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Whiplash is the common name for a hyper extension/flexion injury to the cervical, thoracic or lumbar spines. The injury is referred to as "whiplash" due to the neck or back being thrown forwards and/or backwards at a rapid speed. This causes the fibres of the neck muscles to tear, resulting in pain and often a decreased range of movement.
Whiplash is a commonly associated with motor vehicle accidents, usually when the vehicle has been hit in the rear, [1] however the injury can be sustained in many other ways. In an accident resulting from excessive speed, this concrete truck rolled over into the front garden of a house. ...
Cause A whiplash injury is the result of impulsive stretching of the spine, mainly the ligament: anterior longitudinal ligament which is stretched or tears, as the head snaps forward and then back again causing a whiplash injury.[2] The Insurance Institute for Highway Safety defines whiplash as: "a range of neck injuries that are related to sudden distortions of the neck."[citation needed] It takes about 100 milliseconds for an occupant's body to catch up to the car when it is hit, and it is during this time that the damage occurs.[citation needed] The vertebral column seen from the side The vertebral column (backbone or spine) is a column of vertebrae situated in the dorsal aspect of the abdomen. ...
The Insurance Institute for Highway Safety is a U.S. non-profit organization funded by auto insurers. ...
Whiplash can be caused by any motion similar to a rear-end collision in a motor vehicle, such as may take place on a roller coaster or other rides at an amusement park, sports injuries such as skiing accidents, other modes of transportation such as airplane travel or from being hit or shaken.[3] Shaken baby syndrome can result in a whiplash injury.[2] A rear-end collision in Yate, near Bristol, England, in July 2004. ...
A typical roller coaster The roller coaster is a popular amusement ride developed for amusement parks and modern theme parks. ...
Germany Pavilion, part of the Epcot Center theme park in Orlando, Florida Amusement park (also called theme park) is the generic term for a collection of rides and other entertainment attractions assembled for the purpose of entertaining a fairly large group of people. ...
Shaken baby syndrome (SBS) is a form of child abuse affecting between 1,200 and 1,600 children every year in the USA.[1] SBS encompasses a variety of outcomes that are attributed to shaking an infant or small child. ...
Symptoms Symptoms reported by sufferers include: pain and aching to the neck and back, referred pain to the shoulders, sensory disturbance (such as pins and needles) to the arms & legs and headaches. Symptoms can appear directly after the crash, but often are not felt until days afterwards.[1] A headache is a condition of mild to severe pain in the head; sometimes upper back or neck pain may also be interpreted as a headache. ...
Diagnosis Reliably diagnosing a whiplash injury or disorder is not difficult for a trained doctor. If a patient cannot achieve the full motion, or has excessive range of motion, the probable ultimate cause is the whiplash motion.[citation needed] Diagnosis (from the Greek words dia = by and gnosis = knowledge) is the process of identifying a disease by its signs, symptoms and results of various diagnostic procedures. ...
Québec Task Force The Québec Task Force (QTF) was a task force sponsored by Société d'assurance automobile du Québec (SAAQ), the public auto insurer in the province of Quebec, Canada. The QTF submitted a report on Whiplash-associated disorders (WAD) in 1995, which made specific recommendations on prevention, diagnosis and treatment of WAD. The recommendations have become the base for Guideline on the Management of Claims Involving Whiplash-Associated, a guide to classifying WAD and guidelines on managing the disorder. The full report titled Redefining "Whiplash" was published in the April 15, 1995 issue of Spine.[4] A task force (TF) is a temporary unit or formation established to work on a single defined task or activity. ...
This article or section does not cite its references or sources. ...
1995 (MCMXCV) was a common year starting on Sunday of the Gregorian calendar. ...
Spine is an international bi-weekly peer-reviewed medical journal in the field of the spine. ...
Québec Task Force grades of disorder Four grades of Whiplash-Associated Disorder were defined by the Quebec Task Force on Whiplash-associated disorders (WADs): - Grade 1: complaints of neck pain, stiffness or tenderness only but no physical signs are noted by the examining physician.
