Whiplash is a very common problem afflicting millions of people each year. In fact, there are more than 6 million car accidents each year in the United States alone. Death associated with car accidents occurs every 12 minutes and each year, motor vehicle collisions (MVC) kill 40,000 people. For people aged between 2 and 34 years old, MVCs are the leading cause of death. Another sobering statistic is somebody is injured in a car crash every 14 seconds and about 2 million people receive permanent injuries in car crashes each year. Over a five-year period, over 25% of ALL drivers were involved in a motor vehicle collision. The cost of car accidents averages $1000 for each American per year resulting in a $164.2 billion total cost each year in the United States. Approximately 250,000 children are injured and car crashes, meaning approximately 700 kids are injured daily. Car crashes are the leading cause of acquired disability. Hopefully, these rather startling statistics have gotten your attention. Last month, we discussed various effective ways of reducing the likelihood of even being in a motor vehicle collision (MVC). As an appropriate follow-up, this discussion will cover seatbelts and their role in injury prevention and life-saving capabilities.
In general, the available evidence available is clear – seatbelts save lives! Regarding backseat passengers, wearing a seatbelt is 44% more effective at preventing death than riding unrestrained. Similarly, for those positioned in the rear of a van or sport utility vehicle, the use of rear seatbelts is 73% better at preventing a fatal outcome during a car crash. In more than one half of all fatal car accidents, the victims are not properly restrained. The National Highway Traffic Safety Administration (NHTSA) in 2008 reported the use of seatbelts increased 1% over 2007 with 83% of drivers wearing their seatbelts. The use of seatbelts increased to 90% on highways versus 80% on surface streets (in town). In states where rear seatbelts are required, 85% of adult backseat passengers complied versus states not mandating rear seat seatbelt use where only 66% of the passengers complied. The NHTSA has launched a campaign, "Click It or Ticket" and has provided a guide to seatbelt safety promoting the proper use of the seatbelt and have provided the following safety seatbelts tips:
Make sure your seat belt fits snugly. Seat belts worn too loosely can cause broken ribs or injuries to your abdomen.
Place the lap belt low on your hipbones and below your belly. Never put the lap belt across your belly.
Place the shoulder belt across the center of the chest between the breasts.
Never slip the upper part of the belt off your shoulder. Seat belts that are worn too high can cause broken ribs or injuries to your belly.
The most effective safety protection available today for passenger vehicle occupants is lap/shoulder seat belts combined with air bags.
There is a common myth that seatbelts cause injuries at low speeds and therefore, it is better to not wear the seatbelt when simply traveling in town. There is overwhelming evidence in almost all circumstances, seatbelts save lives, even at low speed collisions. Because the forces that occur in low-speed crashes are transferred to the contents due to the lack of crushing metal and less vehicle damage, the occupants of a car struck at a low speed can be thrown about significantly… striking the windshield, side window and other contents inside the car. We realize that you have a choice in where you choose for your healthcare services. If you, a friend or family member requires care for whiplash, chiropractic care is a logical first choice and we would be honored to offer our services to you.
Health Update: Whiplash
Whiplash – Cell Phones & Other Driving Distractions!
Whiplash is caused by a sudden movement of the head, usually caused by a motor vehicle collision but it can also occur in sports and from slip and fall injuries. The combination of the weight of the head (approximately 15 pounds) and the length and strength of the neck predisposes the neck to be injured when a sudden force is applied. This is also caused by the fact the neck muscles cannot tighten quick enough to prevent injury in these types of injuries. People with slender necks (i.e., women > men) are more prone to injury.
The purpose of this article is to discuss some VERY effective ways to reduce the likelihood of being in a motor vehicle collision, of which the obvious include don’t drink and drive, don’t use your cell phone and drive, and don’t “text” on your phone while driving. Instead, use a hands-free phone or better yet, pull over to talk as you can’t concentrate or fumble around dialing/texting and still pay proper attention to what you’re supposed to be doing – that is, driving!
According to a study conducted by the University of Utah, the distraction resulting from talking on a cell phone when driving is more significant than being intoxicated (0.08% blood-alcohol). Driving inattentively is estimated to be a factor in 20-50% of all police-reported motor vehicle collision’s of which 8-13% are caused by driver distractions (cell phones is estimated to be 1.5-5% of that). One study reported both hands-free and hand-held cell phones were similar, reducing the driver response time to about a 40th percentile compared to a “normal driver.”
It’s believed the “cognitive workload” or, the “thinking” part during conversation causes the primary distraction, not the use of the hands. When compared to talking with a passenger, the University of South Carolina reported planning to speak put far more demands on the brain than listening. Talking to other passengers or on a cell phone are not the only or, the most common of the driving distractions.
