Whiplash is, by definition, the rapid
acceleration followed by deceleration of the head causing the neck to “crack
like a whip” forwards and backwards at a rate so fast that the muscles cannot
react quickly enough to control the motion. As reported last month, if a
collision occurs in an automobile and the head rests are too low and/or seat
backs too reclined and the head moves beyond the allowable tissue boundaries,
“whiplash” injury occurs.
gathering information from the patient, this portion of the history is called
“mechanism of injury” and it is VERY IMPORTANT, as it helps us piece together
what happened at the time of impact. For example, was the head turned upon
impact? Was the impact anticipated? What were the weather conditions (visual,
road conditions)? What was the direction of the strike (front, rear, side,
angular, or combinations of several)? Did a roll over occur? Was a seat belt
used (lap and chest) and were there any seat belt related injuries (to the low
back/pelvis, breasts/chest, shoulder, neck)? Any head impact injuries with or
without loss of consciousness (if so, how long)? Any short-term memory loss and
residual communication challenges (post-concussive syndrome)? All of the answers
to these questions are very important when determining the examination path,
establishing the diagnoses, and determining the treatment plan.
also discussed last month the WAD classification or, Whiplash Associated
Disorders, which was coined in 1995 by the Quebec Task Force. Types I, II, and
III are defined by the type of tissues injured and the history and examination
findings. In 2001, the Quebec Task Force found that WAD II (loss of range of
motion or ROM/negative neurological findings) and WAD III (both ROM loss and
neurological loss) carried progressively greater risk of prolonged recovery
compared to WAD I injuries (those with pain but no loss of motion or
a strong diagnosis allows for accuracy in prognosis and treatment plan
recommendations. For example, in WAD II & III injuries, flexion/extension
x-rays are needed to determine the extent of ligament damage as normally, the
individual vertebrae should not translate or shift forwards or backwards by more
than 3.5mm. Similarly, the angle created between each vertebra in flexion &
extension should be within 11 degrees of the adjacent angles, and if that’s
exceeded, ligament damage is likely to have occurred. So often, ER records
describe little to no information about the historical elements reviewed in the
1st paragraph and if x-rays were taken, they rarely include flexion/extension
are another component of WAD. Here, the first three sets of nerves that exit
the uppermost levels of the spine (C1, C2, and C3) innervate the head. When a
patient describes headaches that start in the upper part of the neck and
radiate up into the head, the distribution of the pain by history can tell us
which nerve(s) are most affected. In the examination, applying manual pressure
to the base of the skull can reproduce pain when a nerve is injured. Tracking
these findings on a regular basis can tell us how the condition is healing.
Chiropractic is at the forefront of diagnosis for WAD!
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.
To schedule an appointment with one of our whiplash doctors in downtown San Francisco call 415-392-2225. Mention this article for a complimentary in house or phone consultation.