Whiplash Related Injuries

The following table lists a number of conditions that various authors have attributed to or associated with whiplash. It is not an exhaustive list.  We have seen the majority of these in our Fort Myers office and most respond extremely well to the natural chiropractic treatment and the physical modalities (DRX9000, ultrasound, electric muscle stimulation, nutritional counseling, massage therapy) we use in our office.  Many times these complaints didn't occur the day of the accident and the person who suffered the injury didn't even correlate it with their trauma (and yet were unsure how the pain or disorder began).  My advice is always to get evaluated by a doctor who has experience with whiplash or car accident trauma as early as possible even if you don't notice a physical ache or pain.  This list contains many of what I call "hidden injuries", that is injuries you might not expect to be caused by your accident.

• Single and multiple cranial nerve palsies
• Peripheral neuropathy.
• Brachial plexopathy
• Dizziness and otoneurological disorders
• Thoracic outlet syndrome
• Oculomotor or other visual disturbances
• Posttraumatic stress disorder
• Herniation of cervical discs; rupture of ligaments and adjacent tissues
• Rim lesions (disc/bone interface)
• Spinal cord injury
• Retropharyngeal hematoma
• Damage to subarachnoid space
• Mediastinitis
• TMJ injury/disruption
• Hypopharyngeal, tracheal or esophageal perforation
• Brain injury
• Hypothalamic-pituitary-thyroid axis disorder
• Damage to the posterior cervical sympathetic nerves
• Menstrual disorders
• Tremor and movement disorders
• Occipital neuralgia
• Cervical dystonia
• Fibromyalgia syndrome
• Allergy
• Breathing disorders
• Cardiovascular disorders
• Digestive disorders
• Low back pain 
  
  Cognitive complaints Currently there is debate as to the nature of the cognitive complaints in persons suffering from whiplash injury. Forgetfulness, mental fatigue, easy distractibility, irritability, word search, and inability to concentrate are some of the more common complaints also in mild traumatic brain injury (MTBI). They are also common among persons recovering from concussion and are sometimes referred to as the postconcussion syndrome. Although the balance of the literature points to a very small lesion in the brain as the source of these complaints-the so-called diffuse axonal injury (DAI), these lesions are very difficult to see, except in more severe cases, using conventional MRI imaging, leaving the subject ripe for debate. Several authors have proposed that chronic pain alone is the source of such symptoms, but the theory fails to explain the symptoms in persons who are not in pain and in persons with abrupt onset of these symptoms.

Blurred vision or oculomotor disorders In the special case of whiplash, blurred vision is often the result of disturbed accommodation and impaired adaptivity to light. Refracting the eyes (i.e., correcting the vision using corrective lenses) will not completely resolve this problem and symptoms may last from a few weeks to months or more and may be sensitive to changing light conditions. Oculomotor disorders can be the result of cranial nerve injury, vestibular, or brain stem injuries. Differentiation requires a careful physical examination and, in some cases, special testing.

Dizziness/light-headedness It has been found that injection of saline solution into the SCM can result in dizziness. Accordingly, any muscular injury here may also have this effect, although there is no other supportive evidence for the phenomenon. These symptoms may be the result of vascular compromise secondary to injury to, or abnormal tone of, the sympathetic nervous system in the neck, or to brain stem or vestibular injury. A clear link has been established between dysautonomia and dizziness and vertigo. The influence of the sympathetic nervous system on the vestibular apparatus may be mediated by cochlear blood flow. Also, one of the prominent symptoms associated with Chiari malformation is dizziness, although this is only rarely likely to be a factor in CAD injury. Dizziness and vertigo may also be the result of slowed blood flow through the vertebrobasilar system. In some cases vertigo may be caused by inner ear damage, such as a perilymphatic labyrinthine fistula-another controversial condition-labyrinthine concussion, or it may be seen in minor brain injury. It can also be a manifestation of TMJ disorder. Migraine headaches are often accompanied by dizziness. Other vascular compromise may result from compression of vertebral arteries secondary to muscle spasm, although this is less likely. Dizziness is a common symptom of whiplash injury, and the evidence that many of the symptoms of CAD injury, such as dizziness, may emanate from the CNS, rather than merely from somatic structures, is mounting. The most common cause of dizziness in CAD patients appears to be proprioceptive abnormalities emanating from upper cervical motion segments.

Tinnitus Ringing in the ears is not common following whiplash but can occur in conjunction with MTBI. It can also result from an autonomic nervous system injury in which the vascular supply to the middle or inner ear is affected.

Disturbed sense of smell Brain injuries can produce a loss of olfaction, or sense of smell. Outside of the context of trauma, this can also be the result of depression and is idiopathic in about 33% of cases.

Headache Headache is the second most common symptom in acute whiplash and often the number one symptoms among those suffering late or chronic whiplash. It is also a common manifestation of MTBI, in which it is more correctly termed posttraumatic headaches (PTHA). There are strict criteria for making the diagnosis, and PTHA should not be applied simply to anyone who has had some type of trauma and who also has headaches: it is intended to imply headache due to brain injury. A variety of headaches have been attributed to whiplash, including migraine and occipital neuralgia.

