In a car accident? In pain? Looking to learn more about whiplash?
This webpage will explain:
- why you may not have had pain right away (maybe hours or days later).
- why x-rays and MRI images may fail to see a cause for your pain
- why whiplash hurts so bad
- the mechanism of the whiplash injury
- why you can have whiplash even at low speeds without much damage to the car
- what speed it takes to get whiplash
- understanding pain
- how more than your neck can be injured
If you want to learn home remedies for your pain, CLICK HERE.
If you are looking for the best chiropractor for your whiplash injuries, look no further. We have Dr. McCoy who is our sports and injury chiropractic specialist. Dr. Karin is not only is an expert on whiplash, but has had personal experience with it. To learn how she overcame her whiplash injuries without resorting to surgery, check out Dr. Karin Drummond's book, "Whiplash to Wellness"
The following is from her "Whiplash to Wellness" book:
Why Feeling Pain can be Delayed
It took me hours before I felt any pain after my auto injury. Why?
When our bodies experience pain or trauma, our prehistoric fight-or-flight system kicks in. Evolutionarily, it was an advantage not to feel pain immediately. In those days, when prehistoric humans were injured, they couldn’t afford to feel pain while the threat was still present. If they felt pain, they wouldn’t be able to fight or flee from the cause of the injury; then they would likely die and not pass on their genes.
We still experience the fight-or-flight reaction today. When we are severely injured, our brains release beta-endorphins, which are basically powerful opiates that block pain.
After a motor vehicle collision, the damage is there; you just can’t feel it. But over time, our kidneys filter these opiates out of our system, and we start to feel the effect of our injuries. Some people report pain three or four hours after the trauma; their injuries are so bad, they feel the pain as soon as the opiate levels start falling because it takes more opiates to block such severe pain. Other people may not feel any effects of the impact until the next day because it takes longer for the body to filter out the opiates to a level low enough to feel the pain.
If the pain starts two days after the trauma, then the person’s pain is likely because of their compensation mechanisms causing injury. For example, a driver feels right knee pain weeks after the car crash. This pain may be caused by the arch of the right foot having dropped from the impact of slamming on the brakes during the collision. This can cause knee pain weeks later because the body has changed its gait cycle to compensate for the collapse of the right arch with every step, which places stress on the knee.
So if you have any doubt if your pain is due to your auto accident, make an appointment with one of our whiplash chiropractic experts, and we will help you determine if your pain is due to the injuries sustained in the car crash.
To X-ray or not
X-rays are great for determining fractures, examining bone pathology, and showing evidence of instability and muscle spasm (Figure 3-1).
Whiplash is often “Invisible”
According to studies, whiplash injuries often fail to show many abnormalities on an X-ray, even with severe or unstable lesions. This is because the image of the neck is taken when the neck is not moving. Damage to ligaments and muscles affect how the neck moves, making it hypermobile and causing pain. X-rays don’t usually reveal how an injured neck looks at rest. If you get an X-ray after a car crash, ask about getting an X-ray taken with your neck in flexion (bending your head forward) and extension (bending your head back). With these images, a healthcare provider is more likely to see any instability caused by a motor vehicle collision. If these images still fail to show any signs of injury, your healthcare provider may order more specialized imaging like Dynamic Motion Imaging that uses fluoroscopy (like an X-ray video of your neck moving).
Many argue that you should X-ray after any trauma. If the instability is extensive enough, a chiropractor can harm someone severely with a manipulation. There have been cases of unknown bone pathology before a trauma that would not have been detected without X-ray. I have heard of people walking into a clinic with a broken cervical spine (not something you want to manipulate at all).
If in any doubt after a motor vehicle collision, you need to get imaging!
If you do not have previous MRI's of your spine, if you get an MRI within 2 months of the injury, you may be able to tell the disc herniations are due to injuries sustained in the car crash because there is still water in the disc. If the disc herniations are due to "old age", they are no longer hydrated and appear different from the newly herniated disc that still has water leaking out of it.
If you are in Bloomington, Indiana and looking for the best chiropractor for you injuries, we were voted Bloomington, Indiana's number one chiropractor. Why trust your hurt spine with anyone else?
Why Does Whiplash Hurt So Bad?
