Doctors' Choice Physical Medicine

Whiplash…Why Do I Hurt So Much?

There are many reasons why whiplash from a car accident can cause long-term pain.  The most common problem is damage to ligaments in the spine.

Whiplash Is Pain From Damaged Ligaments

Certain ligaments in the neck can give rise to pain.  The most intense pain comes from ligaments with the largest amount of pain nerve fibers.  Such as ligaments around the facet joints and the spinal ligaments that hold the neck bones together.  In a whiplash type injury, these ligaments are over-stretched. A “whiplash” injury from a rear-end accident is unique.  Upon impact, your car rapidly accelerates forward while your head remains in its original position.  This action results in an initial straightening of your neck followed by an extreme backward movement of your head.  The ligaments and muscles in the front of the neck become over stretched and tear.  Next your head is propelled forward into extreme flexion, which can then tear the ligaments and muscles in the back of your neck.  All this occurs in slightly more than one-half a second!  It is so fast that you cannot even remember that your head went backwards.  It is faster than your brain can record this trauma!

Whiplash May Be Difficult To Prove

Damage to the ligaments and muscles is difficult to “prove” by x-ray.  Bending views or, flexion/extension x-ray methods help show the damage to the joints.  On the bending x-ray, we will see an abnormal forward and/or backward shifting of the vertebra.  The more abnormal shifting the worse the whiplash.  Sometimes there is permanent damage.  The abnormal shifting of the vertebra on bending x-rays may be present for years or a lifetime.  That is why whiplash pain may be so chronic. Recent technology advances can now record the trauma and long-term damage to muscles.  At our office, we use “dynamic surface EMG” to measure how the neck muscles are working compared to normal.  We can measure muscle spasm and abnormal muscle movements.  This can be a great aid in helping to treat your injury and help your attorney to “prove” your “whiplash” or soft tissue injuries.  You can view a video on dynamic EMG here.

Whiplash May Result In Chronic Pain

Not all car accidents occur from behind.  In fact, only about 1/3 occur from this direction. One study that investigated which direction of impact created the greater degree of injury found that 57% of the chronic pain patient group were in a rear-end collision.  This is a classic whiplash type injury. They also found that women had more ligament injury compared to men.  They surmised it was because women generally have longer and weaker necks.  Frontal and rear end collisions result in significantly higher levels of ligament injury compared to side impacts.

Another well-published reason why neck pain can “hurt so much” after a car crash is that the pain message from the “pain nerves” becomes “memorized” by the brain and nervous system.  It also takes less stimulation of the “pain nerves” (something as simple as turning your neck) to trigger the pain. This is similar to the “phantom limb” phenomenon that often occurs after leg amputation.  Some patients can still “feel” the leg pain after the limb has been removed.

Whiplash Can Be More Than Neck Pain

“Whiplash” injuries may include other symptoms such as:

  • headache,
  • TMJ / jaw pain,
  • dizziness,
  • coordination loss,
  • memory loss,
  • difficulty in formulating thought,
  • poor communication,
  • losing your place during conversation, and more. 

Patients with whiplash injuries need a thorough history and physical examination.  We understand and can perform the special diagnostic tests that are necessary to demonstrate or “prove” whiplash.  We have prepared the necessary reports for many attorneys for successful settlements. If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving high quality evidence-based therapeutic approach at this office.  

Want To Know More?

Doctors’ Choice Physical Medicine and Rehab

Dr. David Novatnak

Glee Pascual, Physical Therapist

Pottsville, Schuylkill, PA