Why Whiplash Turns into Chronic Pain
Whiplash is one of the most common acute injuries that results in chronic pain. Since many cases go unreported, we don’t know exactly how often whiplash occurs. Some sources estimate that up to 3 million people suffer from whiplash in the U.S. every year.
Studies show that at least half of the people who experience whiplash go on to develop chronic neck pain and related symptoms, collectively referred to as “whiplash associated disorders.” Researchers recognize that one reason why so many people suffer long-term effects is because doctors have “thus far been unable to fully characterize the condition.”
In this post I’ll discuss:
- The anatomical structures that can be injured in whiplash
- The varied causes and symptoms of whiplash
- Research on the cause of whiplash associated disorders
- How to heal from whiplash associated disorders with Clinical Somatics exercises
What is whiplash?
Whiplash commonly occurs in car accidents when the head and neck are first thrown backward into hyperextension and then forward into hyperflexion from the impact. However, as you’ll learn in the next section, there are other activities that cause whiplash as well. Whiplash can also occur when the head is suddenly thrown from side to side, such as when a car is T-boned.
The sudden, extreme degree of movement can injure many structures of the neck and surrounding parts of the body:
Muscles in the neck and shoulders can be strained or thrown into spasm
Ligaments that connect the cervical vertebrae and skull can be sprained
Cervical facet joints (the joints in between vertebrae) and the atlanto-axial and atlanto-occipital joints (the junction between the neck and skull) can be damaged
Cervical intervertebral discs can bulge or herniate
Cervical vertebrae can be dislocated or fractured
Joints adjacent to the neck (temporomandibular joint and joints in the thoracic spine, ribs, and shoulders) can be damaged
Nervous system structures including nerve roots, the spinal cord, and brain can be damaged
Vascular system structures including the vertebral artery and internal carotid artery can be stretched and torn
Vestibular system structures of the inner ear can be damaged
Causes of whiplash
Whiplash can occur in a variety of activities that involve sudden movement or impact to the head:
- Automobile accidents
- Physical abuse or assault; being punched or shaken
- Sports such as football, boxing, karate, hockey, field hockey, volleyball, basketball, and soccer
- Cycling accidents
- Horseback riding
- Bungee jumping
- Amusement park rides
- Falls in which the head violently jerks backward
Symptoms of whiplash
Symptoms of whiplash usually develop within 24 hours of the injury and can include:
- Neck pain and stiffness
- Limited range of motion in the neck
- Headaches, most often starting at the base of the skull
- Tenderness or pain in the shoulders, upper back, or arms
- Tingling or numbness in the arms
- Tinnitus (ringing in the ears)
- Visual problems
- Sleep disturbances
- Memory and concentration loss
Why whiplash turns into chronic pain
Some research estimates that 50% of whiplash sufferers go on to develop long-term symptoms. A 20-year prospective study found the number to be higher; of 193 people who had experienced whiplash, 66.9% developed chronic related symptoms. These symptoms included stiff shoulders, neck pain, headache, numbness or pain in the upper limbs, and tinnitus. Unfortunately, as I mentioned earlier, doctors have struggled to determine a consistent cause of these long-term symptoms.
Orthopedic surgeons from London conducted a four-year study of 1025 whiplash sufferers in an effort to understand the cause of long-term whiplash symptoms. They found that the “only totally consistent findings are reduced range of motion and dysfunction of the trapezius muscle.” The researchers suggest that whiplash rehabilitation should target neck stiffness and trapezius dysfunction in particular.
Another study used surface electromyography (EMG) to measure cervical muscle dysfunction in whiplash sufferers. The study found that people with whiplash associated disorders had higher levels of muscle tension than healthy control subjects in their upper trapezius muscle during physical exercise, and a significantly decreased ability to relax the upper trapezius after exercise.
About a second after the head is forcefully thrown or hit, neck muscles reflexively contract in an attempt to stabilize the head. After the injury, the muscles of the neck, and often the shoulders and back as well, remain contracted to splint the injury. Not surprisingly, nearly 9 out of 10 whiplash sufferers have some degree of muscle spasm following the injury.
From my perspective as a somatic educator it seems obvious that like these two studies found, chronic muscle contraction is a likely cause or contributor to many whiplash associated disorders. Chronically contracted muscles feel stiff and painful, and restrict movement of the neck. They limit blood flow, slowing the healing process of injured discs and connective tissues. Tight muscles also compress the spine, potentially causing nerve impingement, inflammation, and disc and joint degeneration.