The two most common causes of distraction-related accidents are “rubbernecking” (looking at outside objects/events) and adjusting the car radio/CD player. Cell phone use was reportedly 8th on that list. Data on the use of a cell phone to text while driving is limited because it is relatively new. However, a preliminary report from the University of Utah found a 6-fold increase in distraction related accidents when texting. The obvious concerns include the eyes off the road and in some cases, the hands off the wheel required for texting/email. Of interest, about 50% of drivers between 16 and 24 years of age compared to 22% of 35-44 year olds have admitted to texting while driving. Some recent highly publicized motor vehicle collision’s caused by texting drivers include a May 2009 Boston trolley car driver and the 2008 Chatsworth train collision that killed 25 people.
A July of 2009 Virginia Tech report of video footage of 200 long haul truck drivers who drove over 3 million combined miles, reported 81% of safety critical events involved driving distractions. They found texting had the greatest relative safety risk at 23 times more likely with their eyes being off the road for 4.6 out of a 6 second during a safety critical event. Another significant cause of driver distraction is drowsiness, which increased the driver’s risk of a crash or near-crash by 4 times, reaching for a moving object increased the risk by 9 times, looking outside/rubbernecking = 3.7 times, reading = 3 times, applying makeup = 3 times, dialing a cell phone = 3 times and talking or listening on a hand-held device = 1.3 times. Eating while driving is also a risk.
As a service to you, we would appreciate it if you would share this information with family and friends so we can all drive more safely and live longer, healthier lives! We realize that you have a choice in where you choose for your healthcare services. If you, a friend or family member requires care for whiplash, chiropractic care is a logical first choice and we would be honored to offer our services to you.
To schedule a FREE Consultation with Dr. Falkenroth, simply call (831) 475-8600
Health Update: Whiplash
Whiplash – Can This Really Happen To YOU?
You’re stopped at red light awaiting a left turn into the grocery store when out of nowhere, you hear the screeching of tires, you turn your head and look into the rear view mirror and see that you’re about to be hit from behind. Then “POW!” The sudden force of the impact propels you back into your seat, your head hits the headrest and then bounces forwards, almost hitting the steering wheel. You feel your body twist due to the angle of the seat belt, your sunglasses fly off and your purse sitting on the seat next to you flies into the dashboard and lands on the floor spilling its contents. You’re not sure what just happened as it all happened so fast. Is this a dream?
After collecting yourself and calming down, you get out of the car to inspect the damage and talk to the driver who just ran into you. You notice that right now, you don’t really hurt that much….but you feel kind of dazed. When you inspect your car, you surprisingly notice very little damage, but it sure felt like your car should be totaled based on the way it felt. The other driver said he was checking the station on the radio, and when he finally saw you, tried to stop and slam on the brakes, but it was too late. He said, “…I couldn’t have been moving more than 5-10 mph when I hit you!” You ask, “How could this possibly feel like such a hard impact? Was he lying to me?” There certainly wasn’t much damage to your car…maybe he was right??? When he asked you if you would, “…let it go,” and not call the police, you almost agree, but something stops you. Even though there is little car damage and, “…he is a nice guy….,” you just don’t feel right in letting it go.
Within 15-30 minutes, you’re REALLY HAPPY you didn’t give in and take his advice as by now, your neck is really starting to hurt. You feel kind of nauseated and light headed. Your head is beginning to pound and you feel like you better sit down. When the police officer approaches he seems distant and you’re having difficulty hearing him. Pretty soon, you notice others helping you onto a stretcher and attaching a neck brace prior to taking you to a local emergency room. At the emergency room, you are confused about the details of the accident but piece together as best you can the events of the evening. They take x-rays, recommend some Advil and ice, and tell you to contact your primary care physician if you have problems. They tell you that you’re going to hurt for a few days and “…that’s normal.” However, over the next several days, pain intensifies to a point where neck and headache pain is constant, you can’t sleep, your memory seems blurry, you can’t seem to concentrate and lose your place during thought and conversation….something is REALLY WRONG!
This scenario is common in a low speed collision related injury. In fact, the less the car is damaged, the greater the impact is to the passengers inside the car (this is called “elastic deformity”). That’s because crushing metal absorbs the energy of the force (ie, “plastic deformity) and if the speed is “too low” and little metal crushing/energy absorption occurs, the G-forces that occurred during the collision are transferred to the passengers inside the vehicle and that force can be significantly greater than a crash that occurs at 2-4 times the 5-10 mph speed. In general, when there is less damage to the car, be aware that the force exerted on the passengers is greater than when car damage occurs. This is why when cars crash during a car race, the race car basically falls apart, leaving the driver enclosed in a cage that prevents bodily damage, and they often walk away from the accident.
