The term whiplash dates back to the early rail road days when rail cars would back up and connect to other rail cars. The impact while hooking up cars caused a whipping back of the neck causing people to call it “rail road neck”. Today we associate it with the hyperextension/hyperflexion motion when someone gets rear-ended. It wasn’t until the late 1990”s that the mechanism of injury was confirmed by using high speed filming on a Digital Motion X-ray while someone was rear-ended. We now know that the neck initially undergoes compression, tension, shear, and rotational forces within 100 milliseconds, bending into a reversed “s” shaped curve. This causes muscle, ligament, joint, and disc injuries in the neck. This can occur before your head hits the head restraint due to poor head restraint positioning or poor posture.
Using the Croft classification system, whiplash injuries are graded on a 1-5 scale, depending on the severity of injury.
Grade 1: Minor muscle strain, no limitation of motion, no ligamentous injury or neurological findings.
Grade 2: Slight injury; limitation of neck motion, no ligamentous or neurological findings.
Grade 3: Moderate injury; limitation of motion, some ligamentous injury, neurological findings may be present.
Grade 4: Moderate to severe; limitation of motion, ligamentous instability, neurological findings present, fracture or disc derangement.
Grade 5: Severe; requires surgical management.
Ligament/joint injury, disc injury, neurological impairment, and fractures are evaluated on every whiplash patient we see. In future posts, I will discuss how rear-end crashes with no visible damage to either vehicle can have enough force to cause ligament instability, joint damage, and disc herniations. These can be permanent impairments causing chronic neck pain and disability.
Barry Matthisen, D.C. Advanced Graduate, Spine Research Institute of San Diego
Alaska Back Care Center