Whiplash neck injury
Typically, the safest place in a car is the seat behind the driver. A child seat is most often placed here and older people and women are seated here. But, despite the relative safety, even there you need to be securely fastened.
Most common injury
The fact is that in an accident, when one car crashes into another from behind, or during heavy braking, passengers in the back seat experience a two-stage sharp flexion-extension movement in the cervical spine, which can cause traumatic damage to the spinal joints and ligaments , muscles, and sometimes nerve roots. This injury is called whiplash. However, sometimes doctors offer other names - cervicocranial accelerator injury or distortion injury of the cervical spine.
Among patients with whiplash injury, there are 2.5 times more women than men, mostly women 30–50 years old. An explanation could be lower neck muscle strength in females, or perhaps it is because women seek medical help more often.
Even in the absence of obvious injuries to the neck, such an injury can cause long-term neck pain, torticollis, cervicobrachialgia, and headache. These symptoms are often accompanied by dizziness, blurred vision, autonomic symptoms, including erectile dysfunction, persistent moderate neuropsychological disorders, and asthenoneurotic manifestations.
Some experts argue that sometimes whiplash has no consequences and that painful sensations are caused by a complex of psychogenic, psychosocial and social factors, and sometimes are a simple simulation. Previously, the term was even proposed - whiplash neurosis. But due to the development of CT and MRI, injuries to the cervical spine and adjacent organs and tissues have become better diagnosed and, accordingly, better treated.
Whiplash Symptoms
The leading symptoms that almost always accompany whiplash injury are pain in the neck and shoulder girdle, which intensifies when moving the head and arms, accompanied by limited movement in the neck (primarily when bending the head), and dizziness, which is observed at approximately 20–25 % of cases of injury, it can be combined with imbalance.
A headache often occurs, which is often localized in the back of the head, but sometimes radiates to the temple and eye socket. Cochlear (noise, ringing in the ears) and visual (blurred image, blurred vision) disturbances are also characteristic, and paresthesia in the facial area may be observed. In almost a third of cases, nonspecific moderately severe cognitive impairment develops: decreased ability to concentrate, mild memory impairment. Mood changes (anxiety, depression) are often observed. It should be noted that after an injury, the neck very often becomes a zone of psychological fixation. Constant neck pain after injury provokes depression, while anxiety and conversion disorders contribute to chronic pain.
How severe is the pathology?
Doctors distinguish 4 degrees of severity of whiplash injury, says Mark Ivanov:
- The first is marked by the following signs:
With a mild concussion, the victim may not feel anything. Symptoms increase slowly. After a few days (sometimes weeks), minor pain in the neck may appear. The victim feels nausea, complains of attacks of dizziness, loss of sensitivity in the fingers. All these symptoms may disappear without medical attention, so with a minor injury and mild symptoms, injured people may not turn to a specialist. This degree of damage occurs most often.
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- Second:
In this case, symptoms appear instantly, immediately after the incident. The pain is severe, the neck is limited in movement (it is impossible to turn the head). The second degree is observed in a third of applicants.
- Third:
There are already focal neurological signs here. The patient complains of severe dizziness, loss of coordination, and vomiting. Tendon reflexes may be weakened (even absent), there may be paresis, and there is a violation of sensitivity.
- Fourth:
Symptoms appear immediately. There may be dislocations and fractures of the vertebrae, and neurological signs are pronounced. The pain affects all parts of the spinal column.
“To identify a whiplash injury, the doctor conducts an examination and determines the circumstances under which the injury may have occurred. He then sends the patient for an x-ray. It can be used to check the condition of the spine. If a disc herniation or spinal cord compression is suspected, the doctor will prescribe an MRI. Additional research methods include computed tomography,” says Mark Ivanov.
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Diagnostics
Questions about the incident itself and the symptoms experienced by patients are the first step to making a diagnosis. You may also be asked to fill out a short questionnaire that can help your doctor assess the frequency and severity of your symptoms and your ability to perform daily activities.
Inspection
During the examination, the doctor feels and turns your head, neck and arms. The doctor may also ask you to make certain movements or perform certain tasks. The examination helps the doctor determine:
- degree of mobility of the neck and shoulders;
- the moment during movement at which pain occurs or the pain intensifies;
- soreness in the neck, shoulders, or back;
- the severity of reflexes, strength and sensitivity in the limbs.
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Radiographic studies
Your doctor will likely order one or more radiographic tests to look for other conditions that may be causing or worsening your neck pain. Such tests could be:
Radiography
X-rays of the neck taken from different angles can help detect fractures, dislocations, or arthritis;
Computed tomography (CT)
CT is a special radiographic technology that allows you to obtain a large number of cross-sectional images, which helps to examine the condition of the bones in detail and identify a possible fracture;
Magnetic resonance imaging (MRI)
MRI is a technology that uses radio waves and a magnetic field to produce detailed three-dimensional images. In addition to bone damage, an MRI can reveal some soft tissue injuries, such as the spinal cord, intervertebral discs, nerves and ligaments.
Course and prognosis
Based on the flow, several periods or phases of chemotherapy are distinguished:
- the most acute. Duration - up to 4 days;
- spicy. Lasts from 4 days to three weeks;
- subacute - from three weeks to one and a half months;
- intermediate - 45-180 days;
- transition to a chronic form with progressive symptoms over six months.
The longer the period without treatment, the worse the future prognosis will be. About 8% of patients subsequently suffer from so-called post-whiplash syndrome.
