Whiplash Injury (Nagging neck pain after an accident)

Whiplash Injury - Painmd
December 1, 2020

Following a car accident, your nagging neck pain may not be just “soft tissue.”  Neck pain is one of the most common chronic pain conditions in modern medicine and can lead to depression, sleep disturbance, and inability to work.  Even though there may be minimal damage to your car, you can still sustain significant whiplash.  In fact, even at low speeds, occupants can experience severe whiplash, the video above demonstrates whiplash injury with a 5 mph collision.

The rapid motion of the neck during a crash can result in a number of injuries, with the majority of these injuries involving “soft tissue”:

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  • Muscles
  • Tendons
  • Ligaments
  • Nerves
  • Discs
  • Micro fractures
  • Facet subluxation
  • Hemorrhage or edema of the pariarticular tissues (facet joints)

The term “soft tissue” is frequently tossed around as if it is an insignificant injury; this could not be farther from reality, as even the brain, liver, and heart are soft tissue, and it’s doubtful you could survive long with any of theose structures damaged.

Soft tissue injuries are difficult to see on x-rays or MRI, and frequently require a diagnostic interventional workup to define.  Soft tissue injuries can lead to significant permanent impairments, and should be treated in a timely and medically appropriate manner in order to mitigate long-term consequences.

Injuries to bony structures are less common, but are usually apparent on x-rays

  • Rim Lesions
  • Endplate avulsions
  • Tears of the anterior longitudinal ligament
  • Uncinate process
  • Articular subchondral fractures
  • Articular pillar
  • Articular processes

Whiplash affects the cervical vertebrae of the neck as well as the first few upper thoracic vertebrae and is most commonly caused by car accidents when the force of a blow from the rear causes the head to whip backward and forward.  The most common facets to be injured are at C2/C3 and C5/C6, which frequently result in referred pain at the locations indicated. As a result of facet joint injury, whiplash patients frequently encounter headaches, back and shoulder pain in addition to neck pain.

This action can cause tears in the muscles, tendons or ligaments of the neck. It can also cause a nerve to become pinched between two vertebrae, resulting in pain or numbness that may radiate down to the shoulder, arm and hand.

The neck is a particularly vulnerable part of the spine because:

  • The head is a free floating weight attached to the fixed thorax like a pendulum
  • The neck has relatively little muscular support
  • During an accident the head is moved with tremendous force back and forth, concentrating the biomechanical forces to just a few cervicothoracic vertebral bodies and their limited support

When the neck is moved quickly and forcefully, it places tremendous strain on the facet joints of the spine — which are located at the rear of the spine. The facet joints normally allow the spine to move in a very flexible manner through flexion, extension and rotation.

Injured people with cervical facet syndrome usually present with severe posterior neck pain and muscle spasms. Outpatient to the neck produces pain over the cervical facets. The pain typically increases with extension of the neck with symptoms of pain overlying the cervical facet joints or regionally to the head, neck or shoulder region.

Unfortunately radiographic diagnoses of these injuries are very difficult. Cervical spine x-rays may reveal focal or diffused cervical spondylosis or loss of normal lordosis, but will not reveal the facet injury itself. The medial branch of the dorsal ramus transmits the pain from inflamed facet joints. Stimulation of the facet nerves often results in referred pain.

Cervical facet blocks at the appropriate level are frequently necessary in the accurate diagnosis of cervical facet pain. The cervical facet block at the appropriate level usually brings immediate relief to the injured person, with pain relief lasting four to six hours after injection being diagnostic.  If successful diagnosis with facet blockade is made, then a more permanent solution may be radiofrequency neurolysis.

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Low back pain with lumbar facet involvement can also be diagnosed similarly. However, lumbar facet joint injuries are far less likely to occur following an auto accident; because the lower back (lumbar spine) is generally supported and not subject to fast and extreme range of motion following a rear end car accident. This is different than the neck (cervical spine), which can only rely on a headrest for protection from these quick acceleration injuries (whiplash).