North Wales PA | Lansdale PA Chiropractor

Chiropractic and Auto Accidents

Risk Factors for Whiplash Injury

Automobile collisions are complex events, and during a crash one person can be injured while another — in the same car, even — may be symptom-free. Dr. Conrad has been serving the North Wales and Lansdale area with chiropractic care for whiplash injuries for over 10 years. It is important to know the risk factors for developing chronic pain from a car crash, and how a Chiropractor can help prevent these conditions from becoming permanent.

In this section, we've reviewed some of the most important studies that examine the role of gender, head position, and other factors that can increase the chance of being injured in a crash. If you are involved in a motor vehice accident, call us today to schedule a consult before long term symptoms set in.

Whiplash Injury: Women Have More Vulnerable Necks

Numerous studies have reported that women are much more likely to be injured in a rear end collision than are men. Krafft et al¹ found that female drivers were three times more likely to be injured than male drivers in whiplash crashes.

Freeman et al² reported that a significant percentage of chronic pain reported by women could be attributed to motor vehicle collisions:

“[Our] study indicates that men with chronic neck, or chronic neck and back pain, are four times more likely to attribute that pain to an MVA than men with chronic back pain. Women with chronic neck, or chronic neck and back pain, are twice as likely to attribute their injury to an MVA vehicle crash compared with their counterparts with chronic low back pain.”

Burgess et al³ reported in 1996 that 89% of the patients with TMJ pain after an auto collision were women. In 2007, Carroll et al⁴ also found that women were much more likely to develop jaw pain after an auto collision than were men.

For years, researchers have speculated as to why women are much more likely to suffer from chronic whiplash pain than are men. A new study5 from Washington State University suggests that it’s the basic anatomy of the female neck that puts women at risk. The researchers examined 14 men and 14 women matched for height and neck length. The goal was to study the differences between the male and female neck in people with the same height.

The authors took x-rays of the necks of all subjects, and then took measurements from the x-rays for vertebral size, posture, and neck geometry. Since the muscles of the neck play an important role in posture and stability, the authors measured the neck strength of the subjects, as well.

The study found the following:

• Because the subjects were matched, there was little difference between men and women in neck length, but there was a large difference between men and women in regard to neck circumference and width. Not surprisingly, the men’s necks were about 15% larger than the women’s necks.
• This 15% difference in size, however, translated to a huge difference in neck strength. Men were 31% stronger in flexion than were women.
• The real dramatic difference, however, came when the researchers studied the x-rays of the subjects. Even though the subjects had the same neck length, nearly all of the dimensions of the female vertebrae were smaller.

The authors state:

“In this sample of men and women who were matched by standing height and neck length, we found that women had significantly smaller external neck and vertebral dimensions and lower neck strength than men. We also found that women have more slender necks and less neck cross-sectional area, i.e., muscle, for a given head size. These findings support our hypotheses and demonstrate that male and female necks are not geometrically similar.”

Whiplash injuries to the cervical spine are caused by shear forces that occur between the vertebrae during a rear end collision. Previous studies have found that being aware of the impending impact is helpful in preventing whiplash injuries. This awareness of the impact allows the occupant of the vehicle to tense the muscles of the neck, providing some support and limiting the shear forces during the crash.

It seems from this fact and this current study that neck strength plays a role in the development of whiplash injury. A man with a larger neck and more muscle mass is less likely to experience injurious forces during a crash than is a woman of the same height—even if they’re in the same car during the same collision.

1. Krafft M, Kullgren A, Lie A, Tingvall C. The risk of whiplash injury in the rear seat compared to the front seat in rear impacts. Traffic Injury and Prevention 2005;4:136-140.
2. Freeman MD, Croft AC, Rossignol AM, Centeno CJ, Elkins WL. Chronic neck pain and whiplash: a case-control study of the relationship between acute whiplash injuries and chronic neck pain. Pain Research and Management 2006;11(2):79-83.
3. Burgess JA, Kolbinson DA, Lee PT, Epstein JB. Motor vehicle accidents and TMDS: assessing the relationship. Journal of the American Dental Association (JADA) 1996;127:1767-1772.
4. Carroll LJ, Ferrari R, Cassidy JD. Reduced or painful jaw movement after collision-related injuries: a population-based study. JADA 2007;138(1):86-93.
5. Vasavada AN, Danaraj J, Siegmund GP. Head and neck anthropometry, vertebral geometry and neck strength in height-matched men and women. Journal of Biomechanics 2007;In press.