It makes sense that a broken bone hurts. You see a hard structure with a break in it. You see the cast that needs to be worn. For us visual creatures, it makes sense that a fractured bones hurts—a lot—and hurts as soon as it is broken.
When I look at pictures of myself taken within two days of the car crash, I can see why people didn’t realize how hurt I was. You can’t see how I couldn’t move without searing pain because I wasn’t moving.
I simply couldn’t turn my head because my protective muscles wouldn’t let me. But just standing there, I looked great. So the pain couldn’t be that bad, right?
I can’t state strongly enough how much pain I was in when this picture was taken. There is just no way to describe the pain that does it justice. But why? Why is there so much pain in the neck and/or spine?
Basic Spine Anatomy
At risk of oversimplifying, the spine is made up of a column of bones with intricate connections. The bones are lined with fascia, ligaments, tendons, and muscles (both big and small). The neck and low back have lordotic curves, and the middle back has a kyphotic curve.
The neck and low back are more vulnerable to rear-end collisions, and the middle back is more vulnerable to front-end collisions.
So How Does the Whiplash Injury Occur?
Without getting complicated, I’m going to use a balloon analogy. When you first try to blow up a balloon, it’s really hard to inflate it. If you stretch it first, it’s easier to blow up. If you deflate it and blow into it again, it inflates even easier.
This is similar to what happens in a whiplash injury.
Imagine two bones surrounded by a thick rubber balloon holding the bones together. If you stretch the bones apart with some pressure, they return to their normal tight position when you let go. But if you use enough force to overstretch the bones apart, the rubber stretches to a point where it thins out. When you let go of the bones, they won’t be held together as tightly as before.
The “balloon” has been “blown up”, overtly stretching it. Now it doesn’t take as much force to “inflate” it.
You are now vulnerable to injury with less force than before the car crash! By simply leaning forward to reach for something, the bones may move apart abnormally and painfully, and bam—you feel severe pain as the bones shear apart.
Before the advent of videography that could capture one thousand frames per second, the scientific explanation of whiplash was that it is simply a hyperflexion/extension (head whipping back and forth) injury (Figures below).
Other experts would argue that the neck could handle such movement without injury, so whiplash was “faked” by people who were just looking to get more money out of the litigation process.
Since the late 1990s, with the ability to see what happens in the first 200 milliseconds of a deceleration injury, we have learned that damage occurs even before the head whips back and forth! At impact, damaging forces cause the vertebrae in the neck to slip forward in an unnatural way, causing injury (Figure 4-3). Using my earlier analogy, this is what “overtly stretches the balloon.” Then, without having a “tight balloon” holding the bones together, when the head does whip back and forth, further damage occurs!
So the other experts were right: A healthy, undamaged neck can handle a whipping back-and-forth action, but it can’t handle that motion after the neck’s supporting ligaments are damaged in the first 200 milliseconds.
If you need an expert witness to explain this to your attorney, our whiplash chiropractic experts are able to go to court for you.
Mechanism of whiplash from being rear-ended
The injury caused by being rear-ended occurs even before your head whips back and hits the headrest. When a vehicle is hit from the rear, the bones in the lower neck slide forward and stretch too far apart in the first 200 milliseconds.
At impact, the lower neck bones are jerked forward with the body before the upper neck and head even move. This can cause injury in less than one-hundredth of a millisecond after the impact.
This shearing force causes the normally lordotic C-curved cervical spine (the normal anatomy of a neck) to misshape into an S-shaped cervical spine
In the images above: The dark lines depict the change of the curvature in the neck from a neutral C curvature to an aberrant S curvature in the first 200 milliseconds after impact.
Even though the shearing movement only takes milliseconds, it can cause so much abnormal movement to the middle bones of the neck (C3–C5) that it can injure the phrenic nucleus. The phrenic nucleus is the “house” of the nerves that supply the diaphragm so we can breathe without having to think about it. Damage to the phrenic nucleus can result in everything from hiccups to affecting one’s ability to breathe. Poetically put, “Nerves C3, 4, and 5 keep the diaphragm alive.”
