FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

D.O. MANIPULATIVE TREATMENT CAN AID WHIPLASH RECOVERY

Question: I was in a car accident about one year ago. I had a whiplash injury that still causes headaches and soreness in my neck and shoulders. How long will the discomfort last?

Answer: Whiplash injuries are, in part, the consequence of human anatomy. The head a relatively heavy object is secured to the end of a flexible support that we call the neck. The suppleness of the neck allows us to move the head so we can effortlessly point our special senses of sight, hearing, smell and taste in the direction we desire. However, there is a "downside" to this flexibility the muscles and ligaments that move and support the neck are easily injured in situations like your auto accident.

As you drive down the highway, your neck muscles are only under sufficient tension to hold the head in a position to see the road. When your car suddenly decelerates as it strikes another object or accelerates when it's struck from the rear by another vehicle, your neck is put under tremendous strain. While your body supported by the car seat, seat belt, shoulder harness, feet and arms slows nearly as fast as the car, the heavy head continues forward or backward, depending upon the forces in the wreck. The head doesn't stop until it has reached or exceeded the normal limits of the neck's mobility. Further, this immense strain occurs so fast that the muscles don't have sufficient time to react. They and the ligaments of the neck get injured and become the source of pain in a whiplash injury.

In severe whiplash, the damage to neck muscles and supporting ligaments is quite apparent. Even damage to the arteries that supply blood to the brain is relatively common. People who suffer this degree of injury about 24 percent of whiplash victims are only a mile-per-hour or two away from having had a fatal accident. Though the majority of whiplash injuries are milder than this, they can still cause excruciating pain that is often incapacitating. This severe pain typically subsides sufficiently to allow return to normal activities in two to eight weeks. However, as you have discovered, the acute phase of whiplash is often followed by a period of several months of chronic discomfort. Neck ache and headache, as well as soreness and muscle tightness in the upper back between the shoulder blades are the most common complaints.

In this chronic phase of whiplash, X-rays, MRI and other tests often are unable to find a clearly identifiable abnormality that causes pain. Insurance companies tend to assume those with this type of whiplash complaint are actually malingering or exploiting the legal system in search of some undue compensation. My experience, however, has been just the opposite. I find that almost all of my patients with chronic whiplash complaints have signs of abnormal motion of the muscles and bones in the neck and back. This abnormality is subtle. It is not like a dislocation or fracture that is easily identified with testing equipment. Fortunately, the most sensitive of testing equipment the trained human hand can easily find it. Osteopathic physicians, chiropractors and physical therapists make their livings doing this.

Unfortunately, identifying the problem doesn't always lead to a simple resolution of it. Physical therapy and osteopathic manipulative treatment usually promote healing, but this is no miracle cure. It takes time to heal the damage that has been done, and healed tissue is not the same as "never injured" tissue. Most people are well within a year but can still tell in subtle ways that their neck isn't the same as it was before their injury. Without examining you, I'm unable to tell where you are along this path of recovery. Your doctor should be able to help you determine what to expect, particularly if he or she has a good understanding of the subtle changes that occur to the musculoskeletal system with a whiplash injury. Perhaps you would benefit from an examination by an osteopathic physician.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.