- Grade 2: neck complaints and the examining physician finds decreased range of motion and point tenderness in the neck.
- Grade 3: decreased range of motion plus neurological signs such as decreased deep tendon reflexes, weakness, insomnia and sensory deficits.
- Grade 4: neck complaints and fracture or dislocation, or injury to the spinal cord.[4]
Consequences The consequences of whiplash range from mild pain for a few days, to severe disability caused by restricted head movement or of the cervical spine, sometimes with persistent pain. The injury can exacerbate pre-existing conditions, such as spondylosis and other degenerative changes.[citation needed] For other uses, see Pain (disambiguation). ...
Look up disability in Wiktionary, the free dictionary. ...
A cervical vertebra Cervical vertebrae (Vertebrae cervicales) are the smallest of the true vertebrae, and can be readily distinguished from those of the thoracic or lumbar regions by the presence of a foramen (hole) in each transverse process. ...
Chronic pain was originally defined as pain that has lasted 6 months or longer. ...
Prevention When travelling in an automobile a properly adjusted headrest can reduce the severity of the injury.[2] The top of the headrest should be in line with the top of the occupant's head. Maintaining an adequate separation from the vehicle in front while driving and pressing your back against the seat while facing forward if a collision appears imminent might also be advisable.[5] This helps prevent the neck being forced backwards, and decreases the risk of whiplash. For the magazine called automobile, see Automobile Magazine. ...
Tailgating is the practice of driving on a road too closely behind another vehicle, such as less than the travel distance in two seconds or equivalently, one vehicle-length for every 5 mph of the current speed. ...
Whiplash protection The focus of preventive measures has been on the design of car seats, primarily through the introduction of headrests. So far the injury reducing effects of head restraints has been relatively low, approximately 5-10%, because car seats have become stiffer in order to increase crash-worthiness of cars in high-speed rear-end collisions which in turn increases the risk of whiplash injury in low-speed rear impact collisions. Improvements in the geometry of car seats through better design and energy absorption could offer additional benefits. Active devices move the body in a crash in order to shift the loads on the car seat.[1] A car seat usually refers to a small seat secured to the seat of an automobile equipped with safety harnesses to hold children in the event of a crash. ...
The headrest on the passenger seat of a Lincoln Town Car. ...
Some car manufacturers have begun to implement various whiplash protection devices in their products in order to reduce the risk for and severity of injury, such as
Whether or not such devices offer any substantial benefit over vehicles without them remains controversial. In a test undertaken by the Swedish National Road Administration and an insurance company (Folksam), one test showed that a whiplash protection device was no guarantee against injury and that the degree of protection varies between vehicles both with and without whiplash protection devices.[9] This page is about the Mercedes-Benz brand of automobiles and trucks from the DaimlerChrysler automobile manufacturer. ...
2004 Mercedes-Benz W169 A200 The Mercedes-Benz A-Class (popularly known as the Baby-Benz) is a supermini produced by the German automaker Mercedes-Benz. ...
Ford may mean a number of things: A ford is a river crossing. ...
Nissan Motor Co. ...
This article is about the European car manufacturer. ...
Peugeot is a major French car brand, part of PSA Peugeot Citroën. ...
Saab Automobile AB is a subsidiary of General Motors. ...
Volvo Cars, or Volvo Personvagnar, is an automobile maker founded in 1927 in the city of Gothenburg in Sweden. ...
Jaguar Cars Limited is a British luxury car manufacturer, with headquarters in Browns Lane, Coventry, England. ...
This article is about the multinational corporation. ...
The Swedish National Road Administration, Vägverket, is a government agency in Sweden. ...
Folksam is one of the largest insurance companies in Sweden. ...
