This week from Dr. Cerami and Utah Sports and Wellness
From: American Journal of Surgery, April 1957 (https://www.americanjournalofsurgery.com/article/0002-9610(57)90527-5/pdf)
Although only 15% of motor vehicle crashes are rear-end collisions, rear-end collisions account for 92% of patients who seek treatment for injuries. Over-compensation by the neck musculature in combination with the sudden deceleration results in acute hyper-flexion of the neck. It is this part of the mechanism, the acute hyper-flexion, that produces the greatest damage. Cerebral concussion is another concern associated with a whiplash injury. This primarily occurs during deceleration (flexion) phase to the occipital areas of the brain. Initial concussion symptoms range from mental confusion or headache to loss of consciousness. Cerebral concussions can also create persistent symptoms such as, headache, vertigo and inability to concentrate, some symptoms may still be present after two years.
This paper represents an attempt to explain the complex symptomatology resulting from the so-called whiplash injury. Previous articles have stated that the hyper-flexion occurs before the hyper-extension. A different sequence of the mechanics of the injury is postulated with the hyper-extension believed to occur first with a resultant over-correction and then the damaging hyper-flexion.
These authors also note:
- Although only 15% of motor vehicle crashes are rear-end collisions, rear-end collisions account for 92% of patients who seek treatment for injuries.
- The collision from behind thrusts the head into a position of acute extension.
- “Over-compensation by the neck musculature in combination with the sudden deceleration results in acute hyper-flexion of the neck.”
- “It is this part of the mechanism, the acute hyper-flexion, that produces the greatest damage.”
- “Cerebral concussion primarily occurs during the deceleration (flexion) phase to the occipital areas of the brain, “accompanied by the torsion of the brain stem.”
- Concussion symptoms may still be present after two years.
- Elastic ligaments are less likely to tear during whiplash than inelastic ligaments
- Patients with ligament injuries have increased pain with even slight motion, causing a splinting of the muscles and a loss of cervical lordosis.
- “Persistent soft tissue complaints and radiculitis are explained on the basis of edema and hemorrhage which occurs with avulsion of the ligaments and musculature of the neck.”
- Subsequent organization of this edema and hemorrhage “results in pressure in and about the foramina with nerve root compression.” [Fibrosis of Repair]
- “Occipital pain may be related to either compression of the greater occipital nerve or may result from avulsion of the insertion of the musculature and ligaments on or near the occipital ridge.”
- “The possibility that hanging the patient’s head over the foot of the bed might result in a more physiologic restoration of the cervical angle.” [Lordosis]
- “Progressive ambulation with or without support to the neck is needed.”
- Cervical collars should be “removed early to prevent atrophy of the neck musculature.”
- Physical therapy consisting of heat, passive motion and intermittent cervical traction is helpful.
- Severe cases may require surgery consisting of cervical laminectomy and decompression.
- Prior articles on whiplash claim that the hyperflexion occurs before the hyperextension: this author believes that the “hyperextension occurs first with a resultant over-correction and then the damaging hyperflexion.”