If you, a loved one, or a friend is struggling with leftover whiplash symptoms from a car accident, we may be able to help put an end to the pain and suffering.
To schedule a FREE Consultation with Dr. Falkenroth, simply call (831) 475-8600.
Health Update: Whiplash
Whiplash – What Is It?
Whiplash is a slang term for an injury to the neck that occurs as a result of a sudden jolt, classically occurring in a car accident, though a slip and fall injury can sometimes result in a similar condition. In a classic rear-end collision, the car is struck from behind and accelerated forward at speed that even if the person knew the impending collision was about to take place, bracing the body prior to impact would not prevent injury. In fact, muscles can only be voluntarily contracted at around 800-1000 msec. and in a rear end collision, the head is “whipped” within a 300-400 msec. time frame. Add to that, the muscles in the front of neck are initially stretched when the car is propelled forward leaving the head in a relatively extended backwards position. Most of the headrests in cars are not properly positioned so the head often goes back much farther than the limits of our muscles, ligaments and joints resulting in stretching and tearing of these tissues. When the tissues in the front of the neck are over stretched, the “rubber band” effect propels the head forward -- overstretching the muscles, ligaments, and joints in the back of the spine. This “crack the whip” phenomenon occurs within 400-500 msec., far quicker than what we are capable of when voluntarily contracting our muscles. Here is a breakdown of what happens in a 5 mph rear-end collision:
0 msec.: At the moment of impact, the car seat just begins to move and the occupant has not yet been accelerated forward.
50 msec.: As the back of the car seat pushes the torso forward, the spine moves forward, resulting in a straightening of the thoracic and cervical spine. About 2-3 G’s of force are exerted on the torso.
75 msec. This difference in motion between the neck and torso results in an S-shaped curve, where nearly all of the bending in the cervical spine takes place in the lower cervical spine. This rapid bending in just a few joints can result in ligament damage in the lower spine.
150 msec.: Here, the torso has pulled so far forward on the lower neck that the head is forced backwards often over the head restraint. Depending on the position of the headrest, the angle of the seat back, and “spring” effect of the seatback, the ligaments in the front portion of the spine are often injured during this phase of the collision. About 3-4 G’s are exerted on the shoulders.
200 msec. Finally, the force of the car seat throws the head and torso forward. Here, 5 G’s are exerted on the head and neck as it whips forwards. All of this is completed in less than 500 msec.
One of the reasons this occurs has to do with the ability of the car – particularly the back bumper to not deform so that the force of impact is transferred directly to the contents within the vehicle (ie., the passengers). At higher speeds, the crushing metal absorbs some of the impact and the contents are actually less jostled and thrown about. This helps explain how a no damage rear end collision can result in greater injury than a higher speed collision.
If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, treatment with the Pro-Adjuster and heated dry hydrotherapy massage may help relieve your pain.
To schedule a FREE Consultation with Dr. Falkenroth, simply call (831) 475-8600.
Many patients ask the question: “…why do I hurt so much now, and hardly hurt at all right after the accident?” Another common question is: “…why does my neck pain after a minor car collision last so long?”
A study that investigated chronic pain and dysfunction in whiplash cases reported a soft tissue origin for injuries associated with low-speed collisions. This means the pain comes from the muscles, ligaments, joint capsules, the disk, but not from a pinched nerve that would send pain down the arm and/or create hand numbness or grip weakness. The study also reported the point at which the neck buckles would only take one fifth to one-fourth of the weight of the person’s head (approximately 2.5 to 3 pounds) if one were to remove all of the supporting muscles, ligaments, and joint capsules. With the muscles and soft tissues intact, there is a very complex buckling pattern that occurs in the neck during most rear-end collisions where the lower half of the neck bends opposite to that of the upper half creating an S-shaped curve (when looking at the neck from the side). When this occurs, the vertebrae in the lower half of the cervical spine extend backwards while the upper half flex forwards, stretching the ligaments beyond the maximum elastic point and tissue tearing occurs. When ligaments stretch or strain, microscopic tearing starts at only 3-5% of tissue strain and when the strain reaches 7-8%, the ligament begins to lose its load carrying capacity and more significant tearing occurs. Unfortunately, none of this can be seen on a standard x-ray and usually goes undiagnosed.