Just 200 milliseconds after impact, the head and the upper neck whip back into extension while the torso is restrained by the seat belt. The figure above shows the hyperextension to an already injured neck leading to disc herniations and possible fractures. This is where hyperextension injuries occur. When the neck jerks back into hyperextension, the deeper posterior structures are crushed as the bones slam together. Without the support of their ligaments, the vertebrae can slip out of their normal position and squish the tissue between them. If the head jerks back far enough, muscles and ligaments in the front of the neck can sprain, tear, and bleed. This can result in one or more blood clots in the soft tissue (which can also elicit pain).
The deeper structures of the front of the neck can get hyper-stretched as well. The anterior longitudinal ligament (the ligament that supports the front of the vertebrae) can tear, leading to instability of the neck bones; the anterior annular part of the discs can tear; and the endplates of the vertebral bodies can fracture.
Then you have the rebound effect.
After all the shearing and hyperextension injuries, the body is thrown forward into hyperflexion (Figure 4-6), where the injured discs are now squished and twisted. This creates a perfect condition for the jelly material inside of the discs to rupture out (herniating the disc).
Mechanism of whiplash from a front-impact collision
With a front impact (like mine), the forward momentum of the upper body causes a shearing action to the discs of the middle (the kyphotic thoracic) spine.
At impact, the mid-back to low-back bones are jerked back before the upper back bones even move.
So, with a front impact, the top vertebrae slide forward on the vertebrae below it (Figure 4-7). Facet joints help limit this type of movement, but if the force is strong enough, it can crack the cartilage and/or fracture the bones of these joints.
Plus, you still have loading (compression) forces on the spine. These forces occur when the body slams down into the seat after being launched off the seat on impact. The discs in the spine can bulge, if not rupture, when the body drops back into the seat.
The spine may also experience twisting forces as the body is pinned back on one side with a seat belt (Figure 4-9). The twisting forces result in some of the facet joints crashing together and other facet joints being torn apart. Both actions can result in injury and pain.
These forces can rupture (herniate) the discs as the vertebrae compress. The compression squishes the jelly material out from the center against the discs’ strained outer fibers, which are twisted more than they can handle. This creates a perfect condition for the jelly material to rupture out of the disc.
The rebound effect in a front-end impact throws the body back. If the impact is hard enough, the neck can be subjected to shearing forces similar to those that occur in a read-end collision.
If intense enough, a deceleration injury can be life threatening. Hyperextension can tear the wall of the large artery coming out of your heart (aortic disruption). Hyperflexion can compress your heart enough to bruise it or fracture your sternum and/or ribs without even hitting the dashboard or steering wheel.
Of course, bones can break if there is a direct impact.
Whiplash can involve more than just the neck
All impacts cause injury to the ligaments, muscles, nerves and joints of not only the neck, but potentially to the back, jaw, and so much more.
The arches of the feet and the ankles, knees, and hips can be injured while slamming on the brakes or from striking the dashboard on impact.
Wrists, elbows, and shoulders can get hurt when the airbag deploys or simply by gripping the steering wheel during the impact.
Jaw-lash is when the jaw gets sprained/strained from the shear forces during the impact. If you have clicking or pain after a jaw injury, you likely have Jaw-lash, trauma induced TMD (temporomandibular joint disfunction). To learn more about jaw pain and natural remedies, CLICK HERE.
If you are in pain, we can help. We are injury specialist chiropractors.
Can a Person Be Injured or get whiplash When There Isn’t Much Damage to the Car?
Yes! I can’t tell you how many times I have heard from my patients that the insurance company for the at-fault driver is claiming the driver or passengers in the other vehicle can’t be seriously injured because there wasn’t much damage to the vehicle.
This is simply not true! These insurance companies are trying to get out of paying for something they are responsible for. I have witnessed too many instances of insurance companies trying to strong-arm my patients into thinking their case is weak and their symptoms are exaggerated. Insurance companies save a ton of money by getting people to settle their cases too early, which results in patients not getting the care they need to fully recover.
I am writing this book to give you and/or your loved ones the backing you need to get a fair settlement. If you’re in pain, you are not well. Don’t let insurance companies convince you that you don’t have a case. Find the treatments that work for you and continue your care until you are well! Don’t settle for less.
