Materiały źródłowe

• #1 Cervical Sprain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK541016/

  The term „whiplash” injury was first coined by Harold Crowe in 1928 to define acceleration-deceleration injuries occurring to the cervical spine or neck region. […] The elusive difficulty that remains in describing these injuries is secondary to the fact that there is, by definition, no structural pathology identified following a comprehensive diagnostic workup. Therefore, WADs remain a diagnosis of exclusion. […] Whiplash-associated disorders describe a constellation of neck-related clinical symptoms manifesting after an MVA or car crash-related mechanism. The pathophysiologic cascade remains poorly understood and ultimately elusive. Previous speculated underlying mechanisms had attributed multifactorial elements including vertebral distraction to the facet joint capsule region of the cervical spine causing pain. Other plausible explanations can include any combination of minor (i.e., clinically irrelevant) injuries to either the facet joint(s), spinal ligaments, dorsal root ganglia/nerve roots, intervertebral discs, cartilage, and paraspinal muscle spasms or contusions of the intraarticular meniscus hemarthrosis may cause symptoms consistent with WADs or „whiplash” injuries.

• #2 Whiplash (medicine) – Wikipedia

  https://en.wikipedia.org/wiki/Whiplash_(medicine)

  Whiplash, whose formal term is whiplash associated disorders (WAD), is a range of injuries to the neck caused by or related to a sudden distortion of the neck associated with extension, although the exact injury mechanisms remain unknown. […] The exact injury mechanism that causes whiplash injuries is forceful sudden hyperextension followed by hyperflexion of the cervical vertebrae, mainly spraining the nuchal ligament and the Anterior Longitudinal Ligament respectively. A whiplash injury may be the result of impulsive retracting of the spine, mainly the ligament: anterior longitudinal ligament which is stretched or tears, as the head snaps forward and then back again causing a whiplash injury. […] Whiplash can be described as a sudden strain to the muscles, bones and nerves in the neck. The neck is made up of seven vertebrae, referred to as the cervical vertebrae.

• #3 Whiplash (medicine) – Wikipedia

  https://en.wikipedia.org/wiki/Whiplash_(medicine)

  There are four phases that occur during „whiplash”: Initial position (before the collision); retraction; extension; and rebound. In the initial position, there is no force on the neck; it is stable due to inertia. […] During the retraction phase, the spine forms an S-Shaped curve, caused by the flexion in the upper planes and hyperextension at the lower planes. If this exceeds their physiological limits, in this phase the injuries occur to the lower cervical vertebrae. In the extension phase, all cervical vertebrae and the head are fully extended, but do not surpass their physiological limits. Most of the injuries happen in C-5 and C-6.

• #4 Mechanism of Soft Tissue Injury and Repair Phases of Healing | North Alabama Spine & Rehab

  https://ihurtdoc.com/mechanism-of-soft-tissue-injury/

  Cervical accelerationdeceleration (CAD) describes the mechanism of the injury, while the term whiplash associated disorders (WAD) describes the injury sequelae and symptoms. […] Whiplash can be described as a sudden strain to the muscles, bones and nerves in the neck. […] There are four phases that occur during whiplash: Initial position (before the collision), retraction, extension and rebound. […] Anterior longitudinal ligament injuries in whiplash may lead to cervical instability. […] They explain that during the retraction phase that is when the actual whiplash occurs, since there is an unusual loading of soft tissues. […] During the retraction phase the spine forms an S-Shaped curve, and this caused by the flexion in the upper planes and hyperextension at the lower planes and this exceed their physiological limits this phase the injuries occur to the lower cervical vertebrae.

• #5 Whiplash | Enhanced Dental CPD Online

  https://www.dentaljuce.com/shorts-whiplash

  Whiplash injuries result from forceful hyperextension followed by hyperflexion of the cervical vertebrae, primarily affecting the nuchal and Anterior Longitudinal Ligaments. […] Whiplash involves a sudden strain on the neck’s muscles, bones, and nerves. The injury process includes four phases: initial position, retraction, extension, and rebound. During the retraction phase, the spine forms an S-shaped curve, causing most injuries in the lower cervical vertebrae (C-5 and C-6). The extension phase involves full extension of the cervical vertebrae and head, limited by the head restraint. […] The interaction sequence in a collision can be detailed as follows: 0 ms: Vehicle impact begins, occupant remains stationary. 100 ms: Seat accelerates, pushing the torso forward while the head remains stationary. 150 ms: Torso accelerates forward, lower neck pulled forward, head hyper-extends. 300 ms: Head and torso move forward, neck hyper-flexes.

