This is beginning to change as whiplash enters a new phase of research and understanding, Dr. Croft and other whiplash researchers point out in the February JACA.
"We have always known that chiropractors are effective with whiplash, but there were lots of theories as to why," explains Dr. Dan Murphy, a chiropractor who teaches on the subject of whiplash throughout the world. "Now, it appears that by the very nature of what we do, chiropractors are most effectively treating the tissues injured during the accident." Dr. Murphy points to research conducted last year in Japan that demonstrates that the facet joint capsules and the annuli of the discs injured during whiplash are the very areas doctors of chiropractic treat during a spinal adjustment.
Dr. Murphy is also excited about two studies -- one in the journal Injury and another in the Journal of Orthopaedic Medicine -- that specifically look at people who failed under medical management and were referred to chiropractors for treatment of chronic whiplash pain. "In both studies," Dr. Murphy says, "the results were phenomenal, and one of the conclusions is that chiropractic is the only proven effective treatment for chronic whiplash."
In addition, research soon to be published in the Journal of Musculoskeletal Pain shows that there are risk factors for acute whiplash injury and that chronic whiplash pain can occur even after the most minor of accidents. "We are finding that risk factors for acute injury, such as having the head rotated, being out of position in the vehicle, lack of preparation for the crash, and being struck from the rear, are present not only for initial injury, but also for chronic injury," explains Dr. Michael Freeman, a chiropractor and PhD clinical assistant professor of epidemiology at Oregon Health Sciences University School of Medicine. "If you are injured, whether the vehicle sustains no damage or is totaled, there is a one-in-three chance you will have chronic pain. It doesn’t matter how much – or how little – damage there is to the vehicle."
Technological improvements are also being perfected in an effort to prevent whiplash. Dr. Croft reports in the JACA article that seat and head restraint improvements have already been made in a few models of Saab and Volvo, for example. Sophisticated forward- and rear-looking systems are also being developed to gauge the distance between cars. A computer chip on board will contain a pre-programmed set of instructions to allow calculation of impending crash conditions. "One of those will gauge speed," Dr. Croft adds, "and if you are gaining on the car in front of you at what the computer is programmed to consider a dangerous rate, it will sound an alarm."
These new developments are extremely important considering the largest single contributor to chronic neck pain and overall spine pain is motor vehicle crashes, the JACA article states. Of the 6 million injuries per year due to motor vehicle crashes, about three million are whiplash-type injuries. Of those, 500,000 to 900,000 will develop chronic pain.
So, how many crashes can actually be avoided? Perhaps only 10 percent, according to Dr. Croft. "But what we’ve found in our whiplash studies is that the people that have the worst outcomes are the ones who were caught absolutely unaware," Dr. Croft adds. "So, we believe that even just a few dozen milliseconds of warning that allow people to brace to some extent are worthwhile."
In the JACA article, Dr. Croft shares seven ways to minimize pain and suffering before, during, and after a whiplash accident.
Shop for a Safer Car
Before you buy your next car, compare vehicle structural design, vehicle size and weight, and restraint systems -- belts, airbags, head restraints, and crash avoidance features. Consider mass and crashworthiness. "Small cars put you at greater risk," adds Dr. Croft. Also, check Insurance Institute for Highway Safety ratings for safest seats, head restraints, etc.
Keep Head Restraints in Up Position
Eighty percent of cars have the head restraint adjusted in the low position, yet research shows that having no head restraint is safer than having one in the low position. In addition, because head restraints are designed to fit the average man, it can be difficult for taller or shorter people to get a good fit. Some add-on head restraints are available, but check first for safety approval and ease of installation.
Prepare for Crash
Crashes happen at lightning-fast speeds, but if you have time to prepare:
- Put your head and your neck all the way back so that you're in contact with the seat back and the properly adjusted head restraint.
- Straight-arm the steering wheel and get a good grip.
- Put your foot on the brake as hard as you can (assuming that you are stopped, of course).
- Look straight ahead, not in the rearview mirror. Don't have your head turned at all.
- Put your neck back slightly so your eyes are looking level -- up at about the top of the windshield.
- Scrunch your shoulders up toward your ears and then brace.
Seek Treatment Immediately
According to Dr. Croft, "It's a huge advantage to get patients when they're fresh. Missing that important two-week opportunity increases the likelihood of a chronic condition."
Do What the Doctor Orders
Exercises, ice, nutrition, soft collars for the first few days, adjusted work stations, deep tissue work in the early stages -- do whatever the doctor prescribes. "I take a shotgun approach," Dr. Croft adds. "That's because, in part, the treatments and the ancillary products we recommend are fairly inexpensive and none of them is dangerous or painful. It’s worthwhile to prevent these injuries from becoming chronic."
Think Ergonomically
Positions to avoid, how to sleep, conditions at work -- these are everyday factors that can hasten healing. For example, patients have problems when their heads are turned for long periods of time, such as when talking to someone to one side, looking out an airplane window, or working at the computer with the copy on the left side. For the latter, Dr. Croft recommends moving the copy toward the middle and the monitor toward the right to even things out. He also recommends an office desk chair with armrests. Without armrests, the weight of the arms is suspended from the shoulders, which tends to pull against the muscles of the upper back, causing strain on the neck.
For more information on whiplash research and prevention, call the American Chiropractic Association at (800) 986-4636 to request a copy of the February issue of JACA.