Biomechanical aspects of whiplash injury Probably the best-known and most controversial injury nowadays is the whiplash injury. The collision forces do not necessarily have to leave external damages on the head, rather they lead to compact brain injuries. In lethal cases, which appear seldom, greater bleedings of the head callosity can be found during the post mortem examination, even though no injuries can be seen from the outside. Then a whiplash injury by a rear impact accident with a compact brain injury is not an absolute whiplash injury. But also an absolute whiplash injury without head impact can lead to cerebral injuries. This could be proved in 1968 by Ommaya et al. in an experiment with monkeys. So a whiplash injury is a distortion of the cervical spine with or without cerebral involvement. According to the Quebec Task Force on Whiplash-Associated Disorders (Spitzer et al. 1995), peripheral disorders such as pain or stiffness in the neck and cerebral disorders such as headache, dizziness, tinnitus, concentration and memory disorders, deglutition dysfunctions and temporomandibular dysfuncions (functional disturbances in the area of the lower jaw at the passage to the temple) are symptomatic. A fibrillating or blurred sense of vision also appear frequently. These symptoms appear with a characteristic latency (time delay) of 0 to 72 hours. The cerebral symptoms mentioned above are relevant in order to chronify a disease. Unfortunately just these symptoms provoke heavy controversies among physicians during the assessment of the connection with the accident (causality). A whiplash injury can emerge almost everywhere: During a traffic accident, while doing sports or at work. Yes, it can even happen while skiing or in an airplane, although it has to be said that car accidents are by far the most frequent reason for a whiplash injury. The critical factor for the occurrence of a whiplash injury is not the place, but the mechanism of the accident, i.e. the body has to perform the movement of a whip stroke. The exact course of such a whip movement during a rear-end collision can be seen in the subchapter. The common diagnostic method with a whiplash injury of the cervical spine is shown in the adjacent diagram and can be looked up in appropriate medical literature. But there are examinations that are generally less known in the emergency departments of hospitals: First, the determination of the brain’s state is mostly missing, even though the appearance of the symptoms mentioned above indicate a damage. Second, the examination of the passage from head to neck is missing. And also the next problem appears here: The possible injuries of the brain, of the passage from head to neck and also of the jaw area (see above) need an interdisciplinary treatment. Thus, depending on the severity of the case specialists from orthopaedics, neurology, ENT medicine, maxillary surgery and neurosurgery would have to cooperate in the creation of a diagnosis and the corresponding treatment. Mostly a whiplash injury is only treated from the point of view of an orthopaedist. This may be sufficient in light cases of the whiplash injury. However, if the patient’s discomfort does not ease, examinations by the specialists mentioned above to clarify the circumstance would immediately have to be ordered. And this is mostly not done, with fatal consequences for the patient, so that irreparable damage can possibly result.
Injuries at the passage from head to neck With a whiplash injury, the cervical spine is over-expanded. But not every “whip stroke” happens in the exact “nodding axis of the head”. If you collide with an obstacle e.g. by car in a rather lateral way, or if cars collide on a crossing, then it is absolutely possible that the whip stroke is triggered a little displaced from the normal nodding axis and that it includes a kind of “head shaking”. So it is indeed possible that twists also occur in the cervical spine. And not only this: We know from the cervical spine’s anatomy that the cervical spine has a network of ligaments and arteries. Furthermore there is a joint connection (head joint) between the Atlas (C1) and the Axis (C2). This is the most flexible, but also the most unstable part of the spinal column. The Dens is a kind of “buttress” and prevents the head from over-flexion. All other movements like head shaking, nodding, turning the head etc. are secured by the ligaments and capsules. In a whiplash injury sometimes a rather violent and not consciously controllable over-flexion of the head occurred. That way it is possible that the head joint consisting of Atlas and Axis is “opened” more than its anatomical limits allow. Exactly this opening has to be prevented on the Axis by the three ligaments Ligamenta alaria right and left and Ligamenta cruciforme, as well as the Membrana atlantooccipitalis anterior on the Atlas, and they can now at least be over-expanded, but also be partially or completely torn. There is another ligament that can be abnormally expanded or torn apart: the Ligamenta transversum. This ligament prevents the Dens from touching the spinal cord. A “simple” over-expansion or twist of the cervical spine is normally cured after about six weeks, a ligament injury is not. And this is exactly where in my opinion an unnecessary and sometimes vehement discussion among physicians begins that is too often carried out to the patient’s disadvantage. The latter will hear an opinion from one doctor and from the other one a different opinion again. Why? The solution of the mystery lies in the exact examination of the patient’s passage from neck to head. Some physicians think that a whiplash injury is a rather light injury. If a damage of the cervical spine were existent, it would be visible on the X-ray images. If there is none, then it is just a whiplash injury. The other physicians have the point of view that the cervical spine can not only become injured in the middle section, but that the head joint and/or the ligaments can also be injured and that this has to be examined.
