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

READER'S WHIPLASH MIGHT BENEFIT FROM D.O. MANIPULATIVE TREATMENT

Question: Last May, over Memorial Day Weekend, I was "rear-ended" in an auto accident and received a whiplash injury. I'm still having trouble with pain and soreness in my neck and shoulders, and I have frequent headaches, which I never had before. How long does it usually take to get over this kind of problem?

Answer: Whiplash injuries are due, in part, to 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 it so we can easily point our head 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. Let's take a look at your specific case. As you drove down the highway, your neck muscles were only under sufficient tension to hold the head in a position to see the road. However, when you were struck from the rear by the other vehicle, your car suddenly accelerated and placed your neck under tremendous strain. While your body -- supported by the car seat, seat belt, shoulder harness, feet and arms -- accelerated nearly as fast as the car, your "heavy head" continued backward. Your head didn't stop until it had reached or exceeded the normal limits of the neck's mobility and thereby strained the supporting muscles and ligaments. It is injury to these structures that is the source of your pain. This type of injury happens less often now that most vehicles on the road have some form of headrest, but it certainly doesn't eliminate the problem, does it?

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 are all well trained in this type of palpatory diagnosis.

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 one 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 take place in 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. Past columns are available online at http://www.FamilyMedicineNews.org.