Who's at Risk of Developing Chronic Whiplash?

Auto injuries are a common problem seen in clinical practice. Most of the time, a patient will have some temporary discomfort that will resolve within a few weeks. A significant percentage of patients – around 20 to 30% – will develop some kind of chronic pain or disability from their injury. Four recent studies have looked at the issue of chronic pain to see if there are any predictive factors that can help us determine who is at risk of developing long-term problems.

The following is a list of documented risk factors found in these studies:

Gender. One of the four studies4 found that women were more likely than men to be injured in general, which confirms previous studies. Researchers speculate that the lower muscle mass in female necks may increase the risk of injury.

Turned head. Two recent studies have been done on this issue, and they both have found that when the occupant’s head is turned at the moment of impact, the spine is exposed to motion that exceeds the normal physiological range. This can result in ligament tears or damage to the spinal nerve roots.2

Direction of impact. It has been known for years that a rear-end collision is more likely to result in injury than is a frontal collision. Pape et al.1 found in their study that rear-end collisions were a greater risk factor than frontal impacts.

Previous injuries. It’s not surprising that a pre-existing injury to the neck or shoulder could be worsened after an auto collision, and that’s what Pape et al.1 found. In fact, patients with a history of neck and/or shoulder pain were more than twice as likely to have chronic problems three years after the collision.

Muscular tension immediately after the crash. Pape et al.1 found that patients with increased muscular tension soon after the crash were 3.43 times as likely to develop long-term symptoms.

Reduced range of motion. Sterling et al.3 found, as have other studies, that reduced ROM predicts symptoms two to three years after the injury.

Immediate pain and/or numbness. Both Sterling3 and Berglund4 found that patients who reported symptoms immediately after the crash were more likely to develop chronic pain. Immediate numbness indicates that the patient suffered some kind of nerve injury in the collision, and unless these types of injuries are diagnosed and treated quickly, they could easily develop into chronic pain. Berglund4 found that these patients were 6.5 times as likely to develop long-term problems.

The issues of reduced ROM and increased muscular tension are related, and understanding this issue is critical in treating auto injury patients. Upon injury to the disk or ligaments of the spine, an immediate reflex reaction is instigated – causing surrounding muscles to contract. This muscular guarding can be palpated as tension or inflammation. The increased muscular activity has the result of restricting ROM. How do these symptoms predict chronic pain? If the underlying tissue damage – ligament or disk – does not heal properly, long-term pain and restricted motion can result.

These studies help us treat auto injury cases in two ways: first, they demonstrate the need to take a careful and thorough history of the collision. For instance, asking the patient if his or her head was turned at the moment of impact can help us diagnose the injury. Second, by being aware of risk factors, we can focus our attention on those patients more likely to suffer long-term consequences of their injury.

1. Pape E, Brox JI, Hagen KB, et al. Prognostic factors for chronic neck pain in persons with minor or moderate injuries in traffic accidents. Accident Analysis and Prevention 2007 Jan;39(1):135-46.
2. Panjabi MM, Ivancic PC, Maak TG, et al. Multiplanar cervical spine injury due to head-turned rear impact. Spine 2006;31(4):420-429.
3. Sterling M, Jull G, Kenardy J. Physical and psychological factors maintain long-term predictive capacity post-whiplash injury. Pain 2006;122:102-108.
4. Berglund A, Bodin L, Jensen I, et al. The influence of prognostic factors on neck pain intensity, disability, anxiety and depression over a 2-year period in subjects with acute whiplash injury. Pain 2006;125(3):244-56.

Seating Position and Gender as Risk Factors for Whiplash Injury

One of the difficulties of dealing with auto injuries is the fact that some occupants experience injury, while others—sometimes in the same vehicle—do not. The reason for this is that there are literally dozens of variables that determine whether or not any individual person will be injured in a car crash.

These variables range from the size of the car, to the type of head restraints, to the unique anatomy of the neck of the person in the car. Because of these many variables, it is impossible to say that any particular person can or cannot be injured in a collision. What we can do is know who is at the most risk of developing symptoms after crash, as that can help us get the proper treatment for those patients.

