Whiplash injuries include damage to the soft tissues of the neck such as muscles, tendons, ligaments, and myofascial tissues. The degree of injury is typically graded on a 1-3 scale from least to most tissue damaged, respectively. A grade 1 sprain (ligament injury) or strain (muscle or muscle tendon injury) includes minimal tissue disruption or tearing while grade 3 sprains and strains include significant tissue tearing and subsequently longer healing times with greater chance of long-term residual problems. More severe whiplash injuries can result in fracture but those types of injuries are not indicated for traction forms of therapy until after the fracture heals and stability is restored to the neck. So, the question is, what role does cervical traction play in the management of neck pain associated with whiplash?

In whiplash injuries, when it feels good to the patient to have someone pull on their neck, that person is a candidate for cervical traction. The amount of weight or traction force and length of time are based on patient comfort and are highly variable. Therefore, it is important to start with a low enough weight so injury to the patient from the traction therapy is avoided. Typically, 5#/15 minutes is a safe starting point, gradually increasing the weight to a maximum tolerated level.

Many insurance companies, based on the published literature regarding cervical traction, regard it as a “medically necessary” form of treatment and hence, a covered service. There are many different cervical traction devices available for home use of which the over-the-door traction unit is typically the least expensive and in some cases mandated prior to insurance allowance for a more expensive pneumatic cervical traction device. Unless there are reasons that over-the-door traction is not tolerated such as jaw pain (due to the chin strap pressure), this approach is commonly utilized. This device includes a water bag that is calibrated for water weight and can be done multiple times a day, depending on each case. There is also a collar-type of traction unit which allows the patient to move around rather than sit in one place. However, the amount of weight is better regulated with the water bag/sitting type. There are laying down types of neck traction which can also be regulated accurately for weight. These tend to be more expensive and insurance companies may require use of the less expensive over the door type first, unless there is a medical reason that a chin strap is not tolerated. Below are pictures of the different types of units available.

We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Whiplash injuries include damage to the soft tissues of the neck such as muscles, tendons, ligaments, and myofascial tissues. The degree of injury is typically graded on a 1-3 scale from least to most tissue damaged, respectively. A grade 1 sprain (ligament injury) or strain (muscle or muscle tendon injury) includes minimal tissue disruption or tearing while grade 3 sprains and strains include significant tissue tearing and subsequently longer healing times with greater chance of long-term residual problems. More severe whiplash injuries can result in fracture but those types of injuries are not indicated for traction forms of therapy until after the fracture heals and stability is restored to the neck. So, the question is, what role does cervical traction play in the management of neck pain associated with whiplash?

In whiplash injuries, when it feels good to the patient to have someone pull on their neck, that person is a candidate for cervical traction. The amount of weight or traction force and length of time are based on patient comfort and are highly variable. Therefore, it is important to start with a low enough weight so injury to the patient from the traction therapy is avoided. Typically, 5#/15 minutes is a safe starting point, gradually increasing the weight to a maximum tolerated level.

Many insurance companies, based on the published literature regarding cervical traction, regard it as a “medically necessary” form of treatment and hence, a covered service. There are many different cervical traction devices available for home use of which the over-the-door traction unit is typically the least expensive and in some cases mandated prior to insurance allowance for a more expensive pneumatic cervical traction device. Unless there are reasons that over-the-door traction is not tolerated such as jaw pain (due to the chin strap pressure), this approach is commonly utilized. This device includes a water bag that is calibrated for water weight and can be done multiple times a day, depending on each case. There is also a collar-type of traction unit which allows the patient to move around rather than sit in one place. However, the amount of weight is better regulated with the water bag/sitting type. There are laying down types of neck traction which can also be regulated accurately for weight. These tend to be more expensive and insurance companies may require use of the less expensive over the door type first, unless there is a medical reason that a chin strap is not tolerated. Below are pictures of the different types of units available.

We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Whiplash can result from a number of causes, not just from motor vehicle accidents. A fall on the ice or a slippery floor, from a sports related injury, or even at the county fair on one of those rides that throws you around can result in the same type of injury. Whiplash occurs when the head is literally “whipped” either forwards and backwards or from side to side. It can include hitting the head but often does not. Symptoms vary considerably and therefore the term, “whiplash associated disorders” or WAD has been adopted, based on the clinical presentation of the patient and on the specific tissues injured. Common symptoms include neck pain, loss of motion, headache and sometimes arm pain or numbness resulting in difficulty driving, working, sleeping and concentrating.