You can suffer injuries inside a car that doesn’t show much damage, especially an older car. Newer cars are designed to crumple on impact, which absorbs the force of the collision. When you’re in a crash in a newer car, the metal bends on impact instead of your body getting jolted or thrown around inside the car.
Older cars have thicker steel. During an impact, the steel doesn’t give as much, so the force transmits to the people inside the car. If the cars collide at stiff points (like the trailer hitch), the car may not have much damage, but the passengers will be injured from the jostling force of the impact.
What Speed Does It Take to Get Whiplash?
You can get whiplash at speeds much lower than those involved in a motor vehicle collision. I have had patients who have suffered a whiplash injury after they’ve slipped on ice, jarring their body and causing their head to whip back in an unnatural position, resulting in further injury.
Speed is just one factor that determines how severe an injury will be. If the angles of the shear forces on the body are such that they reinjure an old injury or cause a new injury, pain results.
Now that you understand a little bit about how physical damage to the body occurs, let me explain why relatively small muscle strains and ligament sprains hurt so bad.
Understanding How Our Bodies Communicate Pain
When we experience a car crash, our muscles kick in and hold us together, since the ligaments that hold the bones of our spine in alignment are now too stretched and loosened too. Adrenaline courses through our body, so we don’t necessarily feel the pain right away. But as the adrenaline wears off and the muscles start getting tired from holding the bones together in a way that they’re not designed to, bones start slipping out of their regular position, putting pressure on our nerves. These nerves have a direct link to the brain. I call this “core pain.”
When the spine is injured, or a neck suffers with whiplash, the nerves going into and out of the spine can be affected. If the cluster of nerve cells known as the dorsal root ganglion is injured, the body’s distal nerve pain signals to the spinal cord are amplified, increasing the sensation of pain. This pain originates close to the spine with a direct connection to the brain. This pain is difficult to block.
When your extremities are injured, two nerves transmit information to the brain: (1) A sensory nerve goes from a distal region of the body, like an arm, hand, leg, or foot, to the spine. (2) A post-synaptic nerve cell continues the transition of information up the spine to the brain. Between these two nerves, the pain response delivered to the brain can diminish or increase.
The space between nerves is called a synapse, which is where chemicals (neurotransmitters) exchange information from one nerve to another. Synapses can be affected by chemicals from surrounding nerves that can deaden the pain. When you experience distal pain, pain gates can close, diminishing the pain. This is why rubbing the area makes you feel better; the touch receptors close the pain gates so the brain can sense their touch input.
Synapses can also be affected by chemicals in the blood, like adrenaline and pain-relieving drugs. Distal pain, like knee pain, is easier to block with pain-relieving medicine than core pain, like spinal injuries.
Nerves inside the spine have a direct link to the brain. This type of pain cannot be blocked, short of medical anesthetics. Spinal injuries cause deep, intense, crippling pain. The pain is compounded by the exhausted muscles still trying to hold things together, producing an increase in metabolic waste as a side effect. Metabolic waste is neurotoxic, which also increases the sensation of pain.
The chronic contractions of a spastic muscle constrict the blood vessels that bring the muscle the nutrients it needs to function and heal. The contractions also constrict the veins and lymphatic vessels, preventing the drainage of toxic metabolic waste.
This buildup of metabolic waste surrounding the muscles and nerves irritates them, making the muscles tender to touch and causing the nerves to fire even more pain signals to the brain. Then the muscles attempt to spasm more, trying to stabilize the injury even further.
To learn how Dr. Karin overcame her whiplash injuries without resorting to surgery, check out Dr. Karin Drummond's book, "Whiplash to Wellness"
Or better yet, call us.
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 Swan, Swan, and Swan, “Decelerational Thoracic Injury,” Journal of Trauma, Injury, Infection and Critical Care.
 Yoganandan et al., “Whiplash Injury Determination,” Spine.
 Davis et al., “Cervical Spine Hyperextension Injuries,” Radiology.
 Davies, “C3, 4, 5 Keeps the Diaphragm Alive,” American Journal of Forensic Medicine and Pathology.
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Drummond Chiropractic, LLC
Best Whiplash Expert Chiropractors in Bloomington
565 N Walnut St
Bloomington, IN 47404
(812) 336 - 2423