A new study from leading whiplash researchers in Sweden adds to our understanding of auto injuries by examining the role of where an occupant sits in the car as a risk factor in being injured:

“The risk of neck injury in the rear seat is rarely studied. The following studies describe the risk of initial neck injury. Based on initial whiplash symptoms reported, to an insurance company, Lövsund et al. (1988) found a 50% lower risk in the rear seat compared to the front seat in rear impacts, when sex was taken into account. In another study by Berglund and colleagues (2003), the relative risk of reported, initial symptoms was over 40% higher for occupants in the passenger front seat and nearly 80% higher in the driver’s seat, compared to the rear seat. Otremski et al. (1989) also found a lower risk of initial symptoms in the rear seat compared to the front and driver’s seat, but the study did not separate the risk for different impact directions. No study mentioned above has controlled for crash severity in the investigated crashes.”

The goal of this current study was to determine injury risk factors of different seating positions, controlling for crash severity.

The authors examined the insurance company data from 195 rear-end crashes that included both front- and rear-seat occupants and where at least one occupant sustained permanent disability. The information on seating position was collected from the insurance data for injured patients, and from questionnaires for the uninjured occupants. After the data was collected, it was analyzed statistically to determine risk factors.

The preceding diagram illustrates the study findings. The number represents the risk ratio for the particular gender and position. For instance, a risk ratio of 3.03 means that that women in the driver’s position would have three times the risk of injury as compared to a male driver.

This study has a number of important findings:

• As dozens of other studies have demonstrated, women are at a much higher risk of injury from a rear-end collision than are men.
• Women are at much greater risk of injury in the back seat, while men are safer there.
• Women are at the greatest risk of injury when they are drivers. “This might have to do with a difference in seating position of the body, especially the thorax, spine, and head. A driver can be assumed to lean the upper body further forward than a front-seat passenger. An increased distance between the head and head restraint/seatback rest has shown a relationship with increased risk of whiplash injury.”

This is the first study of it’s kind to examine the role of seating position with risk of injury after a rear-end collision, and future study is necessary to determine why certain positions are more dangerous for female passengers. But this study can be useful for clinicians and attorneys at explaining why the patient might experience injury while another passenger in the crash experienced no injury.

Krafft M, Kullgren A, Lie A, Tingvall C. The risk of whiplash injury in the rear seat compared to the front seat in rear impacts. Traffic Injury and Prevention 2005;4:136-140.

Turned Head Increases Risk of Neck Injury During Collision

Of the many risk factors that increase the chance of whiplash injury, having one’s head turned at the time of the collision is one that has been recognized since the mid 1990s. In 1994, a group of Swiss researchers¹ found that turned head position was the leading predictor of long-term whiplash pain:

“They reported that radicular deficits and associated radiculopathy were most frequently documented in individuals whose heads were rotated at the time of rear impact and that after 1 year the symptoms significantly worsened.” ²

A few recent studies have examined the issue of spinal nerve ganglion injury. This research is based on the theory that during a whiplash motion, the ganglion is crushed or compressed, injuring the nerve bundle. This injury can then, in turn, result in chronic pain. The earlier studies have indeed found that this compression can occur, but no studies have looked at the issue of turned head position. Now a new team of researchers from Yale has done exactly that.

In this study,³ the authors prepared six human cadaver spines and performed test collisions with them in which the specimens were rotated slightly as if looking to one side. The specimens were subjected to impacts ranging from 2g to 8g of acceleration. They then compared their findings to previous findings on forward head position.

• The authors found significant pinching of the ganglion at C5-C6 and C6-C7 at the highest acceleration when compared to the baseline, 2g acceleration. This is also the area of the spine most likely to be injured in a rear end collision.
• Turned head position significantly increased the risk of compression of the spinal nerve ganglion, when compared to straight-forward head position.
• If the spine has pre-existing degenerative changes, the areas of risk increase to C3 and C4.

The authors state that injury to the spinal nerve ganglion can cause pain in at least two different ways:

• The nerves of the ganglion can become sensitized when compressed, causing pain signals in that spinal root.
• A rear end collision with the occupant’s head turned can result in cervical ligament injury and instability, leading to further, repeated injury to the ganglion. This could in turn result in repeated pain signals being sent to the brain.