Neck pain This is, of course, the most common symptom among those suffering acute whiplash and the second most common symptom (after headache) among those suffering from late whiplash. The most common causes of neck pain are damage to spinal structures in and around the facet joint, disc injuries, ligamentous injuries or instability, and, in more severe cases, fracture of vertebral end plates of other parts of the vertebrae 

Arm pain Most of the upper extremity pain and numbness (including pins and needles sensations) after whiplash injury are the result of referred pain phenomena. The explanation of these phenomena are beyond the scope of this website. Other causes of arm pain include peripheral neuropathy, such as entrapment, disc disease or disc herniation, and thoracic outlet syndrome (TOS), another controversial diagnosis. Some shoulder conditions can also refer pain into the arm.

Shoulder pain A number of conditions can give rise to shoulder pain and this not an uncommon condition after whiplash injury. It can result from direct injury to the shoulder, such as from a shoulder harness or impact with the car's interior, or from referred pain from soft tissues of the neck or a disc lesion. We have also observed that subjects holding the steering wheel vigorously will experience a violent jerking at the glenohumeral joint. Other causes of shoulder pain, such as impingement syndrome, thoracic outlet syndrome (TOS), and rotator cuff inflammation may develop secondary to CAD trauma, either as a result of muscular disuse or paresis of muscles or muscle groups. Imbalance between agonist and antagonist muscles can precipitate shoulder disorders or convert subclinical conditions to clinical conditions. In one study, 53% of the patients were found to have a periarticular shoulder disorder.

Back pain We have found low back pain (LBP) in 57% of our CAD cases (71% in broadside collisions). Others have found LBP in 24-48% of their cases. More recently 40.5% of one group of rear impacted subjects had low back pain at 24 month follow-up. Another group found thoracic and lumbar spine injuries second in frequency only to cervical injuries in rear impact crashes. In a recent study it was found that of those with neck pain following CAD, 43% of females and 31% of males also had back pain-a statistic that is found frequently in this literature.

The exact mechanism of low back injury in rear impact collisions, although not entirely clear, is probably multifactorial. Factors affecting the incidence, nature, and severity of low back injury in automobile crashes include the following: 1) position of the occupant in vehicle, 2) the use or non-use of the seat belt and shoulder harness, 3) deployment of the airbag system, (which is designed to deploy only with frontal impacts, but may deploy in more severe secondary collisions), 4) type of restraint system (i.e., conventional restraints vs. restraints with pretensioners), 5) stiffness of the seat back, 6) inclination of the seat back, 7) properties of the seat back padding, 8) degree of ramping, 9) vector and severity of the collision, 10) second collisions inside or outside the occupant's vehicle, 11) snugness of the restraint system, 12) positioning of the restraint system on the occupant, 13) positioning of the restraint system anchors within the vehicle, 14) physical makeup of the occupant, including stature, build, age, and level of fitness, and 15) preparedness for the collision.

Endocrinological disorders Animal research has demonstrated some degree of injury to the thyroid glands of animals exposed to cervical acceleration/deceleration trauma. In fact, in the 1960's researchers reported hemorrhage or inflammation in the thyroid glands of 50% of the animals they subjected to CAD trauma. There have been no reports of thyroid injury or dysfunction as a result of CAD trauma. We have, however, noticed a trend for patients injured in this way to subsequently develop hypothyroidism. Our research has yielded interesting new findings and correlations in this regard (Sehnert KW, Croft AC: Basal metabolic temperature vs. laboratory assessment in "posttraumatic hypothyroidism." Journal of Manipulative and Physiological Therapeutics (1):6-12, 1996). In particular, it seems there may be some justification for our term posttraumatic hypothyroidism. We were unable to determine the anatomical lesion, but assume that it is either in the pituitary gland or the hypothalamus, either of which may be damaged in MTBI. Menstrual dysfunction and other common complaints seen clinically may have an endocrine etiology.

Unexpected results from new study Perhaps one of the most interesting papers to come along in several years is one in which the authors studied 2,184 residents of Saskatchewan (Canada). The authors inquired about graded neck pain, headache, and depression. Overall, 15.9% reported a history of neck injury from MVC and this was more common in females in all age groups. Perhaps the most important aspect of this study was the association of various comorbidities with the history of neck injury from MVC. The authors looked at allergy, breathing disorders, hypertension, cardiovascular disorders, digestive disorders, and low back pain. They found higher comorbidities in all categories except hypertension, and in many cases the reported complaints were close to twice the severity as those reported in persons with no history of neck injury. In addition, the impact of these comorbidities was greater on the lives of those suffering neck injury than among the uninjured. The authors found that the general health of those having been injured was significantly lower than in those who had not. In the neck injury history group, 9.9% suffered from disabling neck pain in the six month survey period vs. only 3.9% who had no history of neck injury. Headaches that moderately or severely affected the health were likewise more common among the MVC group (33.0%) than the non-MVC group (15.2%). As for depression, the numbers were similar: 32.8% vs. 19.3%, although later multivariate adjustment for confounders found the association to be attributable to other variables.