How can an injury at the passage from neck to head be determined then? The diagnosis and therapy of injuries at the passage from head to neck a bit more closely: Patients with a whiplash injury of the cervical spine that does not involve an osseous injury or the injury of nerval structures face the problem that these patients are examined by accident surgeons, orthopaedists etc. and that normal X-ray images are made for the examination. These images naturally do not indicate changes of the cervical vertebrae resp. of the affected section since normally a static image is taken.
This situation applies also to modern examination, like e.g. computed tomography or magnetic resonance imaging because these are not functional examinations. With a patient lying still, of course no torn ligaments can be detected. This can be compared with a tear-off of the ligaments at the knee-joint. If the knee-joint ligaments are torn, the patient is not capable of walking. But the X-ray images performed while lying do not result in an abnormal statement. If the knee and also the entire leg were examined by a neurologist because the patient could not walk, then no neurological changes at all would be recognizable here either. But if a stress image of this knee-joint, i.e. a functional one, is taken, a dysfunction of the knee-joint, that is, the enlargement of the knee-joint gap in an abnormal form, can immediately be determined and documented. So the conclusion can be drawn that the ligament on the knee-joint or on the ankle must be injured, since otherwise the gap at the joint would not allow such a wide spread. Equally, a ligament injury on the cervical spine cannot be proved because most of the produced X-ray and MRI images are not done functionally.
Head neck joint instability In this case an adequate operation for stabilization can help. The patients with an instability at the passage from head to neck often show the symptoms already mentioned like headache, decrease of memory, partial signs of paralysis, prickle in the arms or legs, frequent dizziness, ringing in the ears, dysfunctions and pain in the area of the jaw joints, of the ears and eyes. These symptoms confirm the suspicion of a structural instability of the passage from head to neck. In order to judge these symptoms better, we have developed a form in which the patient can describe his disorders. - Diagnosis of head neck joint instability
References - ^ a b c d e f Assessment of Whiplash Protection in Rear Impacts (PDF), Swedish National Road Administration and Folksam, April 2005 (English)
- ^ a b c
- ^ Whiplash injury, August 23, 2006 (English)
- ^ a b Guideline on the Management of Claims Involving Whiplash-Associated Disorders, August 23, 2006 (English)
- ^ Bilars skydd mot pisksnärtskada (Protection against whiplash injury in cars) PDF, Swedish National Road Administration and Folksam, August 22, 2006 (Swedish)
- ^ Long Fibre-Reinforced Polyamide for Crash-Active Car Headrests, August 22, 2006 (English)
- ^ Top Safety Ratings For Saab Active Head Restraints, UK Motor Search Engine, August 22, 2006 (English)
- ^ Volvo Seat Is Benchmark For Whiplash Protection, Volvo Owners Club, August 22, 2006 (English)
- ^ Whiplashskydd inte alltid säkrare (Whiplash protection not always safer), NTF, August 22, 2006 (Swedish)
The Swedish National Road Administration, Vägverket, is a government agency in Sweden. ...
Folksam is one of the largest insurance companies in Sweden. ...
April is the fourth month of the year in the Gregorian Calendar and one of four with the length of 30 days. ...
2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ...
The Swedish National Road Administration, Vägverket, is a government agency in Sweden. ...
Folksam is one of the largest insurance companies in Sweden. ...
NTF (National Transfer Format) Designed in 1988 specifically for the transfer of spatial information; it is administered by the British Standards Institution. ...
Further reading MedlinePlus (medlineplus. ...
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