Spinal manipulation of the neck has been found to be highly effective in the treatment of whiplash or WAD, and hence, Chiropractic is often the recommended first order of treatment for patients suffering from this condition. We have previously discussed the steps involved when presenting to a chiropractic clinic, from taking a detailed history and performing a thorough physical examination, and well as the many types of treatment options that exist. Exercise is one of the most important forms of treatment as they can and should be performed multiple times a day as directed by us, so that a return to normal function with no pain can occur as quickly as possible. Presented here are a few VERY EFFECTIVE exercises that we frequently give to patients suffering from WAD:

*For #3, ALWAYS apply a push or resistance with your hand through the FULL range of comfortable motion in that plane. That means, in one direction let the head “win” (like in arm wrestling) and when moving in the opposite direction, let the hand “win,” (but don’t let up pushing with the head). In other words, you are ALWAYS resisting against the movement in both directions moving as far as you can in both directions.

We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

The term “whiplash” usually brings to mind neck pain, headaches and/or a stiff neck. However, there are other symptoms associated with whiplash that we don’t usually think of, such as ringing in the ears or, tinnitus. In the absence of whiplash, there are many people who experience an occasional ringing or sound of some sort in their ears. The ringing may seem to keep time with the heartbeat or, in cadence with breathing and is more common over the age of 40, and more common in men. The sound can be a buzzing, ringing, roaring, hissing or high pitched noise that usually lasts only seconds or minutes at the most. So, think of those times when you’ve noticed tinnitus and ask yourself, “…how would that affect me if that noise never stopped or lasted for hours?”

Before we discuss the association of tinnitus with whiplash, let’s review some facts about tinnitus. There are two primary types of tinnitus: Pulsatile and Nonpulsatile. Pulsatile tinnitus is often caused by sounds created either by blood flow problems in the face or neck, muscle movements near the ear, or changes in the ear canal. The non-pulsatile tinnitus is usually caused by nerve problems involving hearing in one or both ears. The later is sometimes described as a sound coming from inside the head. The most common cause of tinnitus is from hearing loss that occurs from aging – technically called presbycusis. However, it can also occur from living or working in a loud environment. Tinnitus can occur with many types of hearing loss and can be a symptom of almost any ear disorder. Other common causes include earwax buildup, certain medication side effects (aspirin, antibiotics), too much caffeine or alcohol intake, ear infections – which can lead to rupture of the eardrum, dental problems, TMJ or jaw problems, following surgery or radiation therapy to the head or neck, a rapid change in environmental pressure (airplane rides, elevators, scuba diving), severe weight loss from malnutrition or dieting, bicycle riding with the neck extended for lengthy timeframes, high blood pressure, nerve conditions (MS, migraine headache), as well as other conditions such as acoustic neuroma, anemia, labyrinthitis, Meniere’s disease, otosclerosis and thyroid disease. The good news is that most of the time, tinnitus comes and goes and does not require treatment. When tinnitus is associated with other symptoms, does not get better or go away, or is in only one ear, it is wise to consult with us. Spinal manipulation and other chiropractic treatment approaches are often VERY helpful in resolving tinnitus with the benefits of avoiding the need for medications, all of which carry secondary side effects. Chiropractic approaches are also highly effective when tinnitus is accompanied by dizziness or vertigo, usually requiring treatment applied to the upper neck area.

So, how does whiplash cause tinnitus? There are primary as well as secondary causes that can give rise to tinnitus after whiplash. After looking at the long list of causes above, direct trauma to the head such as hitting the side window, the back of the seat, the steering wheel, mirror and/or windshield makes obvious sense. Secondary causes often involve the TMJ or jaw which is commonly injured in whiplash. By itself, TMJ can cause ear pain, tinnitus, vertigo (dizziness), hearing loss, and headaches. Because many nerves that innervate the neck and head arise from the neck as well as from the cranial nerves, spinal manipulation of the neck as well as certain cranial manipulations can have a dramatic benefit in treatment of whiplash induced tinnitus.

We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

The term “whiplash” usually brings to mind neck pain, headaches and/or a stiff neck. However, there are other symptoms associated with whiplash that we don’t usually think of, such as ringing in the ears or, tinnitus. In the absence of whiplash, there are many people who experience an occasional ringing or sound of some sort in their ears. The ringing may seem to keep time with the heartbeat or, in cadence with breathing and is more common over the age of 40, and more common in men. The sound can be a buzzing, ringing, roaring, hissing or high pitched noise that usually lasts only seconds or minutes at the most. So, think of those times when you’ve noticed tinnitus and ask yourself, “…how would that affect me if that noise never stopped or lasted for hours?”

