whiplash

Whiplash: Description

The term “whiplash” summarizes several symptoms that are typically caused by a sudden acceleration and deceleration of the head against the body. This is also called an acceleration-deceleration mechanism.

If the head is jerkily overstretched in this way, especially the muscles and ligaments in the area of ​​the cervical spine (cervical spine) are strained. Therefore, the medical term for whiplash is “cervical spine”, sometimes one reads also from a cervical spine trauma or a whiplash injury.

The external force of a whiplash causes strains, compression and overstretching of muscles and ligaments. Injuries to the bone or nerves are the exception.

Whiplash is not a rare diagnosis and even the most common complication after car accidents. Those affected usually complain of headaches and neck pain after accidents, in addition to muscle pain and tension but still some other symptoms are possible.

Whiplash: symptoms

After the triggering event, it usually takes a few hours before the first symptoms appear. Typical are then increasing head and neck pain and strong muscle tension that cause a stiff neck. Above all, this spasmodic head posture is perceived by many patients as very unpleasant. In some cases, the symptoms radiate in the shoulder, back, jaw or mouth area. The symptoms of a whiplash first increase and reach their maximum after one to three days. After that they usually sound off again.

In addition, whiplash may cause general symptoms such as nausea, dizziness, ear whistles (tinnitus), poor concentration and tiredness. They too are mostly temporary.

Whiplash: complications

A whiplash is unpleasant, but it usually runs harmless. In rare cases, however, complications may occur. This includes:

• Nerve injuries resulting in tingling, sensory disorders or paralysis of the face; Shoulder or arm area can lead
• unconsciousness
• Loss of memory for the period immediately before or after the accident
• Severe nausea with vomiting
• Damage to the bony cervical spine, especially vertebral fractures
• Spinal cord injury, possibly paraplegia
• Vision disorders if the carotid interna, a particular vessel, has been damaged
• A simultaneous traumatic brain injury

Some of these complications can be debated about whether one can even speak of a whiplash. Because vertebral fractures, Neven- / spinal cord damage and other serious injuries are classified specifically and not actually counted for whiplash.

However, a common international classification (Québec classification) divides whiplash into four degrees of severity, of which grade four also includes fractures of the cervical spine. However, some experts call for this degree to be deleted.

Whiplash: late effects

Usually a whiplash is cured after a short time. In some cases, the symptoms may last for months or even years. Such chronicity occurs in particular in people who had pre-injury to the cervical spine before whiplash. Even if bones or nerves are damaged in the course of the cervical spine distortion, this delays healing or leads to permanent damage.

Whiplash: causes and risk factors

By far the most common cause of whiplash is an impact accident. The seat belt fixes the upper body, but not the head. After sudden braking from the drive out, the head thus moves unrestrained towards the upper body to the front. The muscles and ligaments in the area of ​​the cervical spine catch the movement, causing large forces to act on these structures for a short time. Injuries are the result.

However, whiplash injuries are not just caused by car accidents. For example, they can also be used in martial arts, climbing or riding accidents – whenever the head is accelerated in rapid succession and then intercepted by one’s own muscles.

Certain factors make it more susceptible to whiplash, weak lumbar support, or existing pre-existing injuries such as herniated discs or narrowed nerve channels. Degenerative changes of the cervical spine, ie signs of wear, also play an important role. These may have been caused by accidents, but also by diseases of the neck. For example, whiplash patients with rheumatic diseases often have complaints that limit their quality of life for months after the accident.

Chronifying the symptoms of a whiplash injury often involves individual pain sensation and processing. Why some people’s symptoms are more pronounced and / or of a longer duration can often not be explained by physical causes alone.

Here, psychological and psychosocial factors, such as the fear of the consequences of an accident, the general expectation or the culture, seem to play a role. In Germany and Switzerland, for example, the diagnosis of whiplash is made more frequently than in many other countries.

Whiplash: examinations and diagnosis

If a patient presents with the typical whiplash symptoms to the doctor, he will next ask if the symptoms were preceded by an accident and how the accident was. As a rule, the diagnosis already results from the answer. He also asks the patient how severe the pain is and if he has any other symptoms.

Basically, it is very important to make sure that no more serious injuries are behind the symptoms. For example, during the exam, the doctor checks for signs of nerve damage: does the patient feel any tingling sensation or numbness anywhere? Does the pain radiate?

Suspected nerve damage is often consulted with a neurologist. He can use special examinations to determine the possible nerve lesions more accurately and to assess whether further treatment is necessary.

During the physical examination, the doctor also carefully taps the spine. If there are bone fractures or blisters, this leads to increased pain. If this is not the case, it also moves the patient’s head in all directions and observes which movements are restricted or painful.

If the doctor is unsure whether there might be a bony injury, an X-ray of the cervical spine will help diagnose. However, such injuries are the exception. Further examinations are rarely needed, as the limitations usually disappear after a few days. If there is no noticeable improvement over the course of weeks, magnetic resonance imaging (MRI) can be used, which displays the muscles and ligaments in detail.

It is also important that the doctor identifies factors in the conversation with the patient that stand in the way of a quick recovery. For example, it can counteract the fear of more severe injuries or a negative expectation.

Whiplash: treatment

A whiplash is usually treated symptomatically, so painkillers such as acetaminophen, diclofenac or ibuprofen. Most of the complaints can be alleviated. Also, heat pads or thermal patches often describe those affected as pleasant. To counteract tension and a stiff neck, the patient should also apply targeted relaxation exercises and actively move his head. A neck brace, however, is no longer considered useful.

Possible complications of a whiplash injury such as bone or nerve injuries require a special – often surgical – treatment. As long as after an accident it is unclear whether more serious injuries are present, the head should always be kept still.

Although loose massages of the neck muscles may help with mobilization, it is not recommended to use stronger osteopathic or chiropractic manipulations to break important structures of the neck.

For long-term complaints due to whiplash, one must expand the treatment concept. There are psychosomatic practices and clinics that specialize in chronic pain patients and the treatment of long-lasting, complex ailments. In addition to advanced pain therapy with antidepressants, for example, special behavioral and physical therapies can help alleviate the pain.

Whiplash: Prevent

Basically, a strong holding apparatus protects ligaments and muscles from injury. In particular, a trained neck and head musculature can prevent a whiplash or at least reduce its symptoms.

When it comes to preventing chronicity, it is often helpful for the doctor to explain to the patient what exactly happens during a whiplash injury. If the patient has understood that the symptoms are usually harmless and usually go back soon, it has a calming and healing effect.

Whiplash: disease course and prognosis

As far as the whiplash duration is concerned, one hears different statements from experts. In principle, however, the majority of patients are completely symptom-free after some time, most of them after only a few days to weeks.

How high the proportion of chronic courses is, it is difficult to say. Various studies on this topic come to different conclusions. The data range from less than 10 percent to more than 40 percent.

However, experts agree that there are certain factors that make a chronic course of a cervical spasm more likely. In addition to negative psychosocial influences, this includes severe headaches and neck pain that occur immediately after the accident. A restriction of the neck mobility also has an unfavorable effect. The more important it is in patients with one whiplash to relieve the pain and promote mobility as early as possible.