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By Monique B. Harriton
How can whiplash injuries be controversial and even politically incorrect when according to the National Safety Council, which publishes Injury Facts every year, "angle and rear-end collisions added together cause the greatest number of non-fatal injuries"? These collisions are now so common, they are an accepted hazard of city driving.
Here are the latest statistics from Injury Facts for the year 1998:
Rear-end collisions:
Total accidents: 3,700,000
Deaths: 2,300
Non-fatal injuries: 695,000
Angle collisions:
Total accidents: 4,550,000
Deaths: 9,900
Non-fatal injuries: 900,000
It is important to realize these figures only represent reported injuries and accidents. Researchers estimate that true figures would be several times higher if all collisions were reported.
Whiplash injuries are misunderstood for several reasons: first, they are not visible to the naked eye; second, as the driver responsible for the rear-end or angle collision is usually not hurt, it is assumed the passengers of the other car are not hurt either; and third, whiplash injuries are caused by a complex interaction between mechanical factors, such as size, weight, and traveling speed of the cars involved, and body build of the passengers in the rear-ended car. This means there is great variation in whiplash injuries. They can range from a mild to a severe sprain, or even result in a minor closed head injury.
There are seven common whiplash fallacies. In general, most fallacies involve a flat denial of the whiplash injury or they blame the victim.
Fallacy No. 1
Men are more vulnerable to injury because of their greater neck muscle mass. Nothing could be further from the truth. Health care professionals confirm that their whiplash patients are several times more likely to be women than men, that women take longer to heal, and that women are more likely to suffer from chronic whiplash residuals. A bull-necked man (football player, boxer, or weight lifter) is rather whiplash-proof, while a women with a swan-like neck is at much greater risk of injury because her neck is longer and slimmer.
The most common neck size in men's dress shirts is 16 to 16½ inches. However, women whiplash victims answering the author's whiplash questionnaire report having a neck size 13 inches or less in circumference. Yet, there are still cars on the road crash tested with a unisex dummy patterned after the average male, 165 1bs, 5' 10". The neck of the dummy is fabricated of rubber and metal, hardly reflecting women's anatomy. Indeed, it takes a rear-end or an angle collision to show that whiplash injuries are not gender neutral, and that necks are not all created equal.
Fallacy No. 2
"Your neck could not have been injured because there vas no direct impact to your neck." A direct blow does not need to take place for a whiplash injury to occur. The collision can force the neck backward and forward (or sideways in the case of an angle collision) far beyond its normal range of motion. This occurs so fast that neck muscles and ligaments are actually overstretched twice with no time in between to recover.
The neck muscles and ligaments injured are the very same muscles and ligaments that bend the head sideways, backward, forward, and rotate the head. These muscles and ligaments must work sixteen hours a day to hold the head up. This explains why most whiplash victims complain of extreme fatigue toward the end of the day.
A whiplash injury is quite different from a strain or sprain in another part of the body, such as the ankle. First, it is different because it takes place so close to the cervical spinal cord and the brain. Second, the involved anatomy creates a domino effect (neck muscles, ligaments, vertebrae, nerves, blood vessels, and the cervical spinal cord are all very close together). So, if the shock is brutal enough, it could trigger a chain reaction along the cervical spine and upward inside the skull, disturbing the hindbrain. Cervical vertebrae will get slightly displaced, the soft brain (which has the consistency of jello) will bounce against the hard skull (which no longer acts as a protective shell), and nerves and blood vessels will even get bruised.
Why is the neck so vulnerable? First, the neck is very flexible to accommodate our senses of sight, hearing, and smell; second, it is very light (the seven cervical vertebrae only weigh a few ounces); and third, it is positioned between the heavy head (weighing ten to fourteen pounds) and the trunk. Hence, the neck bears the brunt of the impact.
Occasionally, people complain of symptoms quite similar to those of whiplash victims (such as having a sore neck, being in a daze) after going on roller coaster rides. This is why amusement parks now post warnings next to their roller coasters.
Fallacy No. 3
"There cannot be anything wrong with your neck: nothing shows on the X-rays." In other words, there is nothing broken! X-rays can only show a bone fracture or vertebral displacement. They will not show a so-called "soft tissue injury." Soft tissue includes neck muscles, ligaments, nerves, and blood vessels. The new imaging technology is required for a better understanding of what is often dismissed as a soft tissue injury. However, the majority of "hands-on" practitioners have no problem evaluating a whiplash victim's condition.
