In today's video, with the help of the cadavers here in the lab,
we're going to discuss the surprisingly destructive possibilities of...
whiplash.
Let's do this!
There are an estimated 3 million new cases of whiplash,
or what's more properly known as cervical acceleration-deceleration,
each year in the United States.
So if you're someone who has suffered whiplash in the past or is still suffering
whiplash symptoms today, let us know your story in the comments below.
For the vast majority of whiplash, cases come from rear-end collisions,
but technically,
anything that causes the neck and head to whip back and forth can cause whiplash.
So headbangers — I’m looking at you...
But let's say that I am in a rear-end collision.
So what will happen is my seat would actually push
into my thoracic spine, causing my chest to move forward,
but my head and neck would actually stay in place.
Well, at least the upper part of my neck.
And so what that's going to do to my cervical spine is cause
C7 to come forward while C1 stays place in place.
It creates kind of this S-shaped curve to that cervical spine.
Then as I'm in this position, my neck is going to drop into hyperextension
and from there it's going to whip forward into cervical flexion.
Now to understand why this can potentially be so damaging,
let's discuss some of the essential and relevant anatomy of the head and neck.
So what you're looking at here is going to be a sagittal section
of the human head, but our focus is going to be in this region here.
So what you're looking at right here
is going to be the cervical spine or the cervical vertebrae.
If you look closely, you'll even be able to see a little line right here.
This is the separation between C1 and C2.
C2 is much more massive.
This is a really cool bone.
And these two bones actually have a unique relationship
where they kind of like loop around each other and they pivot.
I don't know if my black gloves are going to really show that all that much,
but it's a really unique relationship the C1 and C2 have.
But then we can get to the C3, C4, C5, C6,
and then that's where we've actually made the cut.
And separating these vertebrae are going to be intervertebral discs.
These are fibrous cartilaginous discs surrounding a gelatinous center
and they're really good at shock absorption. So they
get compressed and then they bounce back.
So again, think like as you're jumping, all those discs are just getting squashed
and then bouncing back.
Really, really cool pieces of tissue.
Now, in order to keep these bones in place, though,
there's going to be connective tissues surrounding them.
And on the front side is what's known as the anterior
longitudinal ligament or the ALL.
And the ALL is going to help limit hyperextension.
So you can picture as I'm bringing my neck back, that this ligament
would be experiencing stress and trying to limit that action.
Then on the other side of it, we have what's known as the posterior
longitudinal ligament, but it's kind of hard to parse it out
because it's also blended with something called the dura.
So the dura is
a meninge, and it's what's helping to protect the spinal cord.
So both of these tissues are kind of blending in with each other.
So we have the posterior longitudinal ligament
as well as the dura here and the PLL, or
posterior longitudinal ligament, is going to help limit cervical flexion.
So the opposite of what I just showed you.
Then on this other side, we have a similar relationship as we did
over here where we have the dura and then also on the other side of it is
what's known as the ligament flavum, which is a really cool named tissue.
It just means yellow ligament because it does indeed look yellow.
But then on top of that,
we also then have these spinous processes.
These are the bony projections that people commonly identify with
with the vertebral column.
But in between them is what is known as interspinous ligaments.
Interspinous ligaments
are going to
help reduce or limit cervical flexion.
So they're going to get tight as the neck is
flexing in the cervical region.
And then on top of that, we have what's known in the neck region,
at least as the nuchal ligament or the ligamentum nuchae.
The nuchal ligament is
a continuation of another ligament that would actually be on the surface
of all of the spinous processes down in the thoracic and lumbar vertebrae.
But the nuchal ligament isn't quite unique to humans,
but it's not commonly found in the animal kingdom,
and the nuchal ligament exists in humans, at least to help keep our heads straight.
Or this is one of the reasons — I shouldn't say the only reason —
but it helps keep our head straight as we are running.
So when you're running, your shoulders are actually dropping.
And as that happens, it yanks on your head and wants to pull your head
in all sorts of directions.
So if you didn't have the nuchal ligament as we were running, your head would
just be all over the place, which is obviously not a good thing.
And especially since humans essentially evolved to be long distance runners.
This is an important piece of tissue.
But this is going to help reduce that cervical flexion as well.
And it's also an attachment site for muscles such as the trapezius.
And you can see that it's coming all the way up to that occipital bone.
Now, what we can't see from this view on the other side of the spinal cord,
which is this tissue coming here, are going to be
what are known as spinal nerves.
And these are going to be projecting off of the sides of the spinal cord.
And they're going to be
going
together to help innervate the muscles and tissues
in the upper body, including the upper limbs.
And then what we also can't see from this view at all is on the posterior side,
but we have what are called facet joints.
Facet joints are the connection points between an upper and a lower vertebra.
So you have you have cervical facet joints which are oriented
in the transverse plane, and they allow for rotation in the neck.
In the thoracic region you have them more coronally oriented.
And that allows for lateral flexion in that thoracic region.
And then in the lumbar region, they're oriented in the sagittal plane,
which allows for flexion and extension in the lumbar or that lower back.
But you have to understand these are going to be covered in cartilage.
And so this is also going to experience — if you're experiencing whiplash —
that can start creating some pretty nasty
injuries, potentially, at least on those facet joints.
Now, before
we discuss the potential destruction that whiplash can cause in the body,
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Now that we understand all the anatomy that's going to be involved in whiplash,
I think it's important to quickly discuss the difference between sprains
and strains because they're often confused for one another, despite being
or affecting different tissues.
