| Rear-ended car accidents are common and the | | | | at the level of the disc or more outward away from |
| incidence of whiplash injuries is in the range of one | | | | the center of the spinal canal in the region of the |
| million annually in the United States1. Due to the | | | | foramen through where the nerve roots exit. |
| backward movement of the head upon the neck | | | | Whiplash type injuries of the nerve roots can occur |
| followed by a forward movement of the head, a | | | | also with falls, sudden recoil type movements from |
| whiplash injury often results in nerve related | | | | lifting injuries or with any sudden jerky and forceful |
| myofascial pain. | | | | movements to the head, neck and lower back. |
| Patients may suffer from neck, mid-back, and lower | | | | Quantitative electrodiagnostic studies which reveal |
| back pain and pain down the upper and lower limbs in | | | | the extent of the nerve damage is most useful for |
| various combinations. Often, these patients with | | | | determining the outcome for recovery. The prognosis |
| whiplash injuries sure to car accidents and other | | | | for recovery is dependent on the number and extent |
| trauma also suffer from muscle contraction | | | | of nerve roots involved, presence of nerve root |
| headaches, temporomandibular joint pain and a clicking | | | | impingement, age of the patient, associated degree |
| noise in the jaw joint with jaw movements, dizziness, | | | | of underlying degenerative spine disease, multiplicity |
| unsteadiness, tingling and numbness and coldness in | | | | and diffuseness of symptoms and the initial high pain |
| the fingers. Patients can also suffer from | | | | levels on presentation, etc. These nerve related |
| post-traumatic fibromyalgia resulting in total body pain. | | | | factors are more important than the speed or |
| Soft tissue trauma to the neck can result in an | | | | severity of collision or the extent of damage to the |
| increased incidence of fibromyalgia compared with | | | | vehicle but these factors do contribute to the |
| other injuries. There may also be a post-concussion | | | | amount of nerve damage induced. |
| syndrome leading to memory deficits and | | | | Routine treatments include physical therapy with use |
| concentration problems. | | | | of cold modalities in the acute condition and heat |
| Although symptoms may dissipate within three | | | | modalities such as hot packs after the first 24-48 |
| months of the car accident, 30% of the patients | | | | hours. Medications will include anti-inflammatory |
| may continue with chronic neck symptoms and 10% | | | | medications, pain pills and muscle relaxants. Mobilization |
| of the patients may have chronic headaches. 6% of | | | | of the tissues using massage, TENS unit and gentle |
| the patients may not be able to return to work even | | | | active range of motion can be useful. If cervical |
| after one year post car accident. | | | | collars are used, the narrow portion of the collar |
| Although patients may complain of pain predominantly | | | | must be kept in the front. As a general principle, the |
| on one side, careful neuromusculoskeletal examination | | | | use of the cervical collar should be limited to two |
| will reveal tenderness in many muscles on both sides | | | | hours on and two hours off. A good cervical pillow |
| of the spine, and in both upper and lower limbs with | | | | that supports the neck well during sleep is essential. |
| accompanied restriction in range of motion in many | | | | Patients must lie on their back to sleep. They must |
| joints. Sluggish tendon reflexes may be present. | | | | not sleep on their sides or on the abdomen. They |
| The most motion in a whiplash injury from a car | | | | must not place pressure on their arms and must |
| accident occurs at the C5-C6 vertebra level following | | | | avoid sleeping with their arms under the pillow or |
| 5g acceleration but force is also distributed to the | | | | head. |
| C4-C5 to C7-T1 levels depending on the intensity of | | | | Acute nerve related muscle pain is most responsive |
| acceleration2. Cervical spine x-rays may show | | | | to eToims Twitch Relief Method with treatment |
| straightening of the cervical spine due to paraspinal | | | | directed towards muscles supplied C2 through C8 |
| spasm. CAT scan and MRI scan are often performed | | | | nerve roots with emphasis on muscles supplied by |
| to rule out presence of herniated cervical disk and | | | | the C6 and C7 nerve roots and the trapezius muscles |
| nerve root impingement. Commonly the facet joints | | | | supplied by the C4 nerve root. The entire spine from |
| are involved. These tests may be normal since in a | | | | neck to the lower back needs to be treated. After |
| whiplash, the injury is to multiple level bilateral spinal | | | | controlling the neck pain, treatments also have to be |
| nerve roots. | | | | directed to the muscles supplied by the lumbosacral |
| The nerve roots in trauma induced whiplash injuries | | | | nerve roots. |
| become irritated from being stretched, distorted, | | | | 1. Evans RW. Some observations on whiplash injuries. |
| kinked or transiently compressed against bone either | | | | Neurologic Clinics. 10(4):975-97, 1992 Nov. |