Due to their complicated nature and profound impact on peoples lives, few topics in health care generate as much controversy as whiplash injuries. Unlike a broken bone where a simple x-ray can validate the presence of the fracture and standards of care can direct a health care professional as to the best way in which to handle the injury, whiplash injuries involve an unpredictable combination of nervous system, muscles joints and connective tissue disruption that is not simple to diagnose and can be even more of a challenge to treat. In order to help you understand the nature of whiplash injuries and how they should be treated, it is necessary to spend a bit of time discussing the mechanics of how whiplash injuries occur.
The Four Phases of a Whiplash Injury
During a rear-end automobile collision, your body goes through an extremely rapid and intense acceleration and deceleration. In fact, all four phases of a whiplash injury occur in less than one-half of a second! At each phase, there is a different force acting on the body that contributes to the overall injury, and with such a sudden and forceful movement, damage to the vertebrae, nerves, discs, muscles, and ligaments of your neck and spine can be substantial.
During this first phase, your car begins to be pushed out from under you, causing your mid-back to be flattened against the back of your seat. This results in an upward force in your cervical spine, compressing your discs and joints. As your seat back begins to accelerate your torso forward, your head moves backward, creating a shearing force in your neck. If your head restraint is properly adjusted, the distance your head travels backward is limited. However, most of the damage to the spine will occur before your head reaches your head restraint. Studies have shown that head restraints only reduce the risk of injury by 11-20 percent.
During phase two, your torso has reached peak acceleration - 1.5 to 2 times that of your vehicle itself - but your head has not yet begun to accelerate forward and continues to move rearward. An abnormal S-curve develops in your cervical spine as your seat back recoils forward, much like a springboard, adding to the forward acceleration of the torso. Unfortunately, this forward seat back recoil occurs while your head is still moving backward, resulting in a shearing force in the neck that is one of the more damaging aspects of a whiplash injury. Many of the bone, joint, nerve, disc and TMJ injuries that I see clinically occur during this phase.
During the third phase, your torso is now descending back down in your seat and your head and neck are at their peak forward acceleration. At the same time, your car is slowing down. If you released the pressure on your brake pedal during the first phases of the collision, it will likely be reapplied during this phase. Reapplication of the brake causes your car to slow down even quicker and increases the severity of the flexion injury of your neck. As you move forward in your seat, any slack in your seat belt and shoulder harness is taken up.
This is probably the most damaging phase of the whiplash phenomenon. In this fourth phase, your torso is stopped by your seat belt and shoulder restraint and your head is free to move forward unimpeded. This results in a violent forward-bending motion of your neck, straining the muscles and ligaments, tearing fibers in the spinal discs, and forcing vertebrae out of their normal position. Your spinal cord and nerve roots get stretched and irritated, and your brain can strike the inside of your skull causing a mild to moderate brain injury. If you are not properly restrained by your seat harness, you may suffer a concussion, or more severe brain injury, from striking the steering wheel or windshield.
Injuries Resulting from Whiplash Trauma
As we discussed briefly in the introduction, whiplash injuries can manifest in a wide variety of ways, including neck pain, headaches, fatigue, upper back and shoulder pain, cognitive changes and low back pain. Due to the fact that numerous factors play into the overall whiplash trauma, such as direction of impact, speed of the vehicles involved, as well as gender, age and physical condition, it is impossible to predict the pattern of symptoms that each individual will suffer. Additionally, whiplash symptoms commonly have a delayed onset, often taking weeks or months to present. There are, however, a number of conditions that are very common among those who have suffered from whiplash trauma.
It is the single most common complaint in whiplash trauma, being reported by over 90 percent of patients. Often this pain radiates across the shoulders, up into the head, and down between the shoulder blades. Whiplash injuries tend to affect all of the tissues in the neck, including the facet joints and discs between the vertebrae, as well as all of the muscles, ligaments and nerves.
Facet joint pain is the most common cause of neck pain following a car accident. Facet joint pain is usually felt on the back of the neck, just to the right or left of center, and is usually tender to the touch. Facet joint pain cannot be visualized on x-rays or MRIs. It can only be diagnosed by physical palpation of the area.
