80% of the injuries from car accidents are caused by a “rear end collision where the head and neck of the victim is “whipped” back and forth causing a “whiplash” injury.
Whiplash is an injury to the neck, mid-back, and low back with symptoms radiating into the head (causing cervicogenic headaches), into the shoulders, arms and hands, and into the legs and feet.
Neck pain is clearly the most common symptom of whiplash. The North American Spine Society (NASS) recognizes that other symptoms include the following:
THE CONSEQUENCES OF WHIPLASH INJURY CAN BE VERY SIGNIFICANT.
The NASS recognizes the following:
1. Whiplash injury can cause permanent disability. According to the NASS, about one out of three patients does not totally recover and 10% of people who get neck pain after an MVA wind up with constant severe pain, and those are the patients who need the most medical care.
2. Whiplash Associated Disorder can cause injury to the entire structure of the spine which includes the entire “long chain of bones, discs, muscles and ligaments that extends from the base of the skull to the tip of the tailbone.” That includes the following:
A. The major structural support, the vertebrae (bone);
B. The intervertebral discs which are between two adjacent vertebrae is a disc.
C. The facet joints which are in the back of each vertebra, one on each side. The facet joints are designed to allow smooth motion for bending forward. backward and rotating, but also limit excess motion.
D. The muscles and ligaments surround and support the spinal column.
E. The nerves that supply all of these structures, injury to anyone of which can cause pain.
3. The symptoms of WAD can progressively develop over a period of weeks and months after the collision. The immediate cause of the pain cannot be immediately diagnosed. The existence of facet joint injury and/or injury to the intervertebral discs often cannot be diagnosed until later.
4. Facet Joint Injury is the most common cause of chronic neck pain 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.The cause of facet joint pain can only be determined using an injection called “medial branch block” (MBB). It cannot be diagnosed with an X-ray or MR scan.
5. Injury to the Intervertebral Discs 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 does not heal. In that case, it might get weaker and hurts when stressed during normal activities. The pain comes from nerve endings in the annulus.Disc injury is the major cause of chronic neck pain in about 25% of patients, and there can be both disc pain and facet pain in the same person. A disc can herniate and push up on a nerve. This usually causes more arm pain than neck pain.
6. Muscle Strain Injuries of the neck and upper back also 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 there is something else wrong that sustains the muscle pain, such as poor posture and work habits.
7. Injury to the spinal nerves and the spinal cord can result from the compression caused by a Herniated Disc or Bone Spur. This usually causes arm pain, but there an also be neck pain.
8. The symptoms of whiplash and WAD include the following:
A. Headache due to neck problems is called cervicogenic or neck- related headache. It may be due to injury to an upper cervical disc, facet joint or higher joints called the atlanto-occipital or atlanto-axial joints. Cervicogenic headache can also make migraines worse.
B. Arm pain and heaviness may be due to 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 due to pressure on a nerve.
Pain between the shoulder blades is usually a type of referred pain.
9. Epidural injections into the spinal canal can provide short-term relief in cases of nerve compression with arm pain, but are rarely effective for pure disc pain without radiating symptoms. Facet (zygapophysial) injections may help temporarily with neck pain and are usually tried before radiofrequency neurotomy. Radiofrequency neurotomy (RFN) is a procedure that heats the nerves to stop them from conducting pain signals but is only useful for facet joint pain. It can help for about nine to 18 months and then can be repeated if needed and should only be considered in chronic situations with significant pain.
10. Spinal manipulative therapy (SMT) is usually provided by chiropractors, osteopaths or specially trained physical therapists. SMT can provide relief from symptoms for many patients, and is generally safe. SMT should be combined with strength training and body mechanics instruction.
11. Surgery for chronic neck pain is hardly ever necessary. However surgery can be helpful when there is severe pain arising from one or two discs and the patient is very disabled, psychologically healthy and has not gotten better with nonoperative care. Surgery is done more often when there is pressure on a nerve or the spinal cord.
The NASS tells us that the most common cause of whiplash and WAD is a car crash or motor vehicle collision (MVA) in which one car (the struck vehicle) is hit from behind by another (the bullet vehicle). The Schmidt-Salita Law Team has 40 years of experience in helping the victims of whiplash injuries to the neck and back. Let our experienced lawyers help you and your loved ones obtain justice.
Douglas E. Schmidt has over 40 Years experience in successfully representing the victims of personal injury and wrongful death. He has made a study of both the legal and medical literature relating to whiplash injuries, i.e. flexion/extension or in the words of Dr. Arthur Croft, “the cervical acceleration/deceleration syndrome.”
