Do you have Whiplash?

Whiplash         
Pain in the neck, shoulders, head or the base of the skull that occurs after a motor vehicle accident is often called “whiplash.” Most patients with whiplash recover in a few weeks or at most, a few months, but 15 to 20% of people develop chronic pain. Whiplash is not a trivial problem, because, once it has occurred, only 70% have recovered completely by one year and only 82% have recovered completely by two years. In addition to neck pain, there are many symptoms associated with the whiplash syndrome and include sleep problems, poor concentration and memory, blurry vision, ringing in the ears, fatigue, and weakness.

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The treatment for whiplash syndromes depends on the stage and degree of the problem and which structures have been injured. In addition to soft tissue injury, pain that persists after four to six months is usually due to injury to the facet joints, one or more discs, or both. The diagnosis can usually be made by injections, MRI, and X-rays. Treatment is usually successful, but requires physical therapy, injections, and occasionally surgery.

The term, whiplash, is confusing because it is both a mechanism of injury and the symptoms caused by a car accident. It is due to a traumatic event that causes the head to move suddenly (“whip”) in one direction and then recoil in the other direction. The most common cause of whiplash is a motor vehicle accident in which one vehicle is struck from behind by another. However, it can occur when a car stops abruptly after striking a pole, a wall, or another car, and can also occur after a side impact.

Significant damage to ligaments, discs, and joints can occur even if the swings of extension and flexion are not excessive, but often the neck is forced to the extreme ends of normal range or beyond. Because the trauma is usually sudden, occupants of the car are not prepared for the impact. The muscles are relaxed, which allows more forces on the discs, ligaments and joints. Perhaps the most important fact about whiplash is that significant pain and structural damage can occur at crashes of low velocity.

Whiplash: The causes of the pain
It is the patient with persistent pain without any other specific findings on examination or specialized tests that presents the most problems for the patient himself or herself, the doctors, and the legal system. In the first few weeks to months after motor vehicle accident, it is often impossible to determine the exact cause or causes of the pain. The symptoms and signs are not sufficiently specific. In almost every instance, the muscles and ligaments have been strained and may be inflamed, painful, and tender. However after about 3 months, primary muscle or other soft tissue injuries usually have healed.
The most common causes of persistent pain in whiplash are the facet joints and the discs. There is a poor correlation between the radiographic appearance of the joints and whether they are painful. Some joints which look bad are painless while other joints that look normal can be proven to be a source of pain. Only facet injections can determine whether the joint is painful.

In a research study by Drs. Bogduk and Aprill, in 23% of patients, facet joints alone were the cause of pain, in 20% of patients the discs alone were the cause of pain, and in 41% of patients both the facet joints and discs were contributing. They were not able to identify the source of the pain in only 17% of their patients.

Whiplash: Associated symptoms
Many whiplash patients have symptoms which seem unexplainable, such as headaches, pain in the shoulders, between the shoulder blades, or in one or both arms.

There may be fatigue, dizziness, problems with vision, ringing in the ears, heaviness in the arms, and low back pain. There can be poor concentration or memory, change in emotions with irritability, depression or short temper, and sleep disturbance. Dizziness occurs in one-quarter to one-half of people with whiplash injury. Again, researchers are not sure of the cause. The most likely explanation is an injury to the part of the inner ear that regulates balance. Problems with memory and concentration can be due to the pain itself, depression, medications, or trauma to the brain. Visual disturbances occur in 10 to 30% of whiplash patients and blurred vision is the most common.

Long-term Outcome
Fortunately, most people who suffer neck pain after a whiplash injury will recover by six months. However, a small percentage of people continue to have pain.

Most patients destined to recover completely will have done so by three to four months, after which the rate of recovery slows markedly. By two years, essentially all patients have reached their individual maximum improvement. About 18% continued to have significant pain two years after the accident! Patients who did not get well tended to be older, had pain which began sooner after the accident, and/or had their head rotated to either side at the time of impact. They also found that patients who, before the accident, had a history of neck pain, arthritis of the neck, or headaches did not do as well.

Neck Pain, Whiplash and the Legal System
In our litigious society, it is fairly likely if a person develops neck pain due to a whiplash injury in a motor vehicle accident there will be a lawsuit. Common sense would tell us the greater the pain and impairment, the larger the legal settlement or award might be. Rarely, patients may exaggerate their symptoms or be faking. However, a bigger question is whether the potential for money from a legal settlement can unconsciously prolong or worsen the pain. This is called “secondary gain” and it is unconscious, not fraudulent.

The effects of lawsuits and the outcome of whiplash syndromes
The science shows that personal injury litigation does not adversely effect outcome. In 1983, Drs. Norris and Watt reviewed 61 patients who were treated for whiplash injuries, 41 of whom had personal injury lawsuits. They found no change in symptoms after claims were settled. About ten years later, long after litigation had settled, only 12% had completely recovered, and 48% had pain which interfered with normal daily life.

In another study from 1993, Drs. Parinar and Raymakers re-evaluated patients they had seen previously for legal opinions, not for treatment, 8 years after the initial consultation. They concluded that lawsuits did not influence the timing or degree of recovery.