Disc injury is also a common cause of neck pain; especially chronic pain. The outer wall of the disc (called the anulus) is made up of bundles of fibers that can be torn during a whiplash trauma. These tears, then, can lead to disc degeneration or herniation, resulting in irritation or compression of the nerves running through the area. This compression or irritation commonly leads to radiating pain into the arms, shoulders and upper back, and may result in muscle weakness.
Damage to the muscles and ligaments in the neck and upper back are the major cause of the pain experienced in the first few weeks following a whiplash injury, and is the main reason why you experience stiffness and restricted range of motion. But as the muscles have a chance to heal, they typically don't cause as much actual pain as they contribute to abnormal movement. Damage to the ligaments often results in abnormal movement and instability.
After neck pain, headaches are the most prevalent complaint among those suffering from whiplash injury, affecting more than 80 percent of all people. While some headaches are actually the result of direct brain injury, most are related to injury of the muscles, ligaments and facet joints of the cervical spine, which refer pain to the head. Because of this, it is important to treat the supporting structures of your neck in order to help alleviate your headaches.
A less common, but very debilitating disorder that results from whiplash is temporomandibular joint dysfunction (TMJ). TMJ usually begins as pain, clicking and popping noises in the jaw during movement. If not properly evaluated and treated, TMJ problems can continue to worsen and lead to headaches, facial pain, ear pain and difficulty eating. Many chiropractors are specially trained to treat TMJ problems, or can refer you to a TMJ specialist.
Believe it or not, mild to moderate brain injury is common following a whiplash injury, due to the forces on the brain during the four phases mentioned earlier. The human brain is a very soft structure, suspended in a watery fluid called cerebrospinal fluid. When the brain is forced forward and backward in the skull, the brain bounces off the inside of the skull, leading to bruising or bleeding in the brain itself. In some cases, patients temporarily lose consciousness and have symptoms of a mild concussion. More often, there is no loss of consciousness, but patients complain of mild confusion or disorientation just after the crash. The long-term consequences of a mild brain injury can include mild confusion, difficulty concentrating, sleep disturbances, irritability, forgetfulness, loss of sex drive, depression and emotional instability. Although less common, the nerves responsible for your sense of smell, taste and even your vision may be affected as well, resulting in a muted sense of taste, changes in your sensation of smell and visual disturbances.
Dizziness following a whiplash injury usually results from injury to the facet joints of the cervical spine, although in some cases injury to the brain or brain stem may be a factor as well. Typically, this dizziness is very temporary improves significantly with chiropractic treatment.
Low Back Pain
Although most people consider whiplash to be an injury of the neck, the low back is also commonly injured as well. In fact, low back pain is found in more than half of rear impact-collisions in which injury was reported, and almost three-quarters of all side-impact crashes. This is mostly due to the fact that the low back still experiences a tremendous compression during the first two phases of a whiplash injury, even though it does not have the degree of flexion-extension injury experienced in the neck.
Recovery From Whiplash
With proper care, many mild whiplash injuries heal within six to nine months. However, more than 20 percent of those who suffer from whiplash injuries continue to suffer from pain, weakness or restricted movement two years after their accident. Unfortunately, the vast majority of these people will continue to suffer from some level of disability or pain for many years after that, if not for the rest of their lives.
Whiplash is a unique condition that requires the expertise of a skilled health professional specially trained to work with these types of injuries. The most effective treatment for whiplash injuries is a combination of chiropractic care, rehabilitation of the soft tissues and taking care of yourself at home.
Chiropractic care utilizes manual manipulation of the spine to restore the normal movement and position of the spinal vertebrae. It is by far the single-most effective treatment for minimizing the long-term impact of whiplash injuries, especially when coupled with massage therapy, trigger point therapy, exercise rehabilitation and other soft tissue rehabilitation modalities.
Soft Tissue Rehabilitation
The term 'soft tissue' simply refers to anything that is not bone, such as your muscles, ligaments, tendons, nervous system, spinal discs and internal organs. During a whiplash injury, the tissues that are affected most are the soft tissues, the muscles, ligaments and discs in particular. In order to minimize permanent impairment and disability, it is important to use therapies that stimulate the soft tissues to heal correctly. These include massage therapy, electro-stimulation, trigger point therapy, stretching and specific strength and range of motion exercises.