From this study and others, it is clear that the spinal nerve roots are at risk of injury during rear end collisions. It is important when dealing with whiplash patients to take a thorough history to determine head position at the time of the crash.

1. 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.
2. Tominaga Y, Maak TG, Ivancic PC, et al. Head-turned rear impact causing dynamic cervical intervertebral foramen narrowing: implications for ganglion and nerve root injury. Journal of Neurosurgery: Spine 2006;4:380-387.
3. Slipman CW, Plastaras CT, Palmitier RA, et al. Symptom provocation of fluoroscopically guided cervical nerve root stimulation. Are dynatomal maps identical to dermatomal maps? Spine 1998;23:2235-2242.

Risk Factors for Developing Chronic Pain After Whiplash

A number of studies have been published that help us understand which patients may be at a greater risk of long-term problems from whiplash injuries. The following is a summary of these new findings.

Generalized Pain

Some patients experience a car crash and suffer minor and localized symptoms; a substantial minority of patients, however, experience symptoms that don't resolve, and may even spread to other parts of the body. This generalized pain pattern has been recognized as a risk factor by numerous studies, and a current study looked specifically at this issue.

In this study by Peolsson et al.¹, the authors examined 275 whiplash patients with chronic pain. They gave each patient a battery of pain, psychological, and disability surveys and recorded the number of painful regions that each patient reported.

“According to the present cross-sectional study, widespread pain in chronic WAD is associated with negative consequences with respect to pain intensity, prevalence of other symptoms (including depressive symptoms), some aspects of coping, life satisfaction/quality and general health. Our results indicate that, in different ways, the subgroup with widespread pain had a more fragile life situation than those with more local or regional WAD. Based on our results, we argue that a preventive perspective might be urgent and that clinical rehabilitation requires a broad assessment of the spread of pain, cognitive, and neuropsychological symptoms, and depressivity and catastrophizing thoughts or strategies.”

Central Nervous System Hypersensitivity

CNS hypersensitivity is related to generalized pain, but this recent report by Jull et al.² examined the patients much more thoroughly, and specifically studied those patients with elevated pressure pain threshold or cold hyperalgesia tests. These two tests are useful in detecting an underlying central nervous system “overstimulation” that can occur in some whiplash patients.

In this study, 71 patients with whiplash were given two different treatments; one group was treated with physiotherapy and the other was given a self-management program.

The authors found that the physiotherapy group had more improvement, but “that relief was marginal in the subgroup with both widespread mechanical and cold hyperalgesia.” This study reinforces the idea that those with wider CNS responses to injury are more resistant to effective treatment.
Occupation and Arm and Shoulder Symptoms

Another new study³ looked at what factors influenced recovery in patients who were involved in litigation after their injury. 134 patients were interviewed an average of 11 months after their injury. The authors found the following:

• Patients who experienced “arm pain, upper limb numbness or paraesthesia and bilateral trapezius pain” were more likely to experience long-term problems than those who did not.
• Patients who had jobs that were more physically demanding were more likely to recover early. This is consistent with the previous literature that speculates that those patients with smaller muscle mass (in particular, women) are more likely to be injured than those with larger muscle mass.
• Not surprisingly, this study also found that patients with long-term symptoms were also more likely to seek out physiotherapy treatment .