Prevention
Although it is not always possible to prevent an accident, improving vehicle safety can help reduce the risks associated with an accident. Various improvements to seat belts and head restraints reduce the chance of whiplash. Proper use of these devices plays a key role in preventing such injuries. Head restraints should be designed to prevent the head from being thrown back too quickly during a rear impact. To cope with this task, head restraints should be optimally located directly under the head. If the head restraint is lower than the level of the head, the movement of the head will be unrestricted by a sudden impact, making whiplash more likely. Many cars have additional features such as airbags and air curtains to better protect the driver and passengers from injury.
Treatment
Treatment goals for whiplash include pain control, restoration of neck mobility, and return to normal activity levels. The course of treatment varies depending on the severity of the injury. For some people, over-the-counter medications and home treatment are sufficient. Other people may need more extensive medication and physical therapy.
Pain treatment
Your doctor may prescribe one of the following treatments to relieve your pain:
Peace
Rest may help in the first 24 hours after injury, but prolonged avoidance of activity may delay recovery;
Applying an ice pack or heating pad
Apply an ice pack or heating pad to your neck for 15 minutes up to 6 times a day;
Drugs sold without a prescription
Mild pain relievers such as acetaminophen and ibuprofen can relieve mild to moderate whiplash pain;
Prescription painkillers
A short course of treatment with such drugs can help the patient cope with severe pain;
Muscle relaxants
These medications may relieve pain and restore normal sleep if pain is keeping you from sleeping well at night;
Injections
An injection of lidocaine (an anesthetic) into the area where the painful muscle is located may be used to reduce pain so that the patient can exercise.
Exercise
Your doctor will likely prescribe you a set of stretching and mobility exercises so that you can quickly return to normal activity. To relax your muscles, you may be advised to take a warm shower before exercising.
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Exercises may include:
- neck turns and both sides;
- neck tilts left and right;
- tilting the head forward towards the chest;
- shoulder rotation.
Your doctor may refer you to an occupational therapist or exercise therapist if you need help learning exercises to improve mobility or if you are experiencing chronic pain from whiplash. The therapist may also add additional exercises to strengthen muscles, improve posture, etc. It is necessary to create a program according to which in the future you could study independently at home.
Foam collars
Soft foam cervical collars were once often used for whiplash injuries to restrict neck and head mobility. However, research has shown that immobilizing the neck over a long period of time can reduce the strength of the neck muscles and slow down the healing process.
Recommendations for using collars vary, but generally recommend using them for no more than three hours at a time during the first week after injury, when the patient experiences the most pain. Your doctor may also advise you to wear a collar before going to bed if the pain is making it difficult for you to sleep.
Classification of subaxial injuries of the cervical spine
Clinical classification of subaxial ( C3 - C7 vertebrae) injuries of the cervical spine includes the following types of injuries:
- compression fracture,
- burst fracture,
- flexion-distraction injury of the neck,
- dislocation of the articular processes (unilateral or bilateral),
- fracture of the articular processes.
There is also a classification by Allen and Ferguson for injuries of the cervical spine, which is used in specialized literature and in scientific research. This classification of subaxial ( C3 - C7 vertebrae) injuries of the cervical spine is based on radiographic data and the mechanism of injury:
- flexion-compression,
- vertical compression,
- flexion-distraction: subluxation of the articular process,
- unilateral dislocation of the articular processes,
- bilateral dislocation of the articular processes with 50% displacement,
- complete dislocation (100% displacement),
Potential Complications
If left untreated, whiplash can lead to serious complications:
- post-whiplash injury;
- development of intervertebral hernia;
- visual impairment;
- rupture of muscles and blood vessels;
- increased feeling of anxiety;
- neurological disorders;
- dysphagia (problems with swallowing);
- persistent pain in the occipital part of the head and back;
- post-traumatic osteoarthritis.
“If the patient does not consult a doctor, minor injuries without timely treatment provoke fibrosis, pathological changes in soft tissues that can affect nearby organs, the formation of intervertebral hernias, and post-traumatic osteochondrosis,” says traumatologist Ivanov.
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Causes
This type of injury can result from:
Car accident
Accidents in which a vehicle is rear-ended are the most common cause of whiplash injury;
Fights, assaults, domestic violence cases
Whiplash can also occur when a person is hit or shaken. Whiplash is one of the injuries that can lead to shaken baby syndrome;
Contact sports
Blocking an opponent and other collisions in sports can sometimes lead to whiplash.
Pathophysiology
Let's give an associative analogy. If a person is hit with a whip, his muscles and ligaments will begin to quickly move and contract. As a result, spasms, sprains, ruptures occur, followed by an inflammatory process. The main thing is intensive treatment in the first week after the accident. If the moment was missed, from the point of view of pathophysiology, this is fraught with fibrotic changes with severe pain, which subsequently spreads to the surrounding tissues. Fibrosis is the overgrowth of connective tissue with the formation of scars that cause pain and a constant feeling of discomfort. If a person does not see a doctor for a long time, trying to ignore alarming manifestations, fibrotic changes cannot be avoided. In other words, you should not ignore alarming symptoms and neglect contacting a medical facility.
There is another important pathophysiological point: chemotherapy is often combined with displacement of the cranial bones. In such situations, it is minimal, but has a great influence on the course of the disease, and diagnostic equipment cannot detect it. The displacement is determined by qualified osteopaths: as a rule, already during the first appointment with the patient.