The Full Picture: Proper Assessment Following Motor Vehicle Accidents
Thank you for taking the time to visit my blog! I'm Dr. Spencer Kronz, owner of East Side Family Chiropractic, and I would like to take a moment today to talk to you about the most common injuries associated with motor vehicle crashes. Among much of the general public, it is a common misconception that the severity of injury is dictated by the presence or absence of fractured or broken bones. Many people will visit emergency rooms and urgent care centers immediately following a crash, and upon being told that there are no visible fractures on X-Ray or CT will incorrectly assume that they have not sustained a notable injury. In actuality, whether the result of a car crash or playing with your kids in the back yard, many soft tissue injuries (disc, ligament, tendon, muscle) can and do result in more severe and longer-term pain and disability than their hard tissue (bone) counterparts if not properly assessed, diagnosed, and treated by an experienced professional.
A proper understanding of these injuries must begin with defining a whiplash associated disorder (WAD). First, why do we use the term "whiplash associated disorder" and not simply whiplash? Whiplash is a description of the biomechanical movement that your spine undergoes in reaction to an impact most frequently sustained while not moving, like being rear-ended at a stop light or stop sign. Conversely, whiplash associated disorder is an umbrella term that is used to describe the tissue damage and resulting pain and dysfunction that results from a whiplash motion. Because of the microscopic nature of these injuries and the advanced imaging procedures required to confirm their presence, there is a heavy reliance on the doctor’s clinical experience and medical science is just now beginning to be able to truly define the structures involved and the extent of their ability to cause pain and disability.
In a 2011 paper published in Spine titled "The role of tissue damage in whiplash associated disorders: Discussion paper 1", this topic and the existing scientific literature pointing to the underdiagnosis of soft tissue injuries resulting from crashes is discussed at length. When a whiplash motion causes the structures of the spine to exceed their physiological limits (normal range of motion), injury can frequently occur but is not limited to the zygapophyseal (facet) joints and joint capsules, anterior longitudinal ligament, intervertebral discs, nerve roots and dorsal root ganglion, and of course the surrounding muscles. In addition, there are many scientifically proven factors that can further complicate and increase the risk for serious injury to each of these structures, such as having your head turned at the time of impact, having a surgical implant like spinal fusion hardware, age, position in the vehicle, and even whether or not your pain is validated by friends, family, and medical providers. In the facet joints alone, there is evidence that whiplash can produce saturated afferent signaling (maximal nerve transmission to the brain) leading to a continuous feedback loop and causing persistent pain. The authors also note that it can cause "production of collagen fiber disorganization (abnormal connective tissue structure), axonal (neuron) swelling...and permanent modification in the neuronal signaling in the spinal cord." All of this in the absence of “grossly observable evidence of a rupture or tear."
So what is the major takeaway? Given the wide array of structures that are susceptible to damage and the number of factors that can impact severity, the challenges associated with obtaining an accurate and definite picture of the tissues involved and to what extent makes diagnosing a whiplash associated disorder especially difficult, and nearly impossible in the ER setting. In order to return to pre-collision condition as quickly and efficiently as possible, it is important to have a careful and detailed assessment performed by a professional who is not only properly trained, but more importantly clinically experienced with helping put together the complete picture of what is often a very complex story in order to help you make a full recovery. Because of their vigorous education in diagnosis and drug free treatment of both musculoskeletal and nervous system disorders, doctors of chiropractic are uniquely positioned to guide your care and employ the procedures necessary to return you to pre-accident status quickly and cost-effectively. If you have any questions, please feel free to email me personally at firstname.lastname@example.org.
Curatolo M, Bogduk N, Ivancic PC, McLean SA, Siegmund GP, Winkelstein B. 2011 Dec 1. The role of tissue damage in whiplash associated disorders: Discussion paper 1. Spine. 36 (25 Suppl): S309-S315.