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Wednesday, August 22, 2012

Soft Tissue Injuries: Whiplash Recovery is Estimated to be at 50% or less.


Soft Tissue Injuries.  Whiplash Recovery is Estimated to be at 50% or less.

Alan Himmel, DC.,PA.

I wanted to talk for just a little bit about soft tissue injuries.

Most people think that unless you are a person who has suffered from a soft tissue injury (STI), that these types of injuries are no big deal. Well, nothing can be further from the truth, and I'll tell you why:

The body is an amazing thing. If you simply step out of the way, and let the body do what it does, it heals itself pretty well. For example, of you cut your finger, bite your lip, or even sustain a burn, the skin goes through a process of healing where it sends some specific blood cells to the scene of the injury and gets the job done. Even bone heals up pretty nice as long as the fracture doesn't involve a joint or articulation between two bones.

But, an injury to muscle, ligament, or tendon, or nerve is not the same as a small scratch or a bruise.  I mean, the cellular and chemical process by which the body begins the healing process is the same, but since the injury affects muscles, ligaments, tendons, and nerves, the injury will generally affect the ability of the person to move their body and function.



Anyone who has ever sprained an ankle or a knee knows that these injuries, despite the body's best attempt at healing, take a very long time and also cause permanent deficits in function. Injured tendons and ligaments and other soft tissue usually involves fine tears of the fibers. There are of course different grades of these types of injuries which range from a few small torn micro-fibers, to a severe tear or rupture which should be surgically repaired to reconnect. Every sprain, whether it happens to a person's neck as in a whiplash, or ankle while playing basketball, involve torn fibers. These pulled and torn  fibers are the cause of pain, inflammation and loss of range of motion which is typical of these injuries. So, expect a loss of range of motion of your neck if you have sustained a whiplash.


One of the things that I see in my office, and one that repeatedly comes up on MRI's is straightening of the cervical spine.  It is often seen after a whiplash trauma and is often considered by some doctors to be a normal variant, which is unlikely to be of any concern.  And, I'm sure many of the practitioners out there who are reading this are thinking, " big deal", everyone has this.  In fact many orthopedists are not concerned by this at all.  But, I studied this.  It is my job to tell it like it is, even if it goes against the normal thinking many of my colleagues.  I will tell you why this is something that clinicians should be aware of and in fact, should be concerned about.



You see, the curve, or lordosis, in the cervical spine is not there by accident.  In fact, its there actually to help buffer the spine and protect the spinal cord from shock due to the possibility of axial forces or downward compression from the head due to trauma.  Just think, if you had a spine which was as straight as a pencil, every time you even took a step, the joints of the spine would have to deal with the compressive forces and the possibility of injury or even fracture of a bone.  As an experiment, take that pencil that's on your desk, hold it in your hand, and now, jam it directly into a book or something on your desk.  Now, imagine doing the same thing with a pencil that has a slight c-shape curve to it.  I bet that you could feel the impact of that straight pencil going into the book, but the curved one is able to take or absorb some of the energy of the force.  You will feel that the curved one sent less of a shock up through your hand.   Think about that for a moment.

The next thing you have to be aware of is that the spine has supportive structures like the Anterior Longitudinal Ligaments (ALL) and Ligamentum Flavum (LF) which are often damaged from a whiplash injury. (3)  These ligaments connect from bone to bone, and in this case, your cervical vertebrae, which helps to keep these bones together and keep the normal cervical lordotic curve. An interesting study which confirms injures to these ligaments due to whiplash, was recently completed by Fice and Cronin in Ontario,and in fact, thet studied the minimal G-forces required to cause these ligamentous disruptions. (4)   Thus it is clear that these important ligaments in the cervical spine are there for supportive reasons.  When we see a spine of a patient post whiplash, very often we see the straightening which may be due to a disruption of these important pieces of connective tissue. (5)  Just as you wouldn't ignore an ankle sprain which involves  disruption of ligaments, you should also never ignore disrupted ligaments in the cervical spine.  I think we can all agree that this is a much more critical part of the human anatomy.

So, does this sound like something you want to ignore? These types of injuries without a doubt require some sort of rehab. If left alone, you can expect a permanent loss of function and/or pain. Up to 50% of individuals who suffer a whiplash will fail to recover.(1)  Other studies have the rate of recovery even worse. (2) The patient should be slowly rehabilitated using various methods. This, in my opinion is an emergency. It might not be a life or death emergency, but this injury could cause permanent loss of function of a body part, and sometimes a noticeable straightening and deformity.  It needs to be treated and treated right away in order to limit the amount of loss.

If you have a whiplash type injury, find your local chiropractor.  We are trained to help people hurt like this.  If you are in South Florida, you can call me to schedule an appointment.

I have two websites because I draw patients from both Miramar and Pembroke Pines. Check out my websites: www.MiramarChiropractor.com and www.PembrokePines-Chiropractor.com

Refrences:

1.  2011 Dec 1;36(25 Suppl):S330-4.

Prognosis after whiplash injury: where to from here? Discussion paper 4.

Source

Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland, Brisbane, Queensland, Australia. m.sterling@uq.edu.au
2.  2011 Jan;42(1):25-32.

Identifying predictors of early non-recovery in a compensation setting: The Whiplash Outcome Study.

Source

Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia. pcas0573@uni.sydney.edu.au, petrina@harvard.co.nz
3.   2012 Aug 30. [Epub ahead of print]

The effects of ligamentous injury in the human lower cervical spine.

Source

Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA.
4.   2012 Apr 5;45(6):1098-102. Epub 2012 Jan 28.

Investigation of whiplash injuries in the upper cervical spine using a detailed neck model.

Source

Department of Mechanical Engineering, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1. jfice@uwaterloo.ca
5.   2010 Jan 14;130(1):29-32.

[Anatomy of the cervical spine].

[Article in Norwegian]

Source

Institutt for medisinske basalfag, Avdeling for anatomi, Universitetet i Oslo, Postboks 1105, Blindern 0317 Oslo, Norway. per.holck@medisin.uio.no