Sprains affect ligaments and strains, with a ‘T’, affect tendons and muscles.
And that's how I always remember it
— that the ‘T’ is also in ‘tendon’, so it kind of lines up.
But even within them they are then broken down into what are known as grades.
These are grades of severity.
And that's what I want to discuss right now.
So let's go ahead and just say this is a sprain.
So we're affecting a ligament, but this would be equally true
for muscle or tendon.
So the black lines are representing bones
and then the green lines are going to be representing collagen.
And just so everyone knows and is on the same page, ligaments
are what you place in the body if you want to restrict range of motion.
It's basically a strap that says, “no, you aren't moving
farther than the allowed range of motion.” While muscles
and tendons, on the other hand, also connect bones to each other.
But they are there to generate movement at a joint.
So one restricts movement and one generates that movement.
Regardless, let's go ahead and assume that this is a ligament
and we're discussing a grade one sprain.
So this is essentially like you rolled your ankle.
But that's also very imprecise language because I've heard plenty of people say
they rolled their ankle or something similar when they really had a grade
two sprain.
So again, that's why it's just not the most precise language out there.
But what you can see
are these tiny little red X's are meant to show you minor damage.
How minor? It’s kind of up for debate.
But what this typically comes with is inflammation.
You might get some swelling
— well, obviously swelling, but bruising that that can come with it.
But that inflammation will come with pain and loss of range of motion.
But these are typically going to resolve on their own through rest
and just taking it easy for a period of time.
So again, like “pulling the muscle”, or “rolling an ankle” type of injuries,
even though those are more imprecise.
Grade two, on the other hand, is where things get a lot more severe.
And that's because we're now doing a partial tear.
So the X’s here are saying that part of the ligament has torn
but not the entirety of the ligament. Now,
obviously there's different severities of grade two
because say, if we only had a couple X’s, that's technically a grade two.
But what if we had a bunch of X’s
all the way coming through, but it stops before the end?
That's still technically a grade two.
Grade three is where we have a full on rupture.
So we have ripped through the entirety of the tissue.
Now, depending on where these sprains and strains happen,
sometimes a grade three might actually be better for you in the long run
because it could be easier to replace and treat the injury.
Then with a grade two, you're just stuck in the sense of rehabbing it.
But again, this is circumstantial and it depends on the exact area.
So just understand that when you suffer a whiplash
type event, there can be a whole spectrum.
You could be having grade ones through threes,
you could be only having grade one. It could be
sprains, it could be strains.
There's a lot of different options,
which is why these types of injuries can be so complex.
Let's now discuss what's known as “whiplash syndrome”
or “cervical acceleration-deceleration syndrome”.
And this, unfortunately,
is why whiplash is so potentially and surprisingly destructive,
because this is where patients can feel symptoms of the whiplash
or the traumatic event itself for potentially years to come.
And there's a lot of controversy and debate in this space.
And I'm not going to pretend
to be an expert in insurance and billing and how all of that works out.
But that's where a lot of this controversy comes and a struggle
from a clinical perspective to really isolate and dial in
on some of these symptoms and the cause of those symptoms.
But here's what we do know: people who suffer
from whiplash syndrome can present with neck sensitivity
in terms of proprioception —so the way they just feel “off”.
There's tightness and stiffness in the neck.
Just putting pressure on the neck can even be tender.
So you get that neck pain, you get chronic headaches, you get shoulder pain.
You can even get radiating neurological pain that can go into the limbs.
And this is a product of all the anatomy that we saw.
When you have spinal nerves that are coming out between the vertebrae
and then you lurch them forward very harshly,
you can either cause inflammation to the surrounding tissues — That puts
pressure on the nerves, or you can cause direct damage to the nerves themselves.
Part of that problem in determining all this is medical imaging
and just what people can afford,
what insurance companies are willing to pay in order to detect...
So there's a lot of debate around this.
But unfortunately, also you have people who are willing to take this to
what I personally feel is an illogical extreme.
I've heard many people, especially in the manual therapies realm,
and this is not an indictment of, say, massage therapy as a whole — it's
definitely not that.
But I've heard plenty of massage therapists say things like “knee injuries
or ankle injuries can be a direct product of whiplash”.
And to me, that seems like an extraordinary reach.
I don't know how we really get there.
I understand their logical reasoning.
They are operating off of the transfer of energy
as it ripples through the connective tissues, which is undeniable.
That definitely happens.
But the data really suggests that most, if not all, of
the trauma is really isolated and located
to very specific areas, namely the neck and chest and head.
But you can feel the consequences of that throughout the body
in multiple different ways.
So musculoskeletal pain
definitely happens with whiplash and far and distant musculoskeletal pain.
But to say like, “my ACL is experiencing problems because of the whiplash”,
that feels like a pretty, pretty big reach to me.
This is why it's so important to go see a doctor, no matter how minor
the automobile accident may have been.
Even if it's just a basic fender bender and you “feel fine”,
you still want to get this checked out.
Again, from an insurance and legal perspective,
but also just making sure you're going to be okay.
You always want to get these things documented and just have an understanding
of any potential injuries that you may not be aware of.
Sometimes things can be very subtle.
You just never know how this may shake out in the long term.
And so it's always best to be prepared or overly prepared in the event
that you find yourself whipping your head back and forth.
Thanks for watching, everybody.
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