Welcome to the second in a 12 part series working its way down the body! For February I’m getting it in the neck, with an insight into the world of whiplash. Some politicians would like to tell you it doesn’t exist, but for those who have experienced it, it can truly be a life-changer.
The neck houses not just the muscles, bones and ligaments that allow such amazing range of movement, but also nerves and blood vessels and connects to delicate structures such as the inner ear and cranial nerves. When the body goes through such trauma, these tissues are inevitably put under strain as the whole head suffers rapid acceleration (thrown forward) and deceleration (whipped backwards).
What does Whiplash do to the Body?
Affect balance and / or make you dizzy.
This aspect of whiplash is too often overlooked. There is a key feedback mechanism in your body between your ligaments, your eyes and your inner ears. These three aspects are constantly checking information with each other, relating to balance (where is ‘up’?) joint position (where is my neck and head in space?) and do these input feeds correlate with what your eyes are telling you? If any one of these three inputs are perturbed, commonly the ligaments and the fluid in your inner ear after whiplash, it can play havoc in your brain trying to match this disparate information. This causes headaches, erratic head movements, varying sensations of dizziness and nausea.
Strain the muscles,
causing them to protectively spasm and stiffen. This doesn’t just affect the neck, but can also involve the shoulders and upper back. Depending on the mechanism of the injury (i.e. the details of the car crash), lower backs are often also involved.
Stiff muscles can in themselves be incredibly painful, more than many people realise. It’s tempting to think it’s best to keep still so it won’t hurt.
Surprisingly, this is where gentle regular movements can actually really help, though it is really important to get checked out for fractures before you go down this route, especially if you are having symptoms that feel like your head is unsupported or significantly unstable.
The regular application of a heat pack is also really effective at helping to ease muscle pain and can help with reducing spasm. Forget expensive stick on patches, you are best off with a wheat bag or hot water bottle.
Aside from their role in stabilising joints and limiting their movements to a safe range, ligaments are essential to creating your own sense of self-perception – Proprioception. They contain receptors that give information to your brain of their position in space and the angle of each joint.
You may be surprised at just how many ligaments there are in the neck – these images show how every joint in the neck is wrapped in them, and also how the neck and lower spine are connected by these highly sensitive tissues.
The nerves exit the spinal column through fairly small gaps (called ‘foramen’) between the vertebrae. Muscles control the movement of the joints, and if these are in spasm this can restrict the movement of the nerve through the foramen. Trauma can also cause inflammation in the local area – both physical swelling and the chemical changes in the tissues can cause compression and irritation to nerves. It may not look like there is any problem from the outside (there is rarely any bruising from whiplash) but the symptoms are very real.
Trapped or irritated nerves in the neck can have a wide range of symptoms that are different from person to person. Typically, people experience a ‘toothache’ pain, burning sensations or tingling and pins and needles, or a combination of all these. They may be intense and almost constant, or may only come on during certain postures or movements. They can also be present in the neck only, but may be felt in the arm, the back, and even as far away as the hand. They may even affect the cranial nerves, causing issues with facial sensation, hearing, smell, taste and eye movements.
Whiplash and Politics
Unfortunately, the fact that whiplash has been given a name, in my opinion, does it a disservice. It has changed the car insurance industry for the worst, thanks to the opportunism of the few.
This handy term of ‘Whiplash’ has somehow distanced itself from the facts around this type of injury – a rapid acceleration and deceleration of the delicate muscles and structures of the neck, undergoing forces we were never designed to withstand. Yes, some people recover well and quickly, but that isn’t to say it doesn’t exist, and many people suffer hugely with the consequences.
Symptoms of pain, headaches, dizziness, nausea, neck and shoulder stiffness, can continue indefinitely. Many people don’t see this as related to their car accident as they can go on for so long, but there can be quite simple solutions to these problems, that don’t involve medication.
I often see similar injuries in different parts of the body (knees for example) but because they haven’t got a headline, they are carefully and professionally addressed, rather than being socially dismissed.
What Do the Guidelines Say?
There are official NICE guidelines that state that little needs to be done beyond giving advice, keeping moving and getting back to work as soon as possible. Physiotherapy is mentioned, but little guidance is given on specifically what we can do to help. There is weak evidence for manual therapy and mobilisations. And thankfully many do recover fast and well. But this is usually proportionate to the severity of the crash, and the worse the crash, the worse the symptoms tend to be.
My own personal (!) beef with the guidelines is that they don’t address all the possible problems that whiplash can cause, focusing their outcomes on levels of pain and return to work timescales. They focus their solutions on analgesics and immobilisation.
These are unfortunate but realistic limitations of the research, as every research endeavour has a budget, and certainly whiplash has been given its fair share of attention in recent years. The challenge to physiotherapists is to use their knowledge and skills to ensure patients don’t walk out of their clinic with a future of long-term headaches and neck muscle weakness, and address any underlying problems. And there is plenty that we can do that doesn’t involve mobilisations of the joints – treatment should be tailored to every individual.
Don’t Ignore the Pain
If we treated any other part of the body with immobilisation, what would happen?
Muscle wastage, poor brain-body communication, compensatory and detrimental movements and behaviours.
Why is the neck any different? Fact – it isn’t.
In fact there is evidence to show that muscle can turn to fatty deposits in the neck after a whiplash-style trauma, even when the neck isn’t immobilised by a brace. This is classic atrophy, but hard to detect as it happens in the small stabilising muscles, without obvious visual wasting. The effects of this on function and healthy movement are still being researched.
Long term management in the guidelines focuses on psychosocial issues and pain management. Undoubtedly, long standing pain and unexplained symptoms can have serious effects on the mental health and wellbeing of a sufferer, especially if they have been plunged into a previously unfamiliar world of insurance claims and litigation. Pain may even get worse over time, both due to increased nerve growth (neurogenesis) and increased sensitivity of tissues, allied with an anxious state of mind.But never forget, pain is a message from the body – it will of course persist if we insist on ignoring it.
What Can Be Done?
Don’t just put up with it. There’s no need to suffer in silence, and once rehab is started the body will usually respond very well and you should see a significant change in a few weeks if the whiplash happened in recent months. Longer term cases can take a little longer, but they can still be helped.
Muscles can be effectively eased by acupuncture and manual therapy. Ligaments can be re-trained to correct their position sense through laser-targeting work (which can be fun!), and inner ears can actually be re-set using gentle specialised manoeuvres.
Every case is different, and personal outlook can play a big part in recovery, especially if the person has been suffering or off work for a long time. Physiotherapy will ensure that your whole situation is considered and that your rehab is tailored to you.
So, have you suffered a car crash? Still feeling the effects? Was it even a turning point in your life? If so, get in touch. Physiotherapy CAN help. Now that’s a better headline.