Whiplash Information

Arthur C. Croft, DC, MS, FACO, "Whiplash: A Patient's Guide to Recovery," San Diego, Spine Research Institute of San Diego, 1999

There are many reasons why whiplash injuries have gained an ill-deserved reputation in some circles. Perhaps foremost among these is the inability of many physicians to comprehend the nature of the trauma and the soft tissue injuries that result. These injuries are real and can take many forms.

• Brain Injury

Believe it or not, brain injury — usually minor — is rather common as a result of whiplash injury, due to the mechanical deformation of the brain during the acceleration and deceleration that occurs in a collision. After the initial injury, a cascade of biochemical reactions continues to injure the brain for up to 96 hours. The result is commonly experienced as mild confusion, difficulty concentrating, sleep disturbances, irritability, forgetfulness, angry outbursts, mood disorders and loss of libido (sex drive). These psychological effects have unfortunately been used to suggest that the hapless victim is mentally or psychologically unstable and, therefore, fabricating or imagining other symptoms.

While most patients eventually recover from this type of injury, some never fully regain all of their former cognitive ability. Several studies indicate that some permanent loss in IQ can result.

• Depression

Studies have also shown that significant pain itself can have a temporary adverse effect on a patient's psychological and cognitive (i.e., mental) status. There is also a well-known association between depression and chronic pain: People with chronic pain are much more likely to become depressed.

• Cranial Nerve Injury

Many complaints are related to injuries to these nerves. Some patients, for example, complain of blurred vision after a whiplash injury. This results from an accommodation error in the eye, which adversely affects pupillary dilation and is manifested as mild visual acuity problems (blurred vision). Many eye doctors do not realize that such problems occur after whiplash and will attempt instead to refract these patients — that is, test their vision using conventional ophthalmology/optometry procedures. Corrective lenses cannot remedy this type of blurred vision.

• Dizziness

Dizziness is a sense of balance loss and must be distinguished from vertigo, which is a more severe motion disorder, although the latter is occasionally seen following whiplash trauma. Usually, vertigo is the result of an injury to the inner ear and goes by the name of benign paroxysmal positional vertigo (BPPV). This condition is precipitated by certain motions of the head and generally lasts only 15 to 20 seconds. There is a simple treatment for this condition, which a chiropractic physician can perform. Dizziness, on the other hand, often results from injury to the joints of the cervical spine. It may also be the result of brain stem injury or injury to the brain itself. Usually, it is short-lived and is frequently amenable to chiropractic treatment.

• Hormonal Problems

The endocrine (hormonal) system may be affected by whiplash injury because the part of the brain that controls part of this system (the hypothalamus and the pituitary gland) may be injured during the rapid acceleration and deceleration of the brain.

Symptoms include slowness in cognition (mental acuity), weight gain, fatigue, intolerance to cold, thickening and edema of the tongue, puffiness of the hands and face, constipation, drowsiness, personality changes, loss of hair from the eyebrows and scalp, and musculoskeletal pain. Changes in menstrual flow are also common. Menstrual disorders are often seen following whiplash trauma and appear to have a similar endocrine connection, although the exact mechanism is unclear.

• Headaches

After neck pain, headaches are the most prevalent complaint among those suffering whiplash injury. While some headaches are actually the result of direct brain injury, most are related to injury of the cervical spine (the part of the spine that runs through the neck) and its connecting structures. Many of the structures that are injured in this part of the spine can cause pain to be referred to the head, a fact that has been confirmed in several experimental studies over the years.

Headaches may be of the vascular or "migraine" type with visual disturbance, sensitivity to light and sound, and confusion. Most headaches are caused by muscle tension and spasm in the neck and shoulders.

• TMJ Problems

While I am still in the head, a less common but troublesome disorder that results from whiplash is temporomandibular joint disorder (TMJ). It, too, may cause headaches and is associated with pain in and around the jaw joint, just in front of the ear. Patients also report ringing in the ears. Clicking and popping noises in this joint are found in 40 to 50 percent of the normal population and, by themselves, are not a cause for alarm. However, new noises that arise after whiplash should be evaluated immediately. Many chiropractic physicians are specifically trained to treat TMJ.

• Neck Pain

Neck pain is the single most common complaint in whiplash trauma, being reported by over 90 percent of patients. Studies have shown that most of the structures in and around the spine are vulnerable to injury, and nearly all of them can cause neck pain. Often this pain radiates out across from the shoulders, up into the head and down between the shoulder blades. Because the nerves that provide motor power (i.e., those that make the muscles move) and convey sensory information (i.e., the sensations of touch, vibration, position sense and pain) exit from the spine, they may become inflamed, irritated or compressed by spinal injuries. When this happens, you may experience weakness, clumsiness, tingling, numbness or pain in your arms, forearms, hands or fingers.

• Low Back Pain

Low back pain is another poorly understood result of whiplash trauma. Many doctors, especially those working on behalf of insurance companies, dismiss it as coincidental to whiplash because they fail to comprehend the causal mechanism. Nevertheless, even the Insurance Research Council reports that it is seen in 39 percent of cases of whiplash. Most other studies of whiplash patients also report incidences of low back pain in 35 to 50 percent or more following whiplash trauma.

Other conditions and symptoms sometimes result from whiplash injury. We've merely discussed the most common of the constellation of symptoms here.

You should never assume that any condition is not related to the crash, merely because it develops days or even weeks later. Always report your new symptoms to your doctor so that he or she can make properly assess your condition.