When I started practice years ago, I thought most auto-accidents injuries were just like any other neck or back pain. Over the years and after treating hundreds of patients who were injured in an auto-accident, I came to realize that there was something different about the pain many of my patients developed after being involved in a motor vehicle accident. Many researchers have suggested that the thing that is different between a neck that is hurting from whiplash and most other types of neck pain is the potential for a cash settlement from a lawsuit. They imply that most chronic whiplash suffers exaggerate they their injuries hoping to get a nice settlement for pain and suffering. I even know some doctors who sarcastically suggest the best treatment for whiplash is a settlement check and that the patient’s pain will magically go away once their check clears the bank. Undoubtedly there are some people who look to cash-in when they are involved in a motor vehicle accident. But I observed many more people who continued to seek my care long after their insurance claim had settled. Patients that were actually spending money out-of-their-own-pocket to treat symptoms related to an accident that occurred years even decades ago. When I would treat them, so many of these patients would tell me that they were “never quite right” after their accident. One thing that became clear to me was that whiplash injures are indeed different from other types of painful syndromes that I have been treating.
Recent research is emerging that supports the idea that whiplash is different from other types of neck and back pain. Also that the injuries sustained in a whiplash commonly persist even after the best medical treatments currently available are utilized. A study published in the Journal of Bone and Joint Surgery, followed a group of whiplash victims for 30 years. That is a really long term follow-up period. What the researchers found was a little frightening; less than half of people involved in a motor vehicle accident fully recovered even after three decades. Stated another way this means that one of every two whiplash patients will have problems related to their accident for the rest of their life. It additionally suggests that the current therapies used to treat whiplash patients usually fail to provide relief.
This study supports what I commonly have seen in my own practice treating whiplash patients. Namely that many of them have lifelong problems that persist decades after their case was settled. They weren’t exaggerating their injuries to get a bigger settlement, their injuries were not like most others that heal and resolve over time. Thus it seems that there is something different about whiplash injuries that make them resistant to most types of current care.
Researchers publishing in the Journal of Forensic and Legal Medicine may have an explanation for why whiplash victims are at such a high risk for lifelong pain. They suggest that it is common for whiplash victims to sustain brain, spinal cord and nerve injures leading to hypersensitivity of the pain pathways.
This means that the pain and injury are related to damage in the nervous system not necessarily the bones, joints and muscles. After a motor vehicle accident, a patient may have localized injury to the neck, but damage to the central nervous system magnifies and prolongs the pain from the injured muscle. In fact, we know the delicate nerve fibers called axons are much more susceptible to stretching, twisting and compression than are muscles and joints. We also know that when axons are injured they can produce nerve pain that can persist long after the initial injury to the muscle has healed. Pain from damaged nerve fibers is called neuropathic pain. Neuropathic pain can cause changes in the brain which can cause the pain to spread, making parts of the body that were not injured in the original accident to feel hypersensitive, a condition pain researchers call alodynia.
Furthermore, these injuries to the tiny nerve fibers often can’t be visualized with routine diagnostic tests, so it is not surprising that current treatment helps less than 50% of whiplash patients fully recover. This is why some doctors accuse whiplash patients of “not really wanting to get better” and patients so often feel more pain after standard treatment rather than relief of their symptoms. The treatment for neuropathic pain is entirely different from the treatments that help muscle and joint pain
So how do we improve on this poor success rate in the treatment of whiplash?
To start we must find the area or areas in the nervous system that have been injured and are not functioning properly due to the whiplash. This can be more difficult than it sounds because many of these neurological injuries involve loss of function and tests like X-rays or MRIs are useful for evaluating “structural” not:functional” problems. The truth is that an MRI, the most sophisticated diagnostic imaging test we have available to us, can be used only for assessing the structure of the body. The MRI is incapable of assessing the function of the nervous system and in fact was never intended to assess how well nerves are functioning.
So if a doctor can’t see functional neurological problems even with an MRI scan, how can he identify and more importantly fix malfunctioning circuits in the brain, spinal cord or peripheral nerves?
The answer is straight forward; the doctor must use a functional neurological examination of the patient.
One important part of this functional neurological examination is assessment of a patient’s ability to maintain his or her balance. This functional assessment of balance includes tests with eyes open, eyes closed, standing on a hard surface versus standing on a unstable surface.
I can’t go into too much detail in this article, but a comprehensive balance assessment can tell the doctor if a patient has a poorly functioning peripheral nervous system, if their spinal cord and brainstem is working optimally, even if their cerebellum, inner ear and if the brain itself is functioning optimally. Another functional assessment a doctor can perform to evaluate nervous system function in a patient who has suffered a whiplash is to do a detailed assessment of a patient’s eye movements.
Most people don’t realize that there are a number of different types or classifications of eye movements. Furthermore each type of eye movement is associated with a specific part of the brain. So eye movements, if they are comprehensively and systematically assessed can tell a doctor which part of a patient’s brain is functioning optimally and more importantly those regions of the brain that maybe be structurally intact, but are functioning poorly.
With this information the doctor can devise a specific neurological rehabilitation program for each patient based on the findings of a functional (as opposed to structural) comprehensive examination. Since we now know that whiplash leads to malfunction in the nervous system, treating it based on restoring lost function determined from information derived from a thorough functional neurological assessment is likely to help many more whiplash patients than current therapy. Surely, we expect that a functional neurological approach to whiplash injury will produce better long term outcomes than the current one-in-two results of traditional care.
With traditional treatments, 1-in-two patients are at risk for lifelong, neurologically driven, pain hypersensitivity. Chiropractic neurology deals with the function of the brain, spinal cord and nerves. This allows us to pinpoint areas of the nervous system than may look normal on an MRI, but function poorly. Using techniques like balance assessment and targeting tests we often can identify structures in the nervous system that need treatment and then design a specific rehabilitation program for them. A new and promising approach to chronic whiplash problems.
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