• Chiropractic > Auto Injuries / Whiplash

  What You Should Know If You Have Been Involved In An Auto Accident Did you know that one of the most stressful aspects of living in modern life is dealing with the problems that arise after an auto accident? Were you also aware that some auto accident injuries are hidden and are seldom detected for months or even years? As a result, two things can occur when an injury is not taken care of properly, or the accident victims settle their case with the insurance companies before getting evaluated from a Doctor of Chiropractic trained in soft tissue injuries. ... This Could Be A Big Mistake. Why? Because once you settle your case, you lose the right to have your insurance company pay for treatment if you need it. A good rule of thumb is to be informed of your rights and then make a decision. It is our position that if you were indeed injured, you should get the care you need to get you back to the way you felt and functioned just before the accident. It is not the responsibility of the insurance company to pay for anything more than that. They are not responsibile for pre-existing injuries; only the injuries sustained from the accident. Even if you are just sore, you should get checked out immediately because you may experience pain, numbness, headaches, muscle stiffness, fatigue, and other problems including arthritis many months down the road. Remember, nothing is more important than your health, especially when you start to lose it. Here's where the problem begins... Most people who suffer from an auto accident have one thing on their mind: their automobile! Common questions include: "Who is going to fix my car?" "What will I drive in the mean time?" "Will my insurance rates go up?" "Who is going to pay for it?" And the last thing on their mind is: "Am I Really O.K.?" Not only are auto accidents an inconvenience and a hassle, a common redundant complaint of auto accident victims is that they don't feel like their normal selves. You may also be experiencing obvious pains and symptoms like muscle stiffness or spasm, neck pain, headaches, numbness and tingling, back pain, difficulty sleeping, irritability, memory loss, fatigue, difficulty concentrating and many other difficulties. Or worse than that, you may be injured and feel nothing at all. Either way, did you know that auto accidents can cause post-traumatic osteoarthritis, as well as chronic headaches and migraines? Osteoarthritis can ruin your posture (giving you a slumped or hump back appearance). Osteoarthritis can cause the discs in your spine to degenerate and create scar tissue formation leading to chronic stiffness and the inability to move properly. As a matter of fact... Most Doctors Are Not Trained In The Detection Of These Hidden Injuries... If you have been in an auto accident, you need a Doctor who is trained in the biomechanics of the human body; someone who treats these injuries every day.Dr. Allen Conrad is a Chiropractor with advanced post graduate education in the field of Chiropractic and the treatment of Auto Accidents and Whiplash.In addition,Dr. Conrad can order x-rays or other diagnostic testing to find out if there has been any structural damage. In our office, we evaluate auto accident victims and make any appropriate referrals to other health care providers if needed. Our primary responsibility is giving you the care if you need It, and submitting the required medical reports to the insurance company so your rights are protected. If we can't help you, we will refer you to a Doctor or facility in the North Wales or Lansdale area that can. If you have been in an auto accident recently, there are some important decisions you have to make, and if I were you, I'd make these decisions very carefully. Q: Should I See An Attorney Before I See My Chiropractor? A: It is important to get checked out by A chiropractor who specialized i whiplash treatment like Dr. Conrad first. That way the findings from your exam will allow you the information you need in order to decide if an attorney is necessary. If necessary, we can refer you to a reputable and qualified attorney. Q: What If My Car Sustained Only Minor Damage? A: Documented studies done by Charles Carroll, M.D., Paul McAtee, M.D. and Lee Riley, M.D. revealed that: "The amount of damage to the automobile bears little relation to the force applied to the cervical spine (neck) of the occupants." In other words, the damage to the passengers is not necessarily directly related to the damage to the vehicle. Q: If I Need Treatment For This Injury, Do I Have To Pay For It Myself? A: No, only in very rare circumstances does the patient pay for his care as he goes. Our office provides care "on credit" when patients are represented by an attorney. Some car insurance policies have what is called "Med Pay." This means that medical bills will be paid at 100% up to a certain limit. My office can assist you in obtaining this information before you begin your chiropractic care. Using your medical coverage should not raise your premiums. Q: I've Been To The Hospital And My Medical Doctor, Do I Really Need to See a Chiropractor? A: You need a Doctor of Chiropractic who focuses in the treatment and diagnosis of auto accident injuries. Usually hospitals will check vital signs, make sure there are no life-threatening conditions and release the patient with pain relief medication. They normally do not treat the underlying improper musculoskeletal biomechanics that can and often do lead to future pain. If you are still having problems, you should get a second opinion froma licensed Chiropractorlike Dr. Conrad. If your M.D. has given you pills, you must understand that pills do not correct structural or soft tissue damage. There are special therapies designed for that, and we offer these modalities at our office. Q: Does Your Chiropractic Care Hurt? A: Absolutely not. The care is very gentle and quite soothing. Most patients can hardly wait to get their chiropractic care. Q: Is The Chiropractic Care Safe? A: Yes, chiropractic treatment of whiplash and auto accidents is very safe. Particularly when compared to the side effects from medication. I urge you to go to the patient testimonial tab to get a feel for what you can expect. Click Here for more information on the safety of chiropractic treatment.