Whiplash – Which Treatment Method Is Best?

Whiplash, or better termed, cervical acceleration-deceleration disorder (CAD) is primarily an injury to the soft tissues of the neck – that is, the muscles, their tendon insertions, and the ligaments that hold the joints firmly together. Neck pain is a very common health problem that affects between 10–15% of the population and drives people to all types of healthcare providers. We have previously discussed the reasons why whiplash /CAD injuries occur, the examination process and the prognosis aspects but the argument continues as to what treatment methods work the best when managing patients with CAD.

In the May 21, 2002 issue of the Annals of Internal Medicine, a group of medical doctors and PhD’s reported on neck pain treatment comparing traditional medical and physical therapy approaches verses spinal manipulation. In the study, they compared three common neck pain treatment approaches in a group of 183 patients with chronic neck pain (patients who had neck pain for more than 3 months). The 3 methods included traditional medical care which included medication utilization and rest, manual therapy (chiropractic adjustments) and physical therapy (active exercise training). After 7 weeks of treatment, the percentage of patients who felt either totally resolved (cured) or much improved were 68.3% receiving manual therapy / chiropractic care, 50.8% receiving physical therapy, and 35.9% receiving medical care.

The author, Jan Lucas Hoving, PhD reports that manual therapy / chiropractic was found to be more effective than the other 2 methods “…on almost all outcome measures,” not just a few! Further, although PT scored better than traditional medical care, “…most of the differences were not statistically significant,” meaning, not that much better. The authors appropriately reported that further study was needed to better understand the differences between methods.

In 2008, the “Decade Task Force” reviewed 10 years of studies on the treatment of neck pain and found similar results and referenced many studies that indicated spinal manipulation for neck pain, headaches, whiplash, and other neck related conditions was one of the most effective methods and that patients with neck pain should be given the option of receiving manual therapy / chiropractic before other approaches as it was found to be less expensive, faster in obtaining satisfying results (shorter course of disability), and most effective in terms of long-term benefits. This comparison discussion is by no means meant to minimize the importance of medical and PT care.

However, there appears to be a bias among patients with neck pain to seek medical care first when the studies clearly show chiropractic care is the preferred method. Hence, the purpose of this article is to educate the reader that their choice in treatment for neck pain should favor chiropractic care FIRST, not last. In fact, the sooner manipulation can be applied to the injured joints of the neck, typically the faster the results. For example, long term disability and chronic neck pain can occur from prolonged use of a cervical collar as the structures tighten and stiffen up from being immobile - unable to move because of the collar. Unless there is some unstable condition to the neck (fracture, grade 3 ligament tear, progressive neurological loss, etc.), studies support manipulation / early mobilization of the neck joints after injuries like whiplash verses wearing a cervical collar and rest.

Health Update: Whiplash

Whiplash - Can This Really Happen To You?

The following are excerpts from the expert opinion of Dr. Joseph Cilea of the Advanced Wellness Center in Marlboro, New Jersey.

Pain Management
Acupuncture

     You're stopped at red light awaiting a left turn into the grocery store when out of nowhere, you  hear the screeching of tires, you turn your head and look into the rear view mirror and see that you're about to be hit from behind. Then "POW!"  The sudden force of the impact propels you back into your seat, your head hits the headrest and then bounces forwards, almost hitting the steering wheel.  You feel your body twist due to the angle of the seat belt and your sunglasses fly off and your purse sitting on the seat next to you flies into the dashboard and lands on the floor spilling its contents.  You're not sure what just happened as it all happened so fast.  Is this a dream?


     After collecting yourself and calming down, you get out of the car to inspect the damage and talk to the driver that just ran into you.  You notice that right now, you don't really hurt that much....but you feel kind of dazed.  When you inspect your car, you surprisingly notice very little damage, but it sure felt like your car should be totaled based on the way it felt.  The other driver said he was checking the station on the radio and saw you too late.  He tried to stop and slammed on the brakes but it was too late.  He said, "...I couldn't have been moving more than 5-10 mph when I hit you!"  You ask, "how could this possibly feel so.....hard an impact?  Was he lying to me?" There certainly wasn't much damage to your car...maybe he was right???  When he asked you if you would, "...let it go," and not call the police, you almost agree, but something stops you.  Even though there is little car damage and, "...he is a nice guy....," you just don't feel right in, "...letting it go." 
 

    Within 15-30 minutes, you're REALLY HAPPY you didn't give in and take his advice as by now, your neck is really starting to hurt. You feel kind of nauseated and light headed.  Your head is beginning to pound and you feel like you better sit down.  When the police officer approaches he seems distant and you're having difficulty hearing him.  Pretty soon, you notice others helping you onto a stretcher and attaching a neck brace prior to taking you to a local emergency room.  At the ER, you are confused about the details of the accident but piece together the best you can the events of the evening.  They take x-rays, recommend some Advil and ice, and tell you to contact your primary care physician if you have problems. They tell you that you're going to hurt for a few days and "...that 's normal."  However, over the next several days, pain intensifies to a point where neck and headache pain is constant, you can't sleep, your memory seems blurry, you can't seem to concentrate and loose your place during thought and conversation....something is REALLY WRONG!


     This scenario is not atypical of a low speed collision related injury.  In fact, the less the car is damaged, the greater the impact is to the contents inside the car (this is called "elastic deformity").  That's because crushing metal absorbs the energy of the force (ie, "plastic deformity) and if the speed is "...too low" and little metal crushing/energy absorption occurs, the G-forces that occurred during the collision are transferred to the contents inside the vehicle and that force can be significantly greater than a crash that occurs at 2-4 times the 5-10 mph speed.  In general, when there is less damage to the car, be alert that the force exerted on the contents is greater than when car damage occurs.  This is why when cars crash during a car race, the race car basically falls apart, leaving the driver enclosed in a cage that prevents bodily damage, and they often walk away from the accident.


     If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional assessment and therapeutic approach at our chiropractic facility.