Before we discuss the association of tinnitus with whiplash, let’s review some facts about tinnitus. There are two primary types of tinnitus: Pulsatile and Nonpulsatile. Pulsatile tinnitus is often caused by sounds created either by blood flow problems in the face or neck, muscle movements near the ear, or changes in the ear canal. The non-pulsatile tinnitus is usually caused by nerve problems involving hearing in one or both ears. The later is sometimes described as a sound coming from inside the head. The most common cause of tinnitus is from hearing loss that occurs from aging – technically called presbycusis. However, it can also occur from living or working in a loud environment. Tinnitus can occur with many types of hearing loss and can be a symptom of almost any ear disorder. Other common causes include earwax buildup, certain medication side effects (aspirin, antibiotics), too much caffeine or alcohol intake, ear infections – which can lead to rupture of the eardrum, dental problems, TMJ or jaw problems, following surgery or radiation therapy to the head or neck, a rapid change in environmental pressure (airplane rides, elevators, scuba diving), severe weight loss from malnutrition or dieting, bicycle riding with the neck extended for lengthy timeframes, high blood pressure, nerve conditions (MS, migraine headache), as well as other conditions such as acoustic neuroma, anemia, labyrinthitis, Meniere’s disease, otosclerosis and thyroid disease. The good news is that most of the time, tinnitus comes and goes and does not require treatment. When tinnitus is associated with other symptoms, does not get better or go away, or is in only one ear, it is wise to consult with us. Spinal manipulation and other chiropractic treatment approaches are often VERY helpful in resolving tinnitus with the benefits of avoiding the need for medications, all of which carry secondary side effects. Chiropractic approaches are also highly effective when tinnitus is accompanied by dizziness or vertigo, usually requiring treatment applied to the upper neck area.

So, how does whiplash cause tinnitus? There are primary as well as secondary causes that can give rise to tinnitus after whiplash. After looking at the long list of causes above, direct trauma to the head such as hitting the side window, the back of the seat, the steering wheel, mirror and/or windshield makes obvious sense. Secondary causes often involve the TMJ or jaw which is commonly injured in whiplash. By itself, TMJ can cause ear pain, tinnitus, vertigo (dizziness), hearing loss, and headaches. Because many nerves that innervate the neck and head arise from the neck as well as from the cranial nerves, spinal manipulation of the neck as well as certain cranial manipulations can have a dramatic benefit in treatment of whiplash induced tinnitus.

We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

The term “whiplash” was coined by Dr. Harold Crowe in 1928 during an interview on car collision related neck injuries but he reportedly “…regretted it later.” The term “whiplash” quickly became a household word and relates to a sudden movement of the head producing a neck sprain. It is now accepted that not only forward/backward movements during motor vehicle collisions (MCV) result in neck injury but also side to side and angular movements at the time of impact. In the past, we’ve discussed the number of milliseconds that takes place during the whiplash process after impact (~500 msec.) and the fact that voluntary muscle contraction takes longer (~800 msec.) making it next to impossible to adequately “brace” prior to impact, even when the collision is anticipated. Today, we’re going to look at the symptoms and complaints that are commonly described by whiplash patients.

“Early whiplash syndrome” is defined as the condition where immediate or very close to immediate symptoms are noted. One study reported symptoms commonly described after a MVC include the following: neck pain (93%), headache (72%), shoulder pain (49%) and back pain (38%) and, 87% of patients had multiple symptoms. Others reported nausea (48%) and dizziness (38%) as initial symptoms. For some, many of these symptoms resolve within days, weeks or months leaving a smaller percentage with symptoms that last beyond 6 months, which is then referred to as “late whiplash syndrome.” In one study of 52 patients, symptoms improved over a 2 week to 12 month time frame but then remained static or unchanged for the following year. Another study of 117 patients at the 2-year point, reported the following symptoms (the frequency of occurrence is in parentheses): Neck pain (17%), headache (15%), fatigue (13%), shoulder pain (13%), insomnia (12%), anxiety (11%), concentration loss (10%), and forgetfulness (10%).

Reasons for the continuation into a late syndrome are supported by two possible causes. 1. It is due to a high level initial symptom, including severe neck pain and headache often with radiating arm pain (radiculopathy). 2. It is caused by the stressful events that are present either at the time of the motor vehicle collision or soon thereafter. These stressors could include work loss, marital stress, financial stress, and/or depression or anxiety issues associated with being injured. It was also reported that the specific type of headache suffered in the late whiplash syndrome in a 47 patient study, 74% had tension-type headache, 15% had migraine and 11% had cervicogenic headache. Some authors have reported that the type of headaches that occur as a result of an MVC are similar to almost identical to those seen after head trauma from other causes including sports injuries such as football, hockey, and boxing.