The most effective chiropractic care and soft tissue rehabilitation will be limited in its benefit if what you do at home or at work stresses or re-injures you on a daily basis. For this reason, it is important that your plan of care extend into the hours and days between your clinic visits to help speed your recovery. Some of the more common home care therapies are the application of ice packs, limitations on work or daily activities, specific stretches and exercises, taking nutritional supplements and getting plenty of rest.
In some severe cases of whiplash, it may be necessary to have some medical care as part of your overall treatment plan. The most common medical treatments include the use of anti-inflammatory medications, muscle relaxants, trigger point injections and, in some cases, epidural spinal injections. These therapies should be used for short-term relief of pain, if necessary, and not be the focus of treatment. After all, a drug cannot restore normal joint movement and stimulate healthy muscle repair. Fortunately, surgery is only needed in some cases of herniated discs, when the disc is pressing on the spinal cord, and in some cases of spine fractures.
Kwa sababu ya hali yao ngumu na athari kubwa kwenye maisha ya watu, mada chache katika huduma ya afya hutokeza utata mwingi kama majeraha ya whiplash. Tofauti na mfupa uliovunjika ambapo X-ray rahisi inaweza kuthibitisha uwepo wa kuvunjika na viwango vya huduma vinaweza kuelekeza mtaalamu wa huduma ya afya kwa njia bora ya kushughulikia jeraha, majeraha ya whiplash yanahusisha mchanganyiko usiotabirika wa mfumo wa neva, misuli, viungo na kuvunjika kwa tishu ya kuunganisha ambayo sio rahisi kugundua na inaweza kuwa changamoto zaidi ya kutibu. Ili kukusaidia kuelewa asili ya majeraha ya whiplash na jinsi ya kutibu, ni muhimu kutumia muda kidogo kujadili utaratibu wa jinsi majeraha ya whiplash hutokea. Katika kesi ya ajali ya gari, mwili wako hupitia kasi na kupunguza kasi kwa kasi sana. Kwa kweli, hatua zote nne za jeraha la whiplash hutukia kwa muda usiozidi nusu ya sekunde! Katika kila hatua, kuna nguvu tofauti inayofanya kazi kwenye mwili ambayo inachangia jeraha la jumla, na kwa harakati ya ghafla na yenye nguvu, uharibifu wa uti wa mgongo, neva, diski, misuli, na mishipa ya shingo na uti wa mgongo unaweza kuwa mkubwa. Katika hatua hii ya kwanza, gari lako huanza kusukumwa nje kutoka chini yako, na kusababisha katikati ya mgongo wako kuwa flattened dhidi ya nyuma ya kiti chako. Hii husababisha nguvu ya juu katika uti wako wa mgongo wa shingo, ikifinya diski na viungo vyako. Wakati kiti chako cha nyuma kinapoanza kuharakisha mwili wako mbele, kichwa chako huelekea nyuma, na hivyo kuunda nguvu ya kukata shingo yako. Ikiwa kichwa chako kimewekwa kwa njia inayofaa, kichwa chako kinaweza kusonga umbali mdogo. Hata hivyo, uharibifu mkubwa wa uti wa mgongo utafanyika kabla ya kichwa chako kufikia kifuniko cha kichwa. Utafiti unaonyesha kwamba vifuniko vya kichwa hupunguza hatari ya kujeruhiwa kwa asilimia 11 hadi 20. Katika hatua ya pili, mwili wako umefikia kasi ya juu - mara 1.5 hadi 2 ya gari lako lenyewe - lakini kichwa chako hakijaanza kuharakisha mbele na kinaendelea kusonga nyuma. S-curve ya kawaida huendelea katika uti wa mgongo wa shingo wakati