Why your neck hurts years after an accident

If you have been in a motor vehicle accident then you know the incredible amount of pain and disability that it can cause, even in a low velocity collision. Most whiplash cases are labeled ‘soft tissue injuries’ or injury to the muscles, fascia, tendons, ligaments, and nerves. A recent study showed that a significant number of persons suffering acute neck pain following a motor vehicle collision develop chronic pain that lasts for years. Further, that a significant number of these patients succumb to partial or total disability. Even with treatment many patients suffer for years with post-whiplash pain. Soft tissue injuries are supposed to heal within weeks or months so why the delay? The most common source of the chronic pain: damage to the spinal facet joints. The facet joints are small joints on each side of a vertebrae that, along with the disc, stabilize the spine and allow bending, twisting and side to side movement. In a rear-end automobile collision, the “facet joints undergo a nonphysiologic pinching motion, with compression posteriorly and distraction anteriorly, usually coupled with shear.” This abnormal stress on the joint can cause damage to the capsular structure around the joint, damage to the articulating structures of the joint itself, and even intra-articular hemorrhage. When such damage occurs pain is transmitted to the brain through a medial branch nerve that innervates the facet joint. The problem with facet injuries is that they do not show up on x-rays, CT Scans or MRIs. That is because the injuries involve microscopic damage to tiny features within the joint that are not usually observable in these studies. Often, this leads physicians to the conclusion that there is no structural damage to the spine, and that the pain must be deriving from the surrounding “soft tissues.” This then leads to the conclusion that “soft tissue” injuries ordinarily resolve in weeks or months, not years. So what’s the solution? Well, it’s complicated. In the first month after an accident there is swelling, loss of range of motion and spasm. In this stage the best remedies are usually ice (cryotherapy), gentle massage and joint mobilization, and pain medication if needed. After the first month Chiropractic care is usually the most important modality along with massage therapy and physiotherapy to restore function to the spinal structures and related musculature. Spinal manipulation helps to restore proper mechanics and alignment to the facet joints to maximize the healing process. Most patients return to their pre-accident status within about 6 months after an accident with proper treatment. We do know that certain factors may delay recovery such as not anticipating the impact, having your head turned at the time of impact, and if there was a pre-existing injury at the time of the accident because these factors complicate the injury. Other factors that delay recovery are a sedentary lifestyle, smoking, and age. A study in Spine (Vol 35, No 9) demonstrated that people with chronic whiplash have changes in their muscles, especially in the anterior neck muscles, whereby the muscle tissue has fatty infiltration and therefore cannot function normally. Chronic whiplash can also lead to neurological changes and depression. It is important to treat whiplash properly to minimize the risk of developing chronic problems. It is crucial to implement an active rehabilitation program to regain full function, usually with the help of a Kinesiologist or Physiotherapist. If you have been injured even mildly in a car accident, whether you are at fault or not, your chiropractic care is covered by ICBC and you do not need to pay out of pocket for care. Talk to your Chiropractor if you have been injured so that a proper treatment plan can be implemented. After a thorough assessment your Chiropractor may recommend a combination of therapies utilizing a team approach to maximize results.