• #6 Mechanisms of Whiplash Injury – Whiplash Injury and Chronic Pain: The Anatomy and Current Interdisciplinary Approaches to Management

  https://ecampusontario.pressbooks.pub/whiplashinjuryandchronicpain/chapter/chapter-4-mechanisms-of-whiplash-injury/

  Whiplash injuries commonly occur after an automobile accident. The victim is usually stationary and is struck from behind. A high-impact collision forces the vehicle into forward motion, with the seat taking the torso (body) and the shoulders forward with it. The head and neck, which are not as supported as the rest of the body, are thrown back due to inertia. Shortly after this, the inertia is overcome and the head and neck are thrown forwards into flexion. […] Explanations for the mechanism of whiplash injury (a spectrum of identifiable and non-identifiable injuries) are extrapolated from animal studies, cadaver studies, postmortem examinations, examinations during surgery, and human volunteer studies. […] The presently accepted theory involves formation of an abnormal S shaped curve in the cervical spine. Specifically, the cervical spine from C6 or below attains an initial position of extension. Once it reaches the maximum extension position, it forces the C5 vertebral level to extend. However, at the same time, the upper cervical spine is in a position of relative flexion, producing an S-shaped curve. Normal physiological motion of the neck happens from the top downward, and hence this is considered an abnormal motion pattern. The injury to facet joints is even more severe if the head is rotated.

• #7

  https://chiro.org/Whiplash/Mechanism_of_Whiplash_Injury.shtml

  OBJECTIVE: To propose a different hypothesis of whiplash injury mechanism based on a series of experimental studies summarized in this communication. […] The prevailing view of neck hyper-extension causing the injury has not been supported by recent experimental studies. […] The hyper-extension hypothesis of injury mechanism was not supported by these studies. We found a distinct bi-phasic kinematic response of the cervical spine to whiplash trauma. […] We propose, based upon our experimental findings, that the lower cervical spine is injured in hyperextension when the spine forms an S-shaped curve. […] Our findings provide truer understanding of whiplash trauma and may help in improving the diagnosis, treatment, and prevention of these injuries. […] Understanding the mechanism of injury is important. Knowing the correct injury mechanism will indicate where the potential injury sites are, and which anatomic elements are more likely to be injured.

• #8

  https://kcspineandsport.com/blog/cervical-spine-injury-mechanism-of-whiplash

  Lord et al have shown that the cervical zygapophysial joints are at particular risk of injury during whiplash-type accidents, and that treatment of these lesions has a positive effect on pain and psychological symptoms. […] Yang et al reported that compression of the cervical spine temporarily weakens the cervical ligaments, making them susceptible to injury from extension during whiplash. […] Grauer et al recently published a study that showed that the cervical spine undergoes a „S-shaped curve” during whiplash motion that results in excessive hyperextension of the lower cervical spine. […] Compression of the cervical spine (or axial movement) as a potential mechanism of whiplash injury is getting increased attention in the literature. […] This study confirmed what other studies have shown about compression that during the early phases of the collision (from 50 to about 150 milliseconds), the axial forces on the cervical spine are in the range of 33 pounds.

• #9 Mechanism of whiplash injury – PubMed

  https://pubmed.ncbi.nlm.nih.gov/11415793/

  OBJECTIVE: To propose a different hypothesis of whiplash injury mechanism based on a series of experimental studies summarized in this communication. […] The prevailing view of neck hyper-extension causing the injury has not been supported by recent experimental studies. […] The hyper-extension hypothesis of injury mechanism was not supported by these studies. We found a distinct bi-phasic kinematic response of the cervical spine to whiplash trauma. […] We propose, based upon our experimental findings, that the lower cervical spine is injured in hyperextension when the spine forms an S-shaped curve. Further, this occurs in the first whiplash phase before the neck is fully extended.

