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Monday, October 22, 2012

Whiplash, Damage to the Ligaments, Normal vs Abnormal Spinal Curves, etc.

More on Whiplash, damage to the ligaments, normal vs abnormal cervical curves, etc.

Alan Himmel, DC.

There is no doubt that chiropractors are best known for their excellence in conservatively treating conditions of the spine, and related back pain.  Whiplash of the neck, whiplash of the low back are certainly the most common.  These injuries happen, of course, when a person's body is thrown by force in one direction or the other, which causes the person's head, for example, to want to stay in its original resting position.  Studies show that head restraints reduce cervical spine whiplash injury.  (1)  When the person's body is thrown forward, and the head stays in its original position, only to catch up with the rest of the body after the impact, a person will likely sustain an injury to the cervical spine.  Likewise, if a person's lower body is quickly and forcefully thrown in one direction while the rest of the body is perfectly comfortable in its original resting spot, a person will likely wind up with an injury to the lumbar spine.

As you can see from the illustration above, the forces involved that affect the spine, in these types of traumas, can be very damaging to the muscles of the neck.

These spinal type whiplash injuries vary.  Sometimes the injury is simply to the muscles that support the neck or the low back.  These injuries are usually the least dangerous.  Other times the injury could be to the muscles and tendons, which is more of a troublesome type sprain of the soft tissues.  And, in the more severe cases, the injury could be to the muscles, tendons, nerves, and ligaments.  Any one of the above injuries are very painful and debilitating.  However, the whiplash type injuries to the ligaments are by far the most difficult for patients, and usually require more frequent therapies for a longer period of time.

Above you can see the ligaments that hold the vertebrae together.  As you can see, these ligaments are crucial for the integrity and maintaining the normal anatomy of the spine.  Any disruption of the above ligaments can cause weakness, hyper-mobility, or movements of the bones.

The issue with injuries to ligaments, is that these are supporting structures that connect two or more bones to each other.  These ligaments include the longitudinal ligaments of the spine, and from time to time, depending on who you talk to, I have heard the inter-vertebral discs being referred to as ligaments, because they connect between two bones.  Think of the longitudinal ligaments like the bark on a tree.  They go lengthwise up and down the spine, and in the case of the spine, offer support, so that each of the bones of the spine are lined up on top of the next in a certain fashion, which don't allow the bones to shift and move easily forward or backward. They are very important for support. (2) Very often, one of the most common things I see on x-ray or MRI, to a person's spine after a car collision, is what the radiologist calls "straightening of the spine", or in the more severe cases,  retro (backward) listhesis where a bone moves backward compared to another bone, or antero (forward) listhesis, where a bone moves forward compared to another bone. Take a look below:


The image on the left is a good example of straightening.  The image on the right is the way the cervical curve is supposed to look.

In my opinion, both straightening of the spine or either antero or retro listhesis confirms an injury to the longitudinal ligaments.  This is because these ligaments are designed to keep the vertebra in the correct anatomical position.  Bones that are out of position have lost their supporting structure, which is the function of the ligaments.

Note that the bones have moved in relation to the bone above or below.  This can happen with a disruption of the posterior or anterior longitudinal ligaments.

A colleague of mine likes to tell his patients that these injuries are "very tricky" because often times the patient begins to feel better within a couple of weeks, only to have a relapse in pain, as if the injury just happened.  Worse than that, if left untreated, these types of injuries become more debilitating, and eventually can result in chronic, lifelong physical issues.  Typically, these patients, when left untreated, begin to develop arthritic conditions  because now the mechanics of the joints are not correct, and are stressed.

1.  2009 Nov;24(9):699-707. Epub 2009 Aug 8. Whiplash injury prevention with active head restraint. Ivancic PCSha DPanjabi MMBiomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University, School of Medicine, New Haven, CT 06520-8071, USA.

2.   2012 Oct 11;45(15):2668-72. doi: 10.1016/j.jbiomech.2012.08.012. Epub 2012 Aug 30.  The effects of ligamentous injury in the human lower cervical spine.
Devin Leahy PPuttlitz CM.  Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA.

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