Fallacy No. 4
"All those complaints are psychosomatic!" In this instance, "psychosomatic" is a put-down, meaning that psychological factors are the real cause of the physical symptoms. What the word psychosomatic actually means is that there is a complex interaction between the body (soma) and the mind (psyche). This close interrelationship works both ways. It is totally arbitrary to define it as a one-way interaction. Whiplash injuries are the perfect illustration of this interdependence of mind and body.
When whiplash victims act anxious or irritable, or have crying spells, it may be the vibration from the force of the impact bruised the brain, thereby interfering with neurotransmitter and nerve connections. Psychological treatment at this point is premature. These psychological symptoms usually fade away as physical therapy treatments progress. When whiplash experiments on animals were discontinued, it was not because their suffering was considered "psychosomatic", but because the experiments were considered too cruel.
Fallacy No. 5
Rest and time plus muscle relaxants and tranquilizers will take care of a whiplash patient's distress. It is indeed true that time and rest can help whiplash patients. However, without adequate physical therapy, whiplash patients run the risk of developing a chronic problem with a sore, stiff neck. Physical therapy helps whiplash patients regain some degree of pain-free mobility and prepares them for the exercises they will have to do later on.
The value of muscle relaxants and tranquilizers is more than offset by their side effects. Injured athletes are not dismissed with a prescription for tranquilizers and home rest. Whiplash patients are entitled to the same level of care.
Fallacy No. 6
Whiplash victims are guilty of malingering for monetary gain. The complaints of whiplash patients are suspected of being tainted with ulterior motive. There are no valid statistical studies supporting those suspicions.
Rear-end and angle collisions are not the only causes of whiplash trauma. Lately pediatricians have cautioned parents not to shake their infants. Children can be very seriously injured when shaken by an adult. This "Whiplash Shake Syndrome" is now recognized by pediatricians as a form of child abuse. If a 165-pound adult can do that much harm to a child, is it any wonder that a 3,000-pound car can severely injure the occupants of the car it strikes?
Fallacy No. 7
"If people wore seat belts, they would not suffer whiplash injuries." Seat belts have a great protective feature: in the event of a collision, they can prevent you from being thrown out of the car. There is no denying that seat belts have saved many lives. Unfortunately, seat belts do not prevent whiplash injuries at all. They are now even suspected of compounding some whiplash injuries.
At the present time, the best way to minimize a whiplash injury is having a well-designed, well-positioned, head restraint and a sturdy seatback. In order to act as a dependable head stop, a head restraint must be positioned high enough above the ears, and very close to the back of the head. It should also be made of the same material as the seat and should require no prior adjustment. The Insurance Institute for Highway Safety regularly rates head restraints of new automobiles on their web site: http://www.hwysafety.org/crash/crashgen/head.htm.
To dismiss whiplash injuries with buzz words like "soft tissue injury" or "psychosomatic" will not make whiplash injuries disappear. Fortunately, there are Congresses on Whiplash-Associated Disorders held every year in Canada or Switzerland, where world-known experts present research papers on car design, and on diagnosis, treatment and prevention of whiplash injuries.
References
Injury Facts. Itasca, Illinois, National Safety Council, 1999.
Monique B. Harriton is a retired college librarian whose main interest has been health care issues from the point of view of the customer. After two years of graduate study at the University of Paris, she received a scholarship to attend Carleton College, Northfield, MN, where she earned a B.A. degree. She later graduated from the University of Southern California with a M.S. degree.
She is a member of the National Women's Health Network and of the National Association of Science Writers.
Ms. Harriton's article is based upon her book, The Whiplash Handbook (Charles C. Thomas, Publisher). Her book is the only survivor's guide available for whiplash victims and their families. Ms. Harriton is currently working on a revision of her book, to include the most recent whiplash research. Her e-mail address is Whipinjury@aol.com.
BOSTON GLOBE
(Boston, MA)
May 15, 2006, n.p.
Copyright 2006. THE ASSOCIATED PRESS. All rights reserved. The information contained in the AP News report may not be published, broadcast or redistributed without the prior written authority of The Associated Press.
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