Many variables exist that make assessing the amount of tissue damage difficult to predict or understand. One of these variables is the strength and amount of elasticity of a ligament prior to tearing. Also, the age, gender, and phenotype – that is, skinny, normal, or over weight – makes a difference. Generally, due to a reduced muscle mass in a female compared to most males, women are at greater risk of injury. The position of the person in the car, whether a seatbelt was used or not, if the head was turned before impact, if the collision was anticipated prior to impact, the speed at which one person compared to another can voluntarily contract a muscle are all additional factors affecting the degree of injury and corresponding pain. Another factor is the size of the spinal canal (the place where the spinal cord runs from the brain to the low back) as some people are born with narrow canals, making them more susceptible to injury. Other neurological variables include the degree of the excitability of the nervous system as the more excitable, the lower the pain threshold and pain is perceived more quickly. The type of pain from the deep tissues (ligaments, joint capsules, etc) is different than pain arising from superficial tissues as the former lasts longer and doesn’t follow known neurological pathways into an arm. Also, over time, if pain becomes chronic (pain lasting >3 months), a significantly lower pain threshold is found in these cases vs. normal control subjects.
Hence, when discussing your case with our office, it is important that you share your history of the accident, the time it took after the impact for symptoms to be initially noted, whether it is gradually worsening over time, and any other symptom that is unique to your situation that may not have been discussed here.
Whiplash – Where Is My Neck Pain Coming From?
Last week while driving to work, you’re stopped at a red light and glance in the rearview mirror and notice that a car is approaching from behind way too fast. The next thing you remember is the squeal of the tires and a loud crash with an accompanied sudden jolt as your car is propelled forward by the impact. Your initial reaction is one of shock, wondering is anyone hurt? How bad is my car damaged? Will there be another hit? Should I get out of the car? I’m going to be late for work! Within a few minutes, the police arrives and after about an hour of taking statements from the two drivers and a few witnesses, you decline an ambulance offer to take you to a nearby hospital for an examination as, “…this little stiffness and ache in my neck is no big deal. It’s just a minor whiplash.” Happy you can still drive your car, you arrive at work an hour and a half late. After reviewing the details of the crash with co-workers several times, you begin to notice a headache, your neck stiffening up and movements becoming limited and painful. After another couple of hours and a few Ibuprofen, the pain has increased and you now have a whopping headache. You decide, “I better go see my doctor to see if something is wrong.”
After the exam and x-rays, the doctor shows you a chart and explains the mechanism of injury that usually occurs in a low speed rear-end collision. A couple of things that were said really hit home in helping you to understand how such a seemingly minor crash can create so much pain. The first is that it is not possible to voluntarily contract a muscle quick enough and “brace” to prevent the acceleration of the head. Upon impact, as the car is propelled forwards, the head initially goes backwards and then when the muscles in front of the neck are stretched to their limits, the head is then “whipped” forwards in a “crack the whip” type of response and all of this takes less than 600-700 milliseconds! Because of the far limits of neck motion being reached during this process, the ligaments that hold the vertebra together are often stretched and/or torn. This can be appreciated on the bending neck x-rays which shows one vertebra sliding forwards on the one below and the angle created being greater when compared to the surrounding vertebra.
The second point of discussion that stands out was the fact that your head was rotated at the time of impact from looking in the rearview mirror places the neck at a greater risk of injury because of the twisting motion that occurs during the “whiplash” process. Another interesting point: because there wasn’t a lot of car damage, the shock and force of the impact was not absorbed by crushing metal and that energy is therefore transferred to the contents in the vehicle, including the occupants. That is why your briefcase ended up on the floor and your glasses flew off during the crash. Another point of discussion was made concerning the difference between genders and the degree of injury, as women are more likely to be injured more severely because of the less muscular and sometimes longer female neck. The degree of whiplash injury is also at greater risk when there is osteoarthritis in the neck that pre-exists the crash. An analogy of how a young sapling branch can bend without breaking verses the “old oak branch” which snaps and breaks when its only bent slightly. So, if you are a middle aged, female with a long slender neck with pre-existing arthritis looking in the rearview mirror prior to impact in a rear-end collision, ligament over stretching / tearing is highly probable.
In summary, it is important to obtain prompt evaluation and treatment by your doctor as soon as possible as when time passes without treatment, it is more difficult to bring about a reduction of pain and increased motion and, it will generally take longer. Taking medication for pain only postpones the needed process of restoring movement and function of the neck so that should not be the only treatment. In general, a “wait and watch” approach is not wise in whiplash injuries. If you or a loved one is suffering with whiplash, sharing this information may be one of most significant acts of kindness that you can give to those that you care about.
To schedule a FREE Consultation with Dr. Falkenroth, simply call (831) 475-8600.
