Whiplash is a type of soft tissue neck injury.
The most oft-quoted definition of whiplash is from The Quebec Whiplash-Associated Disorders Cohort Study Spine Vol. 20, #8S 1995. This leading research study defines whiplash as: “an acceleration-deceleration mechanism of energy transfer to the neck. It may result from rear-end or side-impact motor vehicle collisions, but can also occur during diving or other mishaps.
The impact may result in bony or soft-tissue injuries (whiplash injury), which in turn may lead to a variety of clinical manifestations (Whiplash Associated Disorders or WAD).” Another more expressive way of describing or defining whiplash is “an injury in which the person’s neck is snapped in one direction and then the opposite direction. www.nwhealth.edu
Whiplash injury from motor vehicle accidents has normally been attributed to rear-end impacts, which were thought to cause forced flexion of the neck. More recent studies and computer models have defined more carefully the sequence of events following a rear-end collision. At the time of impact, the hit vehicle is accelerated forward, followed after 100 ms by a similar acceleration of the back of the car seat, which in turn pushes forward the occupant’s trunk and shoulders. The head, with no force acting upon it, remains very briefly in a neutral position followed by forced extension of the neck as the shoulders travel under the head. Following extension, the inertia of the head is overcome and it too accelerates forward. The neck then acts as a lever, increasing the forward acceleration of the head forcing the neck into flexion.
The forces involved are considerable: at impact speed of 32 km/h during extension, the human head reaches a peak acceleration of 12G. “Spine: State of the Art Reviews” (7.3 — September 1993) states that “typically the injured individual is the occupant of a stationary vehicle that is truck from behind, although injury can occur following side and head-on collisions. Injury results because the neck is unable to compensate adequately for the rapidity of head and torso movement resulting from the acceleration forces generated at the time of impact. When the physiologic limits of cervical structures are exceeded, anatomic structure of the soft tissues of the neck (including muscles, ligaments, and joint capsules) results.” Although the cause of injury is now better understood, the actual pathology is not well defined. Most experts agree that neck muscles have been injured. There may be strain or cartilaginous injuries to supporting structures of facet and apophyseal joints. There may be injury to anterior and posterior longitudinal ligaments. Throat, jaw and lower back injury may occur.
The symptoms of and disorders that can follow from whiplash injury include:
- Memory loss
- Difficulty swallowing
- Jaw area pain, called “temporomandibular joint” dysfunction or TMJ dysfunction
- Neck pain
- Neck-arm-upper torso area pain called cervicobrachalgia
- Myofascial pain or a collection of musculoskeletal aches or pains with trigger points
- Lower back pain
- Anxiety and depression
The text “Spine: State of the Art reviews” (7.3 — September 1993) states: “myofascial pain is a poorly understood clinical entity despite the fact that it may account for the majority of persistent neck, head and upper thoracic pain following whiplash injury…the trigger point is regarded as a characteristic feature of myofascial pain. Myofascial trigger points are circumscribed (2 — 5 mm in diameter), self-sustaining, hyperirritable foci of tenderness reported to be located within a taut band of musculoskeletal or its associated fascia. Compressing this hyperirritable focus is locally painful and may give rise to characteristic referred pain, tenderness, and autonomic phenomenon. The area of pain referral, which is surprisingly consistent, is termed the “zone of reference.” Myofascial pain is probably the result of an acute muscle strain or overload that occurs at the time of impact. One hypothesis is that a small area of neuromuscular irritability develops and becomes self-sustaining. A tender point may then develop in a band of myofascial pain. Aggravating factors are usually related to activities or postures that cause contraction of involved muscles. Alleviating factors generally attribute to relaxation of the involved muscles.”
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