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