Neck pain from auto accidents
WHIPLASH Background: anatomy of the neck
Whiplash injury can cause many problems with the neck; First lets understand more about the structures in the neck. The spine is a long chain of bones, discs, muscles and ligaments that extends from the base of the skull to the tip of the tailbone. The cervical spine (neck region) supports the head, protects the nerves and spinal cord, and allows for smooth function of the neck during activity. The major structural support is from the vertebrae (bones). Between two adjacent vertebrae is a disc. In the back of each vertebra are two facet joints, one on each side. The facet joints are designed to allow smooth motion for bending forward. backward and rotating, but also limit excess motion. Muscles and ligaments surround and support the spinal column. All of these structures have nerve supplies, and injury to any one of these can cause neck pain.
What causes whiplash?
It is usually not possible to know the exact cause of whiplash in the days or weeks after a car accident. We know the muscles and ligaments get strained and are probably inflamed, but they usually heal within six to ten weeks. Whiplash, Neck, or back pain that lasts longer is usually a result of deeper problems such as injury to the disc, facet joint, or both.
Facet joint pain is the most common cause of whiplash after a car accident.
It may occur alone or along with disc pain. Facet joint pain is usually located to the right or left of the center back of the neck. The area might be tender to the touch, and facet pain may be mistaken for muscle pain. We cannot tell if a facet joint hurts by how it looks on an X-ray image or MRI scan.
Disc injury can also cause chronic neck pain.
The disc allows motion of the neck, but at the same time keeps the neck from moving too much. The outer wall of the disc (called the annulus) can be torn by a whiplash injury. This usually heals, but in some people, the disc does not heal. In that case, it might get weaker and hurts when stressed during normal activities. The pain comes from the nerve endings in the annulus. The disc is the major cause of chronic neck pain in about 25% of patients, and there can be both disc pain and facet pain in some people. Less often, a disc can herniate and push on a nerve. This usually causes more arm pain than neck pain.
Muscle strain of the neck and upper back from whiplash can:
- cause acute pain. However, there is no evidence that neck muscles are a primary cause of chronic neck pain, although muscles can hurt if they are working too hard to protect injured discs, joints or the nerves of the neck, or if something else is wrong that sustains the muscle (whiplash) pain, such as poor posture and work habits.
- Spinal nerves and the spinal cord can be compressed by a herniated disc or bone spur. This usually causes arm pain, but there can also be neck pain. (If you are diagnosed with a herniated disc, see the NASS Patient Education Brochure on Herniated Cervical Disc for more information.)
What are the symptoms of whiplash?
- Headache caused by neck problems is called “cervicogenic” or neck-related headache. It may be caused by a whiplash injury to an upper cervical disc, facet joint. Cervicogenic headache can also make migraines worse.
- Arm pain and heaviness may be caused by nerve compression from a herniated disc, which is easy for your health care professional to diagnose. More commonly, arm pain is “referred” from other parts of the neck. “Referred pain” is pain that is felt at a place away from the injured areas but not resulting from pressure on a nerve. Pain between the shoulder blades is usually a type of referred pain.
- Low back pain is occasionally seen and is quite common after whiplash injury and may be caused by injury to the discs, facet joints of the low back or sacroiliac joints.
- Concentration or memory difficulties can be attributed to the pain itself, medications you are taking for the pain, depression or mild brain injury. You might also experience irritability and depression.
Sleep disturbance can be a result of pain or depression. Other symptoms might include blurry vision, ringing in the ears, tingling in the face and fatigue.
How is whiplash diagnosed?
Your health care professional will ask you about your symptoms and how the whiplash injury occurred, and then perform a physical examination. This will allow the health care professional to know if you need any tests immediately or if they can wait, and also how to best treat your problem. In patients who do not get better soon, a more detailed evaluation and other tests may be needed.
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