By Dr. Ron T. Dummar DC, MAOM

Whether from car accidents, sports activities, or slip and falls, Brain trauma is serious and the neuro-motor effects can be devastating.  Injury to the head and neck is of a most serious matter.  Patients need to understand the risks of refusing proper treatment and care where injury to head or neck are concerned.

Most commonly whiplash and brain injury are detected in reference to motor vehicle collisions.  While other activities also carry risks of spine trauma, such as rodeo and football athletes, whiplash as a result of a collision is seemingly more apparent.  Injury due to motor vehicle collisions can be further complicated by head rotation at the moment of impact.  Additionally being unaware, unable to brace, or otherwise unable to stabilize the spine results in more significant damage to ligaments and joint capsules.   Progressive degenerative conditions also increase severity of trauma as tissues become less elastic, more brittle, and more easily torn.  Therefore older patients are more likely to experience more severely acute trauma, while younger patients, if not treated properly, face developing chronic, sometimes debilitating pain. 

Our current medical system is equipped with sophisticated technology and gadgets designed to discover possible causes of brain trauma.  Unfortunately even the best equipment experiences great difficulty in discovering clues with regard to the cause of more mild brain injuries.  While an unremarkable film reading may suggest no further treatment is needed, research and experience are more telling. Whiplash and brain injury commonly occur in motor vehicle collisions even with impact speeds of only 5mph.  Trauma sustained in this level of collision is far less likely to produce a significant finding on radiographs, yet carries with it an equally pertinent need for treatment.  Consequently it is interesting to note in North America joint soft tissue injuries to the neck related to motor vehicle collisions are increasing even though fatal motor vehicle crashes are decreasing.  This presents an even greater need for physicians to make sure their whiplash, sport injury, and slip and fall patients receive an exam from a highly skilled nerve, joint and musculoskeletal specialist.  It takes only the pressure of a dime on a nerve to take away 60% of its function.  A 6% strain on nervous tissue results in a decrease of function by 70% within 1 hour and complete recovery is possible.   At 12% strain the nerve is completely blocked and recovery is rare.

Whiplash is when the neck is forced through a rapid series of movements at a rate faster than the bones muscles and ligaments can accommodate.  The Physical effects of whiplash are numerous and varied.  It is not uncommon to experience swelling, tenderness, neck pain, shoulder pain, upper back pain, sore throat, difficulty swallowing, jaw problems, vomiting, ringing in the ears, headache, tingling sensations, and visual disturbances.  A patient may also experience irritability, short-term memory loss, insomnia and fatigue.  

That disease and illness are not solely the cause of an isolated incident is well demonstrated by the fact that past traumas, while seemingly benign, are often causal for development of arthritic conditions such as Fibromyalgia.  Additionally many patients present with abnormal spinal curvature.  This abnormal curvature works a chain reaction effect on the body leading to the development of muscular imbalances and ligament compensations.  These abnormal curvatures of the spine are most commonly the result of previous spine injuries not properly treated.

Providing proper treatment of whiplash begins with developing a solid plan for spinal rehabilitation.  That is why I use the Gold Standard for spinal rehabilitation in whiplash; The Croft Guidelines.  Adhering to these guidelines guarantees my patients are receiving the very best strategy for recovery.  

Part of providing proper treatment is timing.  Whiplash victims may not experience symptoms for up to two weeks following the accident.  Patient safety and prevention of trauma to the nervous system must be stressed as the patient is strongly encouraged to seek an evaluation and impending treatment if needed.  If patients opt out on proper evaluation they risk setting the groundwork for developing spinal arthritis and degeneration.  This resulting from the inflammatory response that begins with even mild tissue injury, and is furthered by the laying down of scar tissue acting to seal the joint and prevent further movement.  This sealed joint lacks internal motion.  As a result surrounding joints must increase their workload to maintain the patients previously established range of motion.  This overuse of joints, compensating for the lack of motion in another, undoubtedly contributes to premature degeneration.  While early treatment is advised research has demonstrated over 90% effectiveness of Chiropractic Manipulative Therapy in separate populations of late whiplash patients.  Therefore, any patient suffering with musculoskeletal and joint pain that has a history of involvement in contact sports or motor vehicle collision has a 90% chance of responding favorably to Chiropractic treatment.  

There is also efficacy for acupuncture in reference to chronic pain.  A randomized controlled clinical trial from 2003 compared the use of medications, chiropractic, or acupuncture over the course of 9 weeks in individuals experiencing chronic spinal pain.  Chiropractic was shown to be superior for LBP, but surprisingly to the researchers acupuncture was shown superior for neck pain using NDI scores.

Whiplash and brain trauma is serious, and should not be brushed aside or taken lightly.  Athletes demonstrating even mild signs of brain trauma return to play only at great risk.  Some signs of brain trauma include; loss or decreased ability to coordinate movement of body parts, inability to focus on a task, inability to name an object, visual disturbances, memory loss, inability to categorize objects, balance and movement problems, slurred speech, dizziness, tremors, and loss of ability to coordinate fine movements.  For athletes, a sophisticated understanding and use of fine motor movements is crucial to protecting neurology.  A fighter, who throws a simple light jab, if not thrown properly, can easily damage bone, joint or cartilage.  

When an athlete returns to play with even mild brain trauma he does so under the risk of possibly already having lost fine controlled muscle movements called proprioception.  This means a football lineman may not be able to sense neuromuscularly how to appropriately respond to pressure imposed by the opponent.  This means a soccer player cannot properly control his kicking stance which increases the risk for injury to the knee.  Additionally this means a baseball player may misjudge proper sliding-form and risk injury performing a task that previously seemed innate.  Every part of the sport will seem more taxing for the nervous system following brain trauma, even in mild cases. 

Brain trauma more commonly goes as the adage, the straw that broke the camel’s back.  It is more common to have a series of accidents or events leading to brain and spine injury than an isolated incident.  A recent study demonstrated that high school football athletes on average lose 3-6” in height of the intervertebral discs from the seasons beginning game to the time the last whistle blows.  Losing as much as 1cm of height each game.  These athletes must participate in activities and treatment that acts to expand and open the disc space thereby increasing the disc height and preventing damage to nerve root and surrounding tissues.  This clearly demonstrates the need for regular chiropractic techniques of manipulation, nutrition and distraction among high school football athletes.

While spine and brain injury can lead to fatal results, there is treatment that will reduce negative effects and often resolve symptoms completely.  If trauma is suspected to the spine or head, or if you participate in an activity that provides repetitive opportunities for compression to the spine and neck, seek a neuromuscular evaluation promptly and return to sport or life safely and with properly and freely functioning neurology.

Sources

Giles LGF, Muller R: Chronic spine pain: a randomized clinical trial comparing medication, acupuncture and spinal     manipulation. Spine 28(14): 1490-1502, 2003 (1713)