Schmidt notes that IME doctors all attempt to categorize the victims of whiplash injuries as “crash test dummies” that all react in an identical fashion. The truth is quite the contrary:
Schmidt notes that the literature contains documentation of the many factors that influence the severity and likely permanency of whiplash injuries, which include the following factors:
1.The amount of “rebound” of the target vehicle and the amount of “crush” of the target vehicle. It is a fact of basic physics that it is the sudden movement of the target vehicle that causes the hyperextension of the human spine. For that reason, the amount of sudden movement, or “rebound” of the target vehicle is the single greatest factor in causing flexion-extension injuries of the spine. The more “rebound”, the more injury. To the contrary, the more “crushing” damage to the target car, the less injury because the “crush” absorbs force and reduces the “rebound”. Many defense lawyers and insurance adjusters foolishly think that there is a direct relationship between the severity of human injury and the amount of car damage when in fact the exact opposite is often true. I.E. the more car damage, the more “crush”. Conversely, the more “crush” the less rebound. The less rebound, the less injury. Simplified, the bottom line is “the more car damage, the less injury.”
2. The angle of the collision. There is evidence that any impact that results in the target vehicle being “twisted” or spun at the time of impact is more likely to produce severe injury than a straight-on collision.
3. The differential speed between the two vehicles. A very important factor is that of the differential or “closing” speed between the two vehicles. If the front vehicle is totally stopped and hit from behind at 12 mph the closing speed is 12 mph. Likewise, if the front vehicle is traveling at 20 mph and hit by the rear vehicle going 32 the closing speed is again 12 mph. However, the force of the impact will be greater and the “rebound effect” greater in the case of the impact at higher speeds because there is more “rebound effect” on a car that is already moving.
4. The speed and size of the rear car. It is a simple fact of physics that the larger the rear-ending vehicle is and the faster it is traveling, the greater the force exerted on the target vehicle will be.
5. The speed and size of the front car. Again, the key factor influencing the severity of the injury is the amount of “rebound”. The smaller the target car, the more rebound and, therefore, the more injury.
6. Road conditions. The amount of rebound is directly related to the distance that the car moves after the collision. Thus, slippery road surface conditions cause increased “rebound,” thus increasing the severity of the injury. Conversely & hypothetically, the occupants of the car that is firmly anchored in concrete will not suffer injury because their bodies simply do not move.
7. Head position. It is well established that the degree of severity of injury is greater when the head is turned at the time of impact. (Sturzenegger M, DiStefano G, Radanov BP, Schnidrig A. “Presenting symptoms and signs after whiplash injury: the influence of accident mechanisms”. Neurology 1994; 44:688-693.; Radanov BP, Sturzenegger M, De Stefano G.) “Long-term outcome after whiplash injury. A two-year follow-up considering the features of injury mechanisms and somatic, radiologic, and psychosocial findings.”(Medicine 1995; 74(5):281-296.)
8. Gender. Research has consistently shown that women are at a much higher risk of developing chronic whiplash pain than are men. Experts have suggested that this increased risk may be due to differences in anatomy or seating position. Other experts believe that the difference is due to the fact that females than to have less musculature of the neck and upper back.
9. Victim preparedness. Literature documents the fact that the victim who is unprepared or surprised with no warning of the impending collision will be likely to suffer greater injury to the neck and back than those who have an opportunity to brace themselves thus minimizing the hyperextension. “Presenting symptoms and signs after whiplash injury: the influence of accident mechanisms.” (Neurology 1994; 44:688-693).
10. Head restraints. Research has proven that head rests or restraints that are improperly positioned can actually increase the severity of neck injuries. Research has also proven that nearly 90% of all headrests are not properly positioned. Most people mistakenly believe that the head restraint is a head “rest,” and use it to rest their heads. The restraint should be positioned so that the back of the head touches it. Many adjustable head rests are set too low, so that they act as pivots during hyperextension, causing more injury.
11. Seat Position: Another aggravating factor is that of the seat position. Many drivers drive with the seat set back at an angle so that the upper torso will whip backward with greater force, causing a more serious injury. Even seats that are set too far forward can aggravate the whiplash effect, causing greater hyperextension, even with a head rest.
12. Safety belts. Medical literature has established that while shoulder belts do save lives, they also can exaggerate the flexion-extension mechanism by holding the body in a fixed position while the head experiences an even greater hyperflexion. Because shoulder belts typical only go over one shoulder, they can cause a twisting of the upper torso as one shoulder is being restrained and the other not. This then causes a potential for greater injury due to the twisting forces. Additionally, there is evidence that shoulder belts can cause chest injury. The Schmidt-Salita Law Team has recently handled several cases of severe injury to the sternum which were presumably caused by shoulder belt trauma to the chest.
13. Prior Medical condition. Prior health condition is a very critical factor in determining the severity of injury. Prior neck and back conditions, such as degenerative arthritis or degenerative disc disease can result in a minor impact having major consequences.
14. Time of Pain onset. It is generally recognized that patients with immediate symptoms are at a higher risk of long-term pain from whiplash. Patients who reported pain immediately after their accidents were more likely to have pain at two years post-injury. See Radanov BP, Sturzenegger M, De Stefano G. “Long-term outcome after whiplash injury. A two-year follow-up considering the features of injury mechanisms and somatic, radiologic, and psychosocial findings.” (Medicine 1995; 74(5):281-296).