It’s Only Natural

Chapter V

Whiplash

There is probably no other condition in the annals of medicine about which so much purposeful confusion has been created than the post accident condition known as whiplash.

(These words were originally written over twenty years ago and I had trusted that by now this situation would have changed and the true nature of this injury would have been accepted by all interested parties. I was naive. It seems to me that the purposeful misinformation on this condition and its sequelae is as blatant today as in the past, if not more so.)

This injury, classically caused by a rear-end automobile collision, produces a whipping trauma to the neck that can cause dire future consequences. The immediate injury done to the patient's neck, however, is of such a nature that X-rays and other examinations made shortly after the accident usually show nothing worse than minor muscle spasm. The real damage only shows up much later.

Because much of the early and continuing pain and discomfort from this type of injury can't be substantiated by ordinary medical investigation, insurance companies attempting to minimize their liability, have attempted to convince the medical profession that whiplash injury is a figment of the patient's imagination or merely a guise to bilk the insurance companies. When I first entered the healing profession, forty years ago, I too was much influenced by this insurance company propaganda. I too treated most of these patients only for minor cervical strain and suggested that they settle their claim with the insurance company as soon as their neck felt comfortable.

My rather smug attitude toward this condition was suddenly altered when within a week's time two patients whom I had discharged months earlier returned with their neck condition greatly aggravated. Because I had suggested that both of these patients settle with the insurance company, I felt a certain responsibility to take care of this later aggravation Pro Bona and so treated both of these patients for almost two years without charge. As you can imagine, such an incident is likely to leave a permanent impression on a young struggling physician. After this, I began a thorough investigation of whiplash on my own. From the information I gathered, I became certain that the condition is not a figment of the patient's imagination, but is a very real, physical entity not particularly well understood by any of the healing professions, orthodox or alternative.

The Three Stages of Whiplash Injury

This investigational work and subsequent clinical experience have led me to determine that whiplash may well present three different stages (phases). The first occurs immediately after the accident, the second begins thirty to ninety days afterward, and the last stage, which may or may not occur, becomes manifest only five to twenty years after the original injury.

Surprisingly, the degree of pain and discomfort present in the first stage doesn't necessarily accurately indicate the degree of trouble in later stages. In our experience, those who may exhibit little discomfort in the first stage frequently have severe problems in the second and third stages. Because of this possibility, I consider every whiplash injury potentially serious and capable of permanent disability. I believe it is the physician's duty to inform the patient of this possibility and, whenever possible, to aid the patient in receiving proper compensation for the full extent of this injury from the insurance company involved. As you may surmise, I am not on the insurance companies Christmas list.

Most patients with whiplash suffer some degree of discomfort within a day or two of the original accident. Such disability may be mild or severe, depending on the actual structures affected by the whipping action. This primary discomfort usually abates within a week or two. I reiterate that one can not tell the true significance of the injury by the degree of discomfort and pain experienced in the first stage. Some patients have almost no discomfort at this time, yet years later they develop severe calcium deposits and disc degeneration. On the other hand, some have severe discomfort during the first stage, yet never go into the second or third stages. It is imperative that both physician and patient remember this so they don't gauge insurance liability by the severity of the discomfort experienced during the first stage.

First-stage discomfort is usually treated best by mild physical methods, such as ultrasound, diathermy, and sine wave therapy. Now days we also use the MicroLight 830 low level laser. As mentioned in the last chapter it has revolutionized the treatment of such pain and spasm. An occasional manipulative treatment to the neck may be beneficial, although we strongly recommend against too many or too energetic cervical adjustments at this time. The neck has been injured, the muscles and nerves need time to heal, and they must have rest and relaxation to do this, not constant manipulative aggravation. There are exceptions, but the physician in charge must be aware that treatment should be tailored to the patient's needs and desires at this time.

Many patients benefit from a neck collar during this phase. I usually provide one for each patient, but I don't insist that they wear it unless the neck feels better while the collar is on. Many times the patient experiences less discomfort if his neck is allowed a certain amount of movement, unfettered by such a collar. To many patients, however, the neck feels weak and uncontrollable unless a collar is worn. If used in such a manner, the collar is of great benefit and without adverse effects. Although I've used all types, I now prefer the soft foam collar for most patients.

Low-Back-Neck Syndrome

A reflex injury to the sacral-iliac joint frequently follows the first stage of whiplash; it is too consistent to be coincidental and yet it can't be explained from our knowledge of normal nerve relationships. In approximately 90 percent of my whiplash patients, the sacroiliac joint slips out of alignment a few days after the original accident, whether or not there was any injury to the lower back during the accident. It seems that this is produced by a reflex-caused weakness due to injury of the cervical vertebrae. Although the occurrence of this sacroiliac subluxation is enigmatic, its cure is conventional. It usually is corrected quite rapidly by normal therapy for the low back (see Chapters 3 and 4). The only difference between an ordinary sacroiliac problem and this is that it is often necessary to replace these joints several times before an adequate stable joint is obtained. The joint probably won't stay in place permanently until the neck irritation is reduced to a point where it no longer initiates the causative reflex.

