Whiplash woes
— The Holy Bible, I Samuel Ch. 4, v. 18
YOU could say that a whiplash injury is as old as the chariot. Anytime you put a person in a box on wheels, whether it’s getting pulled by horses or it’s running on gas, an accident can never be far away.
This is how whiplash happens. Say you’re on your merry way to the mall. Your car is cruising at a steady speed when suddenly... BAMMM! Another car, going faster than you are, hits you from behind. The car you are driving is pushed forward from the impact. 100 milliseconds later, your body follows the direction of the car. Your shoulders move forward and your neck and head bend toward the steering wheel. Instinctively, you step on the brakes and so your car stops abruptly. This time your neck moves backwards striking the headrest. My friend, you have just suffered a whiplash injury.
SIGNS AND SYMPTOMS. Within minutes to hours after the accident, you may complain of: • Neck pain and spasm • Dizziness • Blurred vision or ringing in the ears
• Numbness or tingling sensation in the arm or hand
• Shoulder pain or pain in between the shoulders • Low back pain • Irritability • Inability to concentrate or remember
• A sudden interest to call your lawyer (most common finding in Los Angeles, CA)
WHAT TO DO. Assuming that you haven’t broken or dislocated your neck because you’re up and about, it would be a good idea to go immediately to the emergency room.
On the other hand, if you are quite worried, you can stay where you are and ask for paramedic help. A fully equipped ambulance comes with a backboard. You’ll be strapped to one to keep neck motion at a minimum. This should be ideal because you can’t be fully assessed until you are brought to the hospital.
DIAGNOSIS. A whiplash injury is a diagnosis of exclusion. The doctors in the best position to help acutely would be the emergency medicine physician, the neurosurgeon, or the orthopedic surgeon. An initial physical examination must make sure that your spinal cord has not been bruised or crushed. This finding alone will turn your whiplash into a medical and surgical emergency. Most of the insults are in fact in the soft tissues like the disks, muscles, ligaments, and fasciae (muscle covering). Occasionally, there will be associated neck fractures or dislocations. The latter conditions are identifiable by X-rays. However, soft tissues will have to be evaluated using the MRI (magnetic resonance imaging) or a CAT Scan (computerized axial tomography) with contrast dye.
TREATMENT. Emergently, ice for 24 hours may be applied. Immobilization of the neck for purely soft tissue injuries is evolving. In the past, a hard neck collar is worn for weeks. However, if the doctor is certain that no disk herniations, fractures, or other bony problems are present, early neck motion is encouraged. A soft neck collar is worn and removed for early rehabilitation. NSAIDS (nonsteroidal anti-inflammatory drugs) such as mefenamic acid, nimesulide, ketoprofen, piroxicam, diclofenac, and others may be started. Treatment options also include massage, traction, heat therapy, ultrasound, and injections. It is best to consult the rehabilitation medicine doctor (physiatrist) for these.
Chronic conditions from whiplash may need more than conservative measures. In six weeks, if neck pain persists, further examinations are in order. Surgery is an option if a disk herniation is present.
PREVENTION. Other than wearing a seatbelt, it will also help to adjust the headrest of the car seat. The top of the headrest must be at the same level of your head. This rough gauge should allow the headrest to protect the back of your head and not the back of your neck.
Whiplash can happen to just about anyone who gets into a car. Of course, no one ever said that a crash test dummy’s work was any fun anyway.