Chiropractic Research and Studies on Car Accident Injuries

After a car accident, what causes the pain?

Studies looking at whiplash injuries consistently identify the facet joints, or the joints in the back of your neck, as the primary source of whiplash injury pain. The second most common tissue source is the intervertebral disc. Injury to the facet joints and the intervertebral disc produce a chemical inflammation which causes nerve endings to be excited in the local area where the injury has occurred. This causes your brain to sense more pain.

When looking at car accidents and the lower back, studies indicate that the main source of pain is the intervertebral disc. After having had a traumatic injury, the intervertebral disc will degenerate or wear out quicker and we also produce more pain sensing nerve fibers which turns the intervertebral disc itself into a tissue source of pain.

The third and final tissue which produces pain after a whiplash injury or car accident are the muscles. The muscles undergo tremendous stress in a car accident producing many micro-tears within each muscle. Each of these tears will necessitate scar tissue formation and if the muscle does not heal properly may produce chronic pain.

Muscle Pain and Treatment Following Whiplash

Any direct injury to a muscle can cause inflammation and therefore pain. Any long-term or short-term acute musculoskeletal pain often has a significant muscle contribution. Often this is referred to as myofascial pain syndrome. A simple explanation of this syndrome involves these steps:

  1. Inflammation in the muscles results in nerves transmitting pain signals to the spinal cord. In the spinal cord chemicals are released which continue the signal from one nerve to the next heading toward the brain.
  2. Within the spinal cord, these chemicals which are intended to continue the signal toward the brain also stimulate a motor nerve – a nerve designed to contract a muscle. When this occurs your muscle contracts. Chronic pain signals sent from injured muscles cross-talk at the spinal cord with nerves that inadvertently cause muscle contraction near where the pain originated. You may have had this happen when you have injured yourself and felt the area where you were injured. You probably noticed that the muscles were tight all around it.
  3. As a result of the pain, muscle contraction continues – it is therefore very rational that the treatment of your pain would involve first stopping the muscle contraction and the pain which originates the process. This can be accomplished very effectively with ischemic compression, stretching, massage, and most importantly, low level laser therapy.
Managing Whiplash Injuries

The origin of all pain is inflammation and the inflammatory response. This has never been more true than in people who have had car accidents. When your body tissues have been damaged, chemicals are released which cause a complex cascade of chemical reactions which result in pain. These same chemicals which are causing pain also stimulate the process of recovery and healing.

To do so, the body starts to develop scar tissue or fibrosis. A day or two after injury and acute inflammation, the connective tissue (ligaments, muscles, tendons, fascia, etc) begins to react by producing new cells, capillaries to carry blood, and scar tissue.

The Department of Bioengineering and the Department of Neurosurgery at the University of Pennsylvania produced a recent study which was published in the Annals of Biomedical Engineering in 2011.   This was a landmark study and helps to provide us with great information about how to help you get better after an accident. We learn the following details:

  1. The inflammation caused by an accident leaves the ligaments around the joints in your neck forever and permanently changed – which is why patients often have pain for many months following whiplash.
  2. Rear-impact car accidents cause the spine to undergo compression, shear and extension movements which cause the damage to the rear joints called facet joints. If left untreated, these injuries become permanent and chronic.

The following treatment methods must be employed to reach maximum recovery:

* Effective inflammatory control

* Early and aggressive movement of the joints so that the ligaments heal properly. (Chiropractic adjustments)

* Controlled therapeutic exercise to aid in normal scar tissue formation

These steps are the normal protocol in our office to help you get out of pain as soon as possible and make sure your body heals properly to avoid chronic and permanent pain syndromes.

References

1)   Bogduk N, Aprill C; On the nature of neck pain, discography and cervical zygapophysial joint blocks; Pain; August 1993;54(2):213-7.

2)   Cusick JF, MD; Pintar FA; Yoganandan N; Whiplash Syndrome: Kinematic Factors Influencing Pain Patterns; Spine; 2001;26:1252-1258.

3)   Bogduk N; On Cervical Zygapophysial Joint Pain After Whiplash; Spine; December 1, 2011; Volume 36, Number 25S, pp S194–S199.

4)   Travell J, Simons D; Myofascial pain and dysfunction, the trigger point manual; New York: Williams & Wilkins, 1983.

5)   Travell J, Simons D; Myofascial pain and dysfunction, the trigger point manual: THE LOWER EXTREMITIES; New York: Williams & Wilkins, 1992.

6)   Simons D, Travell J; Travell & Simons’, Myofascial pain and dysfunction, the trigger point manual: Volume 1, Upper Half of Body; Baltimore: Williams & Wilkins, 1999.

7)   Gunn CC; The Gunn Approach to the Treatment of Chronic Pain: Intramuscular Stimulation for Myofascial Pain of Radiculopthic Origin; Churchill Livingston, 1996.

8)   Omoigui S; The biochemical origin of pain: The origin of all pain is inflammation and the inflammatory response: Inflammatory profile of pain syndromes; Medical Hypothesis; 2007, Vol. 69, pp. 1169 – 1178.

9)   Cyriax, James, M.D., Orthopaedic Medicine, Diagnosis of Soft Tissue Lesions, Bailliere Tindall, Vol. 1, (1982).

10)   Quinn KP, Winkelstein BA; Detection of Altered Collagen Fiber Alignment in the Cervical Facet Capsule After Whiplash-Like Joint Retraction; Annals of Biomedical Engineering; August 2011, Vol. 39, No. 8, pp. 2163–2173.

11)   Linnman C, Appel L, Fredrikson M, Gordh T, Soderlund A, Langstrom B, Engler H; Elevated [11C]-D-Deprenyl Uptake in Chronic Whiplash Associated Disorder Suggests Persistent Musculoskeletal Inflammation; Public Library of Medicine (PLoS) ONE; April 6, 2011, Vol. 6 No. 4, pp. e19182.

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