Following my previous post on auto collisions, and talking about the stress that our nervous system sustains during such an impact, I figured it would be obvious to write about one of the most common injuries during auto collisions. Whiplash.
Whiplash occurs during a rapid and sudden or violent impact causing the head of both drivers and passengers to jolt in one direction and rapidly sling to the opposite direction. For example the most common accident types are rear end accidents. The individuals being rear ended will initially feel a force causing their neck and heads to jolt backwards, followed by an immediate and rapid sling forward. This type of impact and motion will usually cause strain and injury to the connective tissues of the posterior neck.
Whiplash can occur in any direction. For example if you are the one that rear ended another vehicle, your body and neck will absorb the hit and jolt forward, and sling backwards. Usually in this case, the headrest helps to minimize the chances of injury, but damage can still happen. Same thing if you were hit on the side. In this case, the connective tissues on the side of your neck can get injured. Also, what position your head is in during the moment of impact will also affect which tissues get injured. All of this information is critical during the assessment process before treatment can proceed.
Injury usually occurs during the eccentric contraction of the connective tissues being forced during the second part of the movement. For example, being rear ended will initially cause you to jolt backwards, then sling forward. It's in slinging forward or to the side where the injury usually occurs. As that rapid movement is occurring, those muscles and tissues are contracting in order to prevent the head to go to far out.
An eccentric contraction is the motion of an active muscle while it is lengthening under load. For example when you do a bicep curl, you initially bring your forearm towards your shoulder. When you bring your forearm back down, your bicep is still contracting as it lengthens. It's in this contraction and lengthening of the tissues in your neck that will get strained or tear. Muscle, ligaments, tendons, and nerves are all in danger.
Now, I am using auto collisions as an example for whiplash only because it is a very common injury. But whiplash can occur during any activity or sport that will produce a rapid and violent force on any connective tissue in the neck.
The degrees of injury during whiplash can vary. From a slight strain to those requiring emergency medical attention. The human neck is a complex system made up of bone, muscle, tendon, ligament, fascia, arteries, veins, nerves, lymph vessels and lymph nodes. Not to mention it is where our spinal cord descends down into our spines. Severe injuries then could lead to paralysis or death.
Whiplash injuries can really benefit from manual and movement therapy interventions. When somebody comes to me due to a whiplash injury I will always start with an assessment. During that assessment I want to know what their exact symptoms are, I want to know where they feel pain, any radiating pain or sensations. Do they have headaches?I want to look at the quality of movement and active/passive range of motion. I want to know how much neurological tension is being caused the the nervous system. Most importantly, identify which tissues were injured or strained.
First I would want to reduce any neuro-muscular tension the patient or client may be experiencing. As mentioned in my last post, these traumatic events can cause the nervous system to increase the neural drive to the area, therefore making it tense as a protective mechanism. Not to mention that there is usually a lot of guarding occurring from the individual.
Once we can bypass the tension and guarding by stimulating the parasympathetic nervous system, then we can begin treating and targeting the effected tissues. For this process, massage won't do much. So I rely and use isometric contractions. Mainly PAILS.
Pails stands for Progressive Angular Isometric Loading. Meaning that I am going to have the individual gently contract the injured tissues in the direct angle where the individual is experiencing pain. Isometric means that the tissues are contracting but there is resistance, therefore not allowing any movement. Why is this necessary?
Firstly, isometric contractions can aid with pain reduction. Secondly, in order for the injured tissues to heal quicker and properly, they need to experience stress and tension. It is by force that the healing and renewing cells will know what to do and what direction they need to adapt into. This will also prevent scar tissue from settling in haphazardly and lay down more like a spider web causing restrictions down the line.
Thirdly, isometric contraction will not cause any more inflammation to the damaged tissues. That is because we are avoiding any gliding of tissues, and we perform the contraction right below the pain threshold. So it is a painless process.
I will normally instruct the patient or client on how to perform these isometric contractions at home, along with full neck rotational exercises. Continual stimulation is very important to ensure proper healing and a speedy recovery.
Recovery times depend on many factors. For one, the severity of the injury. I have worked with those that have experienced whiplash that caused nerve damage. Usually we are looking at a few months of recovery. Some can be very minor and will be good to go in a few weeks. Regardless, if you have experienced whiplash (whether recently or years ago), and are experiencing pain, you may want to consider manual therapy as an intervention for your pain.