• #10

  https://chiro.org/Whiplash/Mechanism_of_Whiplash_Injury.shtml

  Our findings suggest that the lower cervical spine injuries occur before the neck is hyper-extended. […] The S-shaped cervical spine curvature in the first phase of trauma was also noted by Svensson in a dummy preparation, but he did not relate it to spinal column injury. […] However, our experimental findings show that the lower cervical levels more consistently exceed their physiologic motion limits while the upper cervical levels did not.

• #11 Cervical Spine Injury Mechanism of Whiplash | Goodman Chiropractic Clinic

  https://www.goodmanchiroclinic.com/articles/cervical-spine-injury-mechanism-of-whiplash/

  Lord et al have shown that the cervical zygapophysial joints are at particular risk of injury during whiplash-type accidents, and that treatment of these lesions has a positive effect on pain and psychological symptoms. […] Yang et al reported that compression of the cervical spine temporarily weakens the cervical ligaments, making them susceptible to injury from extension during whiplash. […] Grauer et al recently published a study that showed that the cervical spine undergoes a S-shaped curve during whiplash motion that results in excessive hyperextension of the lower cervical spine. […] Compression of the cervical spine (or axial movement) as a potential mechanism of whiplash injury is getting increased attention in the literature. […] This study confirmed what other studies have shown about compression that during the early phases of the collision (from 50 to about 150 milliseconds), the axial forces on the cervical spine are in the range of 33 pounds.

• #12 Cervical Spine Injury Mechanism of Whiplash | Goodman Chiropractic Clinic

  https://www.goodmanchiroclinic.com/articles/cervical-spine-injury-mechanism-of-whiplash/

  According to Yang et al, a compressive force of 40 pounds results in a 73% reduction in ligament stiffness at C5-6, so even a 33-pound force could result in a significant loss of ligament stiffness. […] The latest literature, however, has been able to look at each individual segment of the spine, and has found that the spine does not undergo smooth, even extension during whiplash but that the spine is subjected to an S-shaped curve during the early phase of the collision. […] Grauer reported that the whiplash motion was not simply extension, but a complex combination of compression, flexion of the upper cervical spine, and excessive extension of the lower cervical spine. […] A subjects torso shows the ramping-up motion by the inclined seatback during rear-end impact. […] As the head remains in its original position due to inertia in the initial phase of impact, an axial compression force is apt to be applied to the cervical spine, which in turn moves upward and the flexion occurs at about the same time.

• #13 Critical considerations about the onset and epidemiology of whiplash associated disorders presented by the bone and joint decade 2000-2010 task force on neck pain

  https://www.oatext.com/critical-considerations-about-the-onset-and-epidemiology-of-whiplash-associated-disorders-presented-by-the-bone-and-joint-decade-2000-2010-task-force-on-neck-pain.php

  Compression of the cervical spine segments loosens the lower cervical spine ligaments and renders them less capable to withstanding shear forces. […] It is therefore hypothesized that the lower cervical spine segments may be injured as a result of abnormal coupled compression, shear and rotational forces, while abnormal tension-flexion seems to be the main force induced in the upper cervical spine. […] Although research into low speed whiplash biomechanics has enormously enriched our understanding of possible injury mechanisms in WAD, the clinical side of the problem is still unsolved.

• #14 Whiplash Symptoms – Low Back Pain | Frank E. Kaden, D.C. Chiropractic, Inc.

  https://www.kadenchiropractic.com/whiplash-symptoms-low-back-pain/

  Shear forces can cause tearing or stretching of the soft tissues that hold the spine together. […] The primary reason why rear-end collisions cause injury is that the human spine is designed to withstand vertical forces, while a rear-end collision is a horizontal force. The vertical forces are known as axial forces. The horizontal forces, known as shear forces, cause unnatural movements of the cervical spine and can result in damage to the ligaments of the neck. […] In the absence of clear bony pathology after rear-impact collision, we propose that irritation of or injury sustained by the richly innervated spinal soft tissues (i.e., muscles, ligaments, capsules) plays an important role in the pathogenesis of lumbar pain after whiplash injury. This proposition is supported by work of others who performed lumbar spinal segment shear tests and showed that soft-tissue injuries occurred with a shear load as low as 1200 N. […] So, according to this preliminary study, the car seat back exerts enough force during such a collision to injure the connective tissue of the lumbar spine.