kiti chako kinarudi mbele, kama springboard, ikiongeza kasi ya mbele ya mwili. Kwa bahati mbaya, hii nyuma ya kiti cha mbele ya nyuma hutokea wakati kichwa chako bado kinakwenda nyuma, na kusababisha nguvu ya kukata shingo ambayo ni moja ya mambo mabaya zaidi ya jeraha la whiplash. Madhara mengi ya mifupa, viungo, neva, diski na TMJ ambayo naona kliniki hutokea wakati wa awamu hii. Katika hatua ya tatu, mwili wako unashuka nyuma kwenye kiti chako na kichwa na shingo yako ziko kwenye kasi yao ya juu ya mbele. Wakati huohuo, gari lako linapungua mwendo. Ikiwa umepunguza shinikizo kwenye pedali ya breki wakati wa hatua za kwanza za mgongano, inawezekana itatumika tena wakati wa hatua hii. Kuongeza kasi ya breki kwa gari yako kwa sababu ya kuendesha gari yako kwa kasi zaidi, na kuongeza uzito wa jeraha la mviringo wa shingo yako. Unapokuwa ukisonga mbele kwenye kiti chako, ukanda wako wa usalama na kamba ya bega hufungiwa. Yaelekea hii ndiyo hatua yenye kuharibu zaidi ya ugonjwa wa whiplash. Katika hatua hii ya nne, mwili wako unasimamishwa na mkanda wa usalama na kushikilia mabega na kichwa chako kina uhuru wa kusonga mbele bila vizuizi. Hii husababisha mviringo mkali wa shingo yako, kushinikiza misuli na vifungo, kupasua nyuzi katika diski za uti wa mgongo, na kulazimisha uti wa mgongo kutoka kwa nafasi yao ya kawaida. Ugonjwa wa uti wa mgongo na mishipa ya neva hufadhaika na kuharibika, na ubongo wako unaweza kushambulia sehemu ya ndani ya fuvu la kichwa, na kusababisha uharibifu wa ubongo wa kiwango cha chini hadi cha wastani. Ikiwa umefungwa kwa njia isiyofaa na kamba ya kiti, unaweza kupata mshtuko wa ubongo, au jeraha kubwa zaidi la ubongo, kwa kugonga gurudumu au kioo cha mbele. Kama tulivyojadili kwa ufupi katika utangulizi, majeraha ya whiplash yanaweza kuonekana kwa njia mbalimbali, ikiwa ni pamoja na maumivu ya shingo, maumivu ya kichwa, uchovu, maumivu ya mgongo wa juu na bega, mabadiliko ya utambuzi na maumivu ya chini ya mgongo. Kwa sababu ya mambo mengi ya kuathiri jumla ya whiplash, kama vile mwelekeo wa mgongano, kasi ya magari, na jinsia, umri na hali ya mwili, haiwezekani kutabiri muundo wa dalili ambazo kila mtu atateseka. Kwa kuongezea, dalili za whiplash kwa kawaida huanza kwa kuchelewa, mara nyingi huchukua majuma au miezi ili kuonekana. Hata hivyo, kuna hali kadhaa ambazo ni za kawaida sana miongoni mwa wale ambao wamepatwa na majeraha ya whiplash. Hii ni moja ya malalamiko ya kawaida katika whiplash, na inaripotiwa na zaidi ya asilimia 90 ya wagonjwa. Mara nyingi maumivu hayo huenea kwenye mabega, kichwa, na chini kati ya bega. Whiplash huathiri tishu zote za shingo, pamoja na viungo vya pande na diski kati ya uti wa mgongo, pamoja na misuli, ligaments na neva. Maumivu ya viungo vya sehemu ni kisababishi cha kawaida cha maumivu ya shingo baada ya aksidenti ya gari. Maumivu ya sehemu ya nyuma ya shingo huonekana upande wa kulia au kushoto wa shingo na kwa kawaida huwa nyeti kwa kugusa. Maumivu ya viungo vya sehemu haziwezi kuonekana kwenye picha za X-ray au MRI. Inaweza kugunduliwa tu kwa kupima kimwili eneo hilo. Uharibifu wa diski pia ni kisababishi cha kawaida cha maumivu ya shingo; hasa maumivu sugu. Sehemu ya nje ya diski (anulus) ina nyuzi ambazo zinaweza kuvunjika wakati wa majeraha