The Second Stage

If the second stage is to occur, it will usually begin to show up a few weeks after the first-stage symptoms have abated. The second stage begins with symptoms such as unexplained headaches, tingling down the arms into the hand, pressure on the chest, dizziness, vertigo, recurring low-back pain and other reflex symptoms related to nerve pathways of the neck. These second-stage symptoms are usually due to nerve and soft tissue damage that occurred at the time of the accident but that is just now beginning to cause actual reflex disorders. These symptoms can be so bizarre and severe that many patients think they are losing their minds. Physicians may be mystified-although the symptoms are positive and concrete to the patient-because a cursory physical examination usually doesn't disclose any physiologic or anatomic reason for these symptoms. They are real, however, and usually respond well to the physical therapy methods used at our Center

In this second stage, great help can be obtained from the careful use of cervical traction. We use intermittent motorized traction; this, combined with gentle manipulation and other relaxing physical therapeutic methods, can usually relieve second-stage symptoms within a reasonably short time. In selected patients benefits may be obtained by the use of home cervical traction but if used the patient must be very carefully trained in its use.

These second stage patients often require a considerable amount of emotional support from the attending physician, particularly in reassuring them that their condition is physical, not psychological or emotional. If this is not given, the doctor will usually be disappointed in the patient's progress.

The Third Stage

It is a very fortunate whiplash patient who does not progress beyond the first stage, and one should be pleased if the disorder stops at the second stage. Unfortunately, many patients suffer the consequences of third-stage developments. The third stage may occur as late as ten to fifteen years (or longer) after the original accident. It is even possible that some patients who had minor first-stage discomfort and no second-stage discomfort may later develop third-stage problems. Unfortunately, in these cases, even when attended by the most conscientious physician, all insurance liability will probably have been discharged years earlier. It is therefore usually necessary for the patient with third-stage trouble to foot the bill himself. It is routine in our Center to suggest to patients that they do not settle a whiplash claim for at least eighteen months to two years after the original accident. Obviously, however, even this rather conservative approach won't cover many of the really delayed third-stage problems.

Third-stage difficulties arise from the fact that when this type of injury occurs, small areas of necrosis (dead tissue) are produced in various sections of the cervical spine. As the years pass, the body lays down calcium deposits in these necrotic areas in an attempt to support the injured tissue. The calcium deposits may, in the ensuing years, cause pressure on nerves and muscles, preventing proper bony articulations. Such pressures and impingements cause many of the third stage symptoms. It is also possible that some of the nerves and small blood vessels that feed the cervical spinal discs are also destroyed or injured in the original accident. In time, the nutrition to these discs is diminished and they gradually atrophy, causing the vertebrae they separate to move closer together. This produces nerve root pressure which in turn may cause added symptoms to this stage of whiplash.

Third-stage problems are not likely to go away as rapidly or as completely as those of the first or second stage. Once the calcium has accumulated and the discs have thinned, the patient is confronted with a permanent chronic malformation of the cervical spine.

Symptoms sometimes begin as pain in the neck or shoulders, but more commonly as pain or tingling in the arm or hand, particularly when the patient tries to sleep at night. These latter symptoms are caused by direct root pressure on the cervical nerves.

The most useful therapy for third-stage afflictions is intermittent motorized traction to the cervical spine, diathermy to the neck, and ultrasound to the whole of the upper back. To these old standbys may now be added home traction in selected patients and the use of the Low Light Laser in all patients.

Because the injury is permanent, it is necessary to have the patient return occasionally for maintenance traction therapy after his acute problem has abated. Most patients faithful to this maintenance schedule remain nearly symptom-free.

Parting Words

This discussion of whiplash is based entirely on my personal experience of the last forty years and that of the other physicians at our Healing Research Center. To my knowledge, there has been little research into the pathologic aspects of these three stages. These last forty years, however, has assured me that these stages exist and that they can be treated successfully as I have described. I would like to include, however, a few closing admonitions for those so injured.

If you are ever "rear ended" while riding in an automobile or have any other reason to think you have a whiplash type injury, look for a physician familiar with the methods described here. Don't let anyone convince you that it isn't a serious injury or that your symptoms are imaginary.

If you have been injured, be sure that the accident is properly recorded and that you contact any insurance carriers involved in the case so they can be prepared to cover you properly as early as possible. See to it the a full set of X-Rays of the neck are made shortly following the accident. These will usually not reveal damage at this time but they will allow you to prove that you were normal prior to the accident if later X-Rays show third-stage damage as described above.

Don't settle any whiplash case as long as you have any degree of pain. In our own Center, we don't settle for at least eighteen months to two years after the original accident.

After the whiplash injury, be very careful about who you let adjust your neck. Frequent chiropractic or osteopathic adjustments at this time can be injurious.

If you have a physician who understands the whiplash injury as I have outlined it here, please follow his instructions. Don't think he is being overly cautious if he doesn't want to release you when you think you feel well. Very few patients understand the possible consequences of a whiplash accident.

If your physician doesn't seem to understand or accept the consequences of your accident, give him this chapter to read. If he still isn't interested or doesn't think our presentation valid, find another physician. Your future health and welfare depend on it. Many physicians have been, and still are, so influenced by the literature published by insurance companies that they still can not accept that whiplash is the potentially serious injury it is.

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