• #15 The Pathophysiology and Mechanism of Acute and Chronic Whiplash Injury: A Narrative Review

  https://www.painresearch.or.kr/journal/view.html?doi=10.56718/ijp.22-004

  Patients with whiplash injuries usually complain of neck, shoulder, or back pain; dizziness; headache; vertigo; paresthesias; and cognitive or psychological symptoms. […] This review briefly summarized the pathophysiology and mechanisms being investigated by many researchers to potentially explain whiplash injury. Each anatomical area described is injured during a whiplash exposure if the impact during whiplash injuries exceeds that tissues tolerance. For each anatomical area affected during whiplash injuries, continued research is necessary to better understand the pathophysiology and mechanisms of whiplash injuries. […] The facet joints of the cervical spine are reportedly the most common source of neck pain. […] Based on the previous studies, two mechanisms of the facet joint injury have been suggested: an excessive strain of the facet joint capsule and pinching of the synovial fold.

• #16 Cervical Sprain and Strain: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/306176-overview

  Facet capsular ligaments have been shown to contain free (nociceptive) nerve endings, and distending these ligaments by administering facet joint injections has produced whiplash-like pain patterns in healthy individuals. The cervical facet capsular ligaments may be injured under whiplashlike loads of combined shear, bending, and compression forces; this mechanism provides a mechanical basis for injury caused by whiplash loading. […] Chronic pain associated with cervical strains is most likely to affect the zygapophysial (facet) joints, intervertebral discs, and upper cervical ligaments. […] Neuroanatomic studies reveal that the facet joint is richly innervated and contains free and encapsulated nerve endings. […] The nonphysiologic kinematic responses that occur during a whiplash impact may induce stresses in upper cervical neural structures or in lower facet joints. The result may be compromise sufficient to elicit neuropathic or nociceptive pain.

• #17

  https://scholars.duke.edu/individual/pub701805

  A comparison of cervical facet capsule strain fields in cadaveric motion segments exposed to whiplash-like loads and failure loads. […] The cervical facet capsular ligament is thought to be an anatomic site for whiplash injury, although the mechanism of its injury remains unclear. […] The cervical facet capsular ligaments may be injured under whiplash-like loads of combined shear, bending, and compression. The results provide a mechanical basis for injury caused by whiplash loading.

• #18 Cervical Spine Injury Mechanism of Whiplash | Goodman Chiropractic Clinic

  https://www.goodmanchiroclinic.com/articles/cervical-spine-injury-mechanism-of-whiplash/

  The lower vertebral segments (C6, C5 and C4) are extended and rotated earlier than the upper vertebral segments. […] Those motions are beyond the normal physiological range of motion. […] The result of this abnormal motion? The facets of the vertebrae, rather than sliding over each other smoothly, are jammed into each other. […] Such abnormal motions are believed to result in joint injury, a lesion that would not be detectable with modern imaging techniques, but one that could cause chronic pain. […] This current study also evaluated the role of muscle tension on the kinematics of the neck, and found that, indeed, tensing of the muscles resulted in a 30-40% reduction in total head extension. […] The average start time of the neck flexors discharge was measured here to be 79 ms. […] The interpretation of these variations in terms of neck moment, shear and axial compression forces reveal that the axial compression force applied to the cervical spine is approximately 150 N with the rigid seat around 100 ms in the early phase of impact, which is about twice greater than the standard seat.

• #19 The Pathophysiology and Mechanism of Acute and Chronic Whiplash Injury: A Narrative Review

  https://www.painresearch.or.kr/journal/view.html?doi=10.56718/ijp.22-004

  Previous studies using autopsy and magnetic resonance imaging on patients with whiplash injuries have suggested an injury to the ligaments and intervertebral discs of the cervical spine. […] Altered blood flow rates due to narrowing or spasm of the vertebral arteries in patients with whiplash injuries have been linked to chronic symptoms of headache, tinnitus, blurred vision, vertigo, and dizziness. […] Direct injury to cell bodies within the dorsal root ganglion could thus explain many of the typical whiplash symptoms, such as neck pain, headache, dizziness, vertigo, visual disturbance, and radiating pain. […] The direct mechanism of neck muscle injury is linked to eccentric contractions (imposed lengthening during active contraction). […] In previous studies, psychological components has known to be one of causes of symptoms of the whiplash syndrome.