ya whiplash. Matatizo hayo yanaweza kusababisha kuharibika kwa diski au kupasuka kwa diski, na kusababisha kuchochea au kukandamiza mishipa ya neva inayopita katika eneo hilo. Kwa kawaida, maumivu hayo huathiri mikono, mabega, na sehemu ya juu ya mgongo, na yanaweza kusababisha udhaifu wa misuli. Uharibifu wa misuli na ligaments katika shingo na sehemu ya juu ya mgongo ni sababu kuu ya maumivu ya wiki chache za kwanza baada ya majeraha ya whiplash, na ni sababu kuu kwa nini wewe uzoefu stiffness na ukomo wa mwendo. Lakini kwa kuwa misuli ina nafasi ya kupona, kwa kawaida haisababishi maumivu mengi kama inavyochangia harakati zisizo za kawaida. Mara nyingi uharibifu wa vifungo husababisha mwendo usio wa kawaida na kutokuwa na utulivu. Baada ya maumivu ya shingo, maumivu ya kichwa ni malalamiko ya kawaida kati ya wale wanaosumbuliwa na majeraha ya whiplash, na huathiri zaidi ya asilimia 80 ya watu wote. Wakati maumivu ya kichwa ni matokeo ya moja kwa moja ya majeraha ya ubongo, wengi ni kuhusiana na majeraha ya misuli, ligaments na viungo facet ya uti wa mgongo wa shingo, ambayo rejea maumivu ya kichwa. Kwa sababu hii, ni muhimu kutibu miundo ya kuunga mkono ya shingo yako ili kusaidia kupunguza maumivu yako ya kichwa. Ugonjwa mwingine ambao haupatikani mara nyingi, lakini unaodhoofisha sana, ni ugonjwa wa kifua. TMJ kawaida huanza kama maumivu, clicking na popping sauti katika taya wakati wa harakati. Ikiwa haijathibitishwa na kutibiwa vizuri, matatizo ya TMJ yanaweza kuendelea kuongezeka na kusababisha maumivu ya kichwa, maumivu ya uso, maumivu ya sikio na ugumu wa kula. Wataalamu wengi wa chiropractic wamezoezwa kwa ajili ya matibabu ya matatizo ya TMJ, au wanaweza kukuelekeza kwa mtaalamu wa TMJ. Uwe na imani au la, majeraha ya ubongo ya kiwango cha chini hadi cha wastani ni ya kawaida kufuatia majeraha ya whiplash, kwa sababu ya nguvu kwenye ubongo wakati wa awamu nne zilizotajwa hapo awali. Ubongo wa binadamu ni muundo laini sana, ulio katika umajimaji wenye maji unaoitwa umajimaji wa uti wa mgongo. Wakati ubongo unapoelekezwa mbele na nyuma kwenye fuvu la kichwa, ubongo hupiga kutoka ndani ya fuvu la kichwa, na kusababisha kuvuja au kutokwa na damu kwenye ubongo. Katika visa fulani, wagonjwa hupoteza fahamu kwa muda na kuwa na dalili za mshtuko wa ubongo mdogo. Mara nyingi, hakuna kupoteza fahamu, lakini wagonjwa hulalamika juu ya kuchanganyikiwa kidogo au kutoelewana mara tu baada ya aksidenti. Matokeo ya muda mrefu ya majeraha ya ubongo ya kiasi chaweza kujumuisha kuchanganyikiwa kidogo, ugumu wa kukaza fikira, matatizo ya usingizi, kukasirika, kusahau, kupoteza hamu ya ngono, kushuka moyo na kutokuwa na utulivu wa kihisia. Ingawa si kawaida, neva zinazohusika na hisia yako ya harufu, ladha na hata maono yako zinaweza kuathiriwa pia, na kusababisha hisia ya ladha iliyopunguzwa, mabadiliko katika hisia yako ya harufu na matatizo ya kuona. Kwa kawaida, maumivu ya kichwa yanatokana na majeraha ya kiwiko cha shingo, ingawa katika baadhi ya kesi, majeraha ya ubongo au shina la ubongo yanaweza kuwa sababu pia. Kwa kawaida, kizunguzungu hiki ni cha muda mfupi sana hupungua kwa kiasi kikubwa kwa matibabu ya chiropractic. Kwa sababu ya maumivu ya mgongo, watu wengi huona whiplash kama ugonjwa wa shingo, lakini