Whiplash Is Not A Diagnosis
Not a week goes by that a patient doesn’t come in and tell me that he/she has or had whiplash. Whiplash is not an injury, it’s a mechanism of injury. Saying you have whiplash would be like saying you have “fell on my back” or “slip and fall”.
So now that we understand that whiplash is not an injury, lets talk about one of the most common injuries whiplash can cause…Subfailure Injuries.
Subfailur Ligament Injuries
Ligaments are fiberous connective tissue that hold bony joints together. They attach from bone-to-bone with the purpose of stabilizing joints and allowing them to move within their normal range of motion. Unlike other connective tissue, such as muscles, they are not very elastic and do not stretch very well. This is critical to understanding how these tissue get injured in car crashes.
Ligament Instabilities Defined
“The loss of the ability of the spine under physicologic loads to maintain relationships between vertebrae in such a way there is neither damage nor subsequent irritation to the spinal cord or nerve roots, and, in addition, there is not development of icapacitating deformity or pain due to structural changes.”
White AA, Panjabi MM: The problem of clinical instability in the human spine: a system approach. Clinical Biomechanics of the Spine. 1978:192
The adult cervical spine is unstable when:
- a) All the anterior or all the posterior elements are destroyed or unable to function.
- b) More than 3.5mm horizontal displacement of one vertebra in relation to an adjacent vertebrae measured on lateral x-rays.
- c) More than 11º or rotation difference to that of either adjacent vertebra measured on lateral cervical neutral or flexion-extension x-rays.
- d) Cervical kyphosis.
Future Health Problems
Joint instabilities resulting from ligament injuries causes not only increased pain but may also lead to additional health problems including: disc derangement, degenerative changes, increased pain, nerve entrapment and spinal cored compression.
Proper Diagnosis Leads To Proper Treatment
Special evaluation of joint instabilities needs to be considered when determining the most appropriate treatment. Frequently joint instabilities will not be detectable on neutral lateral and anterior x-rays, cervical flexion/extension and open mouth lateral bending films should be taken to determine the true integrity of the spinal ligaments. If injuries to the lumbar spine are suspected; flexion/extension and lateral bending films of the lumbar spine are recommended. Think about an athlete with a torn ACL; the knee and supporting ligaments may appear fine in the neutral position but when the knee is put under stress with pushing or pulling the lower leg, pain is created because the injured ligaments are stressed. Similarly many injures in the spine will only present themselves when the spine is stressed in flexion/extension or lateral bending.
Special consideration needs to be considered with treating injuries with instabilities because improper treatments and irritate and potentially make the instabilities worse.
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