• #20 The pathology of whiplash: Neck sprain | British Columbia Medical Journal

  https://bcmj.org/articles/pathology-whiplash-neck-sprain

  Common spinal lesions consistently observed in autopsy spines, cadaver spines from crash studies, and experimental neck extension injuries in primates include disc tears, avulsions, and facet hemarthroses. […] Clinical studies alone cannot adequately describe the pathology of severe whiplash, as most imaging is unable to demonstrate it. […] The terms whiplash and acceleration injury to the neck describe an injury mechanism without specifying a pathology. […] Whiplash assumes no head impact, though in modern vehicles, the back of the head impacts on the head restraint, unless there is hyperextension over the top of a low-positioned head restraint. […] However, hyperextension is not essential for a neck sprain to occur. […] Most soft-tissue lesions observed in autopsy studies were not visible on postmortem radiographs.

• #21 The pathology of whiplash: Neck sprain | British Columbia Medical Journal

  https://bcmj.org/articles/pathology-whiplash-neck-sprain

  Even magnetic resonance imaging (MRI) grossly underestimates the extent of injuries found at surgery. […] This deficiency in objective imaging methods may explain some of the inadequacy in diagnosing organic disorders in severe whiplash. […] Recent developments have found objective evidence of nociceptive pain in specific injured joints in patients who may otherwise have been dismissed with psychological disorders. […] Most of these significant physical injuries with organic pathology appear to have occurred in collisions with a high force of impact. […] The consistent nature of these soft-tissue injuries clearly points to the most likely sites of injury. […] Cervical disc, ligamentous, and zygapophyseal joint injuries were four times more frequent than vertebral fractures. […] Both extension and side flexion injuries may injure cervical dorsal root ganglia.

• #22 Anterior Longitudinal Ligament Injuries in Whiplash

  https://centenoschultz.com/understanding-anterior-longitudinal-ligament-injuries-in-whiplash/

  The cervical anterior longitudinal ligament (ALL) is a very important neck ligament that can commonly be injured by whiplash. The head and neck snapping backward in whiplash cause injury to the ALL. […] The most common cause of ALL ligament injuries is hyperextension injury and whiplash injuries. Whiplash is defined as an injury caused by a severe jerk to the head with a rapid back-and-forth whipping motion of the head and neck, typically in a motor vehicle accident. The back motion typically injures the ALL. […] ALL injuries usually occur in conjunction with other cervical injuries. […] Depending on the mechanism and severity of whiplash injuries, these structures may remain damaged, leading to continued pain and symptoms. Injury to the ALL and other ligaments leads to chronic neck instability, which can further cause damage to the neck structures, prolonging symptoms or causing new symptoms due to continued stress on the neck.

• #23 The pathology of whiplash: Neck sprain | British Columbia Medical Journal

  https://bcmj.org/articles/pathology-whiplash-neck-sprain

  The major injuries were confined to one or two levels, most often at C5-6 and C6-7. […] The disc usually tears in linear fashion along the disc vertebral junction in subjects under 55 years. […] Herniations were usually contained by an intact posterior longitudinal ligament. […] The anterior muscles tear last. […] Imaging demonstrated herniations, but it may miss avulsions, which occur along an anatomical line where the vertebra meets the disc. […] Late pathologies may be secondary to the initial injury rather than the direct result of it. […] Dorsal root ganglion injury was identified in one-third of the subgroup who survived injury for more than 1 hour. […] A comparison of lesions in those with head injuries and those with no evidence of head impact showed that the spinal injuries were similar, despite a slight excess of upper cervical lesions in those with head injuries.

• #24 Mechanism of Soft Tissue Injury and Repair Phases of Healing | North Alabama Spine & Rehab

  https://ihurtdoc.com/mechanism-of-soft-tissue-injury/

  Recently, an intriguing new hypothesis for injury has been tested by Svensson et al. […] They found pressure pulses 10 times higher than normal. These pulses produce pressure gradient injuries to cervical and upper thoracic dorsal root ganglia which were demonstrable on light microscope examination and which are postulated as a mechanism of nerve injury. […] Finally, because so many of the symptoms and conditions, like TOS, TMD, PCS, CTS, etc., develop subsequent to CAD injurysome developing weeks or months laterCAD syndrome should be looked upon as a process rather than a single event.

