Whiplash Injuries: It's Complicated

This excerpt from the December, 2011, issue of Spine is somewhat technical, but may give you an idea of the complexity of whiplash injuries.

"Nikolai Bogduk, MD, PhD, in a recent narrative review published in Spine, summarized evidence which demonstrates that injuries to the cervical zygapophysial (also known as facet) joints are the primary source of pain following hyperflexion-hyperextension injuries following motor vehicle collisions.

Postmortem Studies

Examination of cervical spines of persons killed in motor vehicle collisions identified a number of non-lethal injuries including a variety of injuries to the cervical facet joints, such as intra-articular hemorrhages and lesions, as well as fractures to the subchondral bone, articular cartilage, and articular process. According to the studies, virtually none of the lesions to the facet joints were present on postmortem radiography.

Biomechanical Studies

In vivo studies of the biomechanical causes of post-whiplash neck pain demonstrate the cervical spine is compressed from below as the trunk rises toward the head. This causes sigmoid deformation when the lower cervical spine is subjected to an abnormally high posterior sagittal rotation. The upper vertebrae rotate in a sagittal direction with practically no posterior translation. The anterior vertebral margins are widely separated, while the posterior inferior articular processes carve into the superior articular surface of the adjacent lower vertebral body. These abnormal movements produce posterior facet joint lesions and rim lesions of the intervertebral disc due to avulsion of the annular fibrosis from the vertebral endplate.

During hyperflexion-hyperextension injuries, the facet joints are initially compressed beyond normal physiological limits, followed by excessive straining to the capsule and annulus fibrosis. The amount of stress increases with the level of impact during trauma. Studies show the C4-5 disc is particularly susceptible to injury in a relatively low speed impact, while C3-4,C5-6 and C6-7 are at increased risk as impact acceleration increases.

A study of post-whiplash lesions in 21 cadavers found intervertebral disc injuries in 90% of the subjects, anterior longitudinal ligament tears in 80% of the cadavers, and a 40% incidence rate of facet capsule joint tears. Other injuries included tears of the annulus fibrosis, anterior longitudinal ligament, and facet joints."

Is Barefoot Running Bad For You?

A podiatrist explains the 10 myths about running barefoot (or barefoot running style). After reading "Born to Run" two summers ago, I decided to give it a try. I find that if I'm feeling various little pains in my feet or legs, or anywhere else for that matter, a bit of barefoot running (usually in Vibram Five Fingers) makes everything re-organize, and I feel great. If you are thinking about trying this for yourself, be sure to go slowly, as most likely your foot and leg muscles are deconditioned and will take awhile to strengthen.

Massage May Accelerate Healing

If you've ever had a massage, you know how relaxed you feel afterwards. Now, according to a recent article in Science News, massage has been shown to both reduce levels of inflammatory proteins and increase a compound (PGC1-alpha) which plays a role in muscle fiber maintenance and cell metabolism.

If you haven't done so already, we invite you to take advantage of our introductory offer for a one-hour Swedish massage for just $29. The purpose of this offer is to introduce you to our new massage therapist and the benefits of massage. Call our scheduling line 206-409-9447 to set your appointment. We welcome your referrals of friends and family for this special offer, as well.

Jefferson Award Nominee--Vote for an Unsung Hero!

In his work as a personal injury attorney, Richard Adler worked with a number of clients suffering from Traumatic Brain Injury (TBI). Many of his clients and their families struggled to get the care and services they needed. Richard stepped in to fill a void, becoming president of the Brain Injury Association of Washington (BIAWA). He then went to work in the community. In addition to coordinating care and services, Richard has also been the legal guiding light behind two key Washington State bills for TBI survivors. The "Tommy Manning Act," was named after a TBI survivor and established funding for TBI support services in Washington State - a first! He then championed the "Zackery Lystedt Law" establishing guidelines for the management of concussions for young people involved in sports. It was the first law of its kind in the United States. Richard then forged relationships with nationally known sports physicians, the National Football League, and the Centers for Disease Control, and has fostered the passage of similar legislation in a majority of the 50 states.

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