Because “whiplash” results in a mechanical type of injury to the small joints of the neck, muscles and ligaments, the only logical choice for management and treatment is chiropractic. This is because chiropractic addresses the mechanical injury with a manual, hands-on approach specifically aimed at restoring function in the injured area. Studies are clear that whiplash patients make a faster, less painful recovery, return to work and desired activities faster and are the most satisfied when utilizing chiropractic when compared to covering up the symptoms with medications that have negative side effects that interfere with being able to think and ultimately, reduce productivity.

We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Last month, we discussed 10 facts about whiplash in attempt to dispel the myths about this topic. Due to the amount of information available, we couldn’t cover them all. So, here are 10 more interesting facts about whiplash:

1. Much has been published on the association between ongoing whiplash symptoms and litigation. There is now plenty of evidence that ongoing whiplash injury related symptoms occur regardless of the presence or absence of litigation.
2. The concept of a delay in symptoms means minimal injury is dispelled. In fact, it’s considered “the norm” that symptoms are delayed.
3. Mild traumatic brain injury (MTBI) or post-concussive syndrome can occur as a result of whiplash trauma. The good news is that, in most cases, recovery occurs within the first 3 months.
4. In the European Spine Journal, a recent study reported that between 1 and 2 years after a whiplash injury, 22% of patients’ conditions worsened. Condition deterioration at the 2 year mark has also been reported in other studies.
5. More detailed studies that followed whiplash patients through time, reported that 45% remain symptomatic at 12 weeks (3 months) and 25% at 6 months. Others reported the recovery time in most “minor cases” is 8 weeks (2 months), time to stabilization (not recovery) in the more severe cases was 17 weeks (4 months), and in the most severe category, 20.5 weeks (5 months). Hence, the concept that whiplash, like all other injuries heal in 6-12 weeks is challenged (note, there is little support for this common myth).
6. Each year, approximately 1.99 million Americans are injured in motor vehicle collisions.
7. Since 1990, a mean of 40% of a pool of whiplash patients from all vectors of collision (that is, rear, front or side impacts) were still symptomatic at a 2 year follow up. 59% of ONLY rear-end collision patients remained symptomatic at a 2 year follow-up.
8. Although these estimates vary, approximately 10% of WAD (whiplash associated disorders) injured subjects become disabled to a point of not being able to continue working.
9. Children who sustain whiplash injuries display sleep disturbances, nightmares, difficulty talking to parents and friends (brain injury), mood changes, poor academic performance and fears of participating in higher impact sports. Moreover, children tend to be overlooked in the evaluation and treatment process since they tend to complain less.
10. If the size of the 2 impacting vehicles is the same, an 8 MPH impact produces 2 times the force of gravity. When the bullet vehicle is larger than the target vehicle, the difference increases dramatically.

We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

In whiplash research, many articles have been published that conflict or contradict each other. The goal of this Health Update is to report the “facts” about whiplash.

• It is more common to have a delay in the onset of whiplash symptoms. Symptoms may start about two hours after the initial injury or it may take days, weeks, or months before you feel anything.
• For whiplash caused by car accidents, the severity depends on the force of the impact, the way you were seated in your car, and if you were properly restrained using a shoulder and seat belt.
• Tests show the soft tissues in your neck sustain injury at a threshold of 5 mph. That means if you’re rear-ended at 5 mph or slower, you have a lower chance of getting whiplash. However, most rear-end car accidents happen at speeds of 6-12 mph.
• If you’ve been in a car accident, it’s a good idea to be evaluated even if your car didn’t get damaged and you don’t feel any pain.
• Although whiplash is most often associated with car accidents, you can also get whiplash from sports such as snowboarding, boxing, football and gymnastics.
• The concept of “no car damage = no injury” is COMPLETELY false. Most cars can withstand collisions of up to 10 MPH and as pointed out above, only in collisions < 5 MPH are you less likely to be injured. Collisions that occur between 6-12 MPH cause the highest percentage of whiplash injuries (which is below the threshold of car damage in most cases). Also, the energy of the impact is transferred to the contents inside the car when there is no vehicular damage (that means you).
• Mild traumatic brain injury (MTBI) can occur in motor vehicle collisions even if the head does not hit an object inside the car, although it’s more common when there is a head strike. The symptoms associated with MTBI are often referred to as “Post Concussive Syndrome.”
• Approximately 10% of whiplash injured patients become totally disabled.
• Of the studies published since 1995, over 60% of whiplash patients required long-term medical care.
• Risk factors for long-term symptoms associated with WAD include: rear impacts, loss of the cervical lordosis curve, pre-existing degenerative arthritis, use of seat belts & shoulder harness (low speed impacts only), poor head restraint position or shape, non-awareness of the impending collision, female (especially long slender neck), head rotation at impact.

We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.