there was “significant hypometabolism” or
decreased brain function and hypoperfusion or decreased blood
in the parieto-occipital regions on the right and left side
compared to the control group.
But most revealing was the authors’ statement as to
the possible cause of the brain changes after they ruled
out direct injury to the brain and brain structures: “It
is hypothesized that parieto-occipital hypometabolism may
be caused by activation of nociceptive afferent nerves from
the upper cervical spine.”
Chronic cervical zygopophysial
joint pain after whiplash: a placebo-controlled prevalence
study. Lord, WM, Barnsley L. Wallis BJ, Bogduk N. Spine. 1996;21:1737-45.
This
double-blind placebo-controlled trial implicates the facet
joints as the most common pain source from whiplash type injury.
It builds on other research pointing to the same source of
whiplash pain.
Copyright 2004 Koren Publications, Inc. & Tedd
Koren, D.C.
Top of Page