Reflexive muscle contraction often continues long after a structural injury has healed, because muscle contraction becomes learned by our nervous system. The more often we repeat a muscle contraction, the more deeply learned it becomes; this is what we refer to as muscle memory. So the longer it takes for structural whiplash injuries to heal, the more likely it is that the surrounding muscles will continue to splint the painful area and remain chronically, subconsciously contracted for years.
Another factor that increases the likelihood of developing chronic muscle tension is the emotional trauma of being in a car accident or experiencing any event that causes injury. Strong negative emotions not only trigger muscle tension but also cause that muscle tension to become deeply learned quickly. Instead of requiring many repetitions like practicing your tennis swing, your nervous system immediately learns to keep certain muscles tight, and links that subconscious muscle tension with your emotional state. Researchers have found that an important predictor of whiplash associated disorders 12-14 years later is being in a negative emotional state in the days following the injury. And a study of 6,000 whiplash sufferers found that those who had a positive attitude about their recovery actually recovered more than three times faster than those who didn’t, and those who had low expectations of complete recovery were four times more likely to experience long-term symptoms.
Treating whiplash associated disorders with Clinical Somatics exercises
Clinical Somatics exercises are an ideal method of recovery for many whiplash associated disorders because pandiculation is the most effective way to release subconsciously held muscle tension. In addition, the exercises are extremely slow and gentle, and can be modified or substituted if the position or movement is painful.
People with chronic pain and limited mobility resulting from whiplash should work with releasing all of the muscles of the neck, shoulders, upper and lower back, chest, and abdomen. Even if pain is not present or tension is not felt, the musculature of the entire upper body has adapted to the injury, and the overall pattern of tension and posture must be addressed in order to make lasting progress. Releasing chronic muscle tension will also prevent future spinal degeneration and often relieve nerve impingement by reducing pressure on the spine and spinal nerves.
Following is a list of exercises from the Level One and Level Two Courses that are particularly helpful for whiplash associated disorders. If any of the exercises increase your pain, skip them for now. I’ve made a few notes about modifications.
LEVEL ONE COURSE
Arch & Flatten: If this or any exercise in which you lie on your back is uncomfortable for your neck, put a folded towel or thin pillow under your head and neck. Only use as much padding is needed to make your neck comfortable; don’t overdo it. Reduce the padding as you are able to.
Back Lift: If turning your head to the side is not comfortable, you can do this with your neck straight and head facing the floor, with your forehead on the floor so that the back of your neck stays long.
Upper trapezius release: This is at the end of the Bonus Video: “Ultimate Pandiculation.” This exercise can be done standing or sitting upright.
Arch & Curl: Same modification as Arch & Flatten if necessary.
Side Curl: Be sure to support the weight of your head with your hand. If the movement is still not comfortable, then do just the lower body part of this movement—it will still help to release your obliques.
One-sided Arch & Curl: Same modification as Arch & Flatten if necessary.
Diagonal Arch & Curl: Same modification as Arch & Flatten if necessary.
Washcloth: Start by focusing on just the upper body part of this exercise.
Shoulder releases: These are in the Bonus Video: “Carpal Tunnel Exercises.”
Flowering Arch & Curl: Same modification as Arch & Flatten if necessary. Start by focusing on just the upper body part of this exercise.
LEVEL TWO COURSE
Head Lifts: Same modification as Arch & Flatten if necessary.
Lower Back Release: Same modification as Arch & Flatten if necessary.
Proprioceptive Exercise 1
Scapula Scoops Part 1: Same modification as Arch & Flatten if necessary.
Scapula Scoops Part 2: Same modification as Arch & Flatten if necessary.
Diagonal Curl: Same modification as Arch & Flatten if necessary.
Shoulder, Elbow & Wrist Releases: Same modification as Arch & Flatten if necessary.
Standing Hamstring Release
Seated Hamstring Release
Head & Knee Lifts
Face & Jaw Exercises
The Pain Relief Secret: How to Retrain Your Nervous System, Heal Your Body, and Overcome Chronic Pain by Sarah Warren, CSE
Somatics: Reawakening the Mind’s Control of Movement, Flexibility and Health by Thomas Hanna