kwa kawaida maumivu ya mgongo ni ya kawaida. Kwa kweli, maumivu ya mgongo hupatikana katika zaidi ya nusu ya mgongano wa nyuma ambao majeraha yaliripotiwa, na karibu robo tatu ya ajali zote za upande. Hii ni kwa sababu ya ukweli kwamba sehemu ya chini ya mgongo bado hupata compression kubwa wakati wa awamu mbili za kwanza za majeraha ya whiplash, ingawa haina kiwango cha flexion-extension majeraha uzoefu katika shingo. Kwa utunzaji unaofaa, majeraha mengi ya kichefuchefu ya upole hupona ndani ya miezi sita hadi tisa. Hata hivyo, zaidi ya asilimia 20 ya wale wanaopata majeraha ya whiplash wanaendelea kuugua maumivu, udhaifu au kupunguza mwendo miaka miwili baada ya ajali yao. Kwa bahati mbaya, wengi wa watu hawa wataendelea kuteseka kutokana na kiwango fulani cha ulemavu au maumivu kwa miaka mingi baada ya hapo, ikiwa si kwa maisha yao yote. Whiplash ni hali ya kipekee ambayo inahitaji utaalam wa mtaalamu wa afya aliyefundishwa hasa kufanya kazi na aina hizi za majeraha. Matibabu bora ya majeraha ya whiplash ni mchanganyiko wa matibabu ya chiropractic, ukarabati wa tishu laini na kujitunza nyumbani. Matibabu ya chiropractic hutumia udhibiti wa mkono wa uti wa mgongo ili kurudisha mwendo wa kawaida na nafasi ya uti wa mgongo. Ni moja ya matibabu bora zaidi ya kupunguza athari za muda mrefu za majeraha ya whiplash, hasa wakati unaunganishwa na matibabu ya massage, matibabu ya trigger point, mazoezi ya mazoezi na matibabu mengine ya tishu laini. "Kama ""viungo laini"" ni neno la kawaida linalomaanisha kitu chochote ambacho si mfupa, kama vile misuli, ligaments, tendons, mfumo wa neva, disks ya uti wa mgongo na viungo vya ndani." Wakati wa majeraha ya whiplash, tishu zinazohusika zaidi ni tishu laini, misuli, ligaments na disks. Ili kupunguza madhara ya kudumu na ulemavu, ni muhimu kutumia matibabu ambayo huchochea tishu laini kupona kwa usahihi. Hizi ni pamoja na tiba ya massage, electro-kuchochea, trigger hatua ya tiba, kunyoosha na nguvu maalum na mbalimbali ya mazoezi ya mwendo. Chiropractic na matibabu ya tishu laini ni muhimu sana kwa ajili ya afya ya mwili, lakini kwa sababu ya hali ya afya, inaweza kuwa vigumu kwa mtu kufanya kazi nyumbani au nyumbani. Kwa sababu hii, ni muhimu kwamba mpango wako wa huduma uendelee katika masaa na siku kati ya ziara zako za kliniki ili kusaidia kuharakisha uponyaji wako. Baadhi ya matibabu ya kawaida ya nyumbani ni kutumia pakiti za barafu, kupunguza kazi au shughuli za kila siku, mazoezi maalum, kuchukua virutubisho vya lishe na kupumzika. Katika baadhi ya kesi kali za whiplash, inaweza kuwa muhimu kuwa na baadhi ya huduma ya matibabu kama sehemu ya mpango wako wa jumla wa matibabu. Matibabu ya kawaida ya matibabu ni pamoja na matumizi ya dawa za kupambana na uvimbe, relaxants misuli, sindano trigger uhakika na, katika baadhi ya kesi, sindano epidural spinal. Matibabu haya yanapaswa kutumiwa kwa ajili ya kupunguza maumivu kwa muda mfupi, ikiwa ni lazima, na si kuwa lengo la matibabu. Baada ya yote, dawa haiwezi kurudisha mwendo wa kawaida wa viungo na kuchochea uponyaji wa misuli yenye afya. Kwa bahati nzuri, upasuaji unahitajiwa tu katika baadhi ya kesi za herniated disks, wakati diski ni kushinikiza juu ya uti wa mgongo, na katika baadhi ya kesi ya fractures uti wa mgongo.