• #25 Cervical Sprain and Strain: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/306176-overview

  The muscular component of the head-neck complex plays a central role in the abatement of higher acceleration levels; it may be a primary site of injury in the whiplash phenomenon. […] Cervical muscle strains induced during a rear-end impact are greater than the injury threshold that had previously been reported for a single stretch of active muscle, with larger strains in the extensor muscles being consistent with clinical reports of pain in the posterior cervical region after the occurrence of a rear-end impact. […] An overload injury to the muscle-tendon unit produces cervical strain because of excessive forces on the cervical spine. This injury is accompanied by elongation and tearing of muscles or ligaments, secondary edema, hemorrhage, and inflammation. Many cervical muscles attach directly to bone (periosteum), and the muscle response to injury is contraction, with surrounding muscles recruited to splint the injured muscle.

• #26 Cervical Sprain and Strain: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/306176-overview

  Cervical strain is produced by an overload injury to the muscle-tendon unit because of excessive forces on the cervical spine. The cause is thought to be the elongation and tearing of muscles or ligaments. Secondary edema, hemorrhage, and inflammation may occur. […] A major advance in the understanding of chronic pain following whiplash injury over the past two decades has been the discovery that central sensitization plays an important role in symptom perpetuation. […] Many cervical muscles do not terminate in tendons but attach directly to the periosteum. Muscles respond to injury by contracting, with surrounding muscles recruited in an attempt to splint the injured muscle. Myofascial pain syndrome, which is thought to be the resultant clinical picture, may be a secondary tissue response to disc or facet-joint injury.

• #27 Evaluation of surface electromyography of selected neck muscles during the whiplash mechanism in aware and unaware conditions due to safe punching in kickboxing | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-023-06563-y

  It was proven that expecting the impact increases neck muscle activation by 400%. […] In the present study, real tests were conducted in the kickboxing club by hitting safe punching. […] Compared to the unaware condition, the SCM muscle, as a representative of the neck flexors, was recruited with more activity in the aware conditions, the activity of which significantly influenced the prevention of neck extension. […] Further, a significant difference was observed between the warned and unwarned subjects in terms of the neck extension, reflecting the risk factor for neck injury in unaware conditions. […] We hope that by understanding the results of muscle activity in two conditions (aware and unaware), we can encourage coaches to implement neuromuscular coordination and proprioception exercises to restrain and reduce risk of the neck injuries with the whiplash mechanism in kickboxing.

• #28 Pathogenesis of Chronic Whiplash-associated Disorder – Whiplash Injury and Chronic Pain: The Anatomy and Current Interdisciplinary Approaches to Management

  https://ecampusontario.pressbooks.pub/whiplashinjuryandchronicpain/chapter/chapter-6-pathogenesis-of-chronic-whiplash-associated-disorder/

  Claudias problem involved probable soft tissue injury, altered central processing, and central sensitization, and was characterized by bracing pain behaviors. […] Knowledge of altered central processing early in whiplash can help direct treatment for those with high pain, high disability, low self-efficacy and other prognostic indicators suggesting a poor or slow recovery. These indicators may suggest reduced chances of success with standard treatments and are shown to be associated with poor recovery. […] There is evidence that the mechanisms in whiplash involve central sensitization. As described above, this process involves persisting pain complaints in the absence of evident tissue damage, a common picture in patients with associated whiplash disorders. Central sensitization may involve temporal summation of pain or wind-up, increased activity of pain facilitatory pathways, malfunctioning of descending pain inhibitory mechanisms, altered sensory processing in the brain, and long-term potentiation of neuronal synapses in the anterior cingulate cortex.

• #29 Whiplash and its Connection to Brain Injury

  https://www.butlerprather.com/blog/whiplash-and-its-connection-to-brain-injury/

  Whiplash can cause concussions and more severe traumatic brain injuries. […] The same mechanism of injury that causes whiplash injuries can also cause brain injuries. […] Anytime a force is strong enough to cause a whiplash injury, this could also lead to the brain jostling around inside of the head and striking directly against the skull. This can lead to brain bruising and contusions, bleeding around the brain, and brain swelling. […] The force that causes whiplash injuries could lead to a relatively minor concussion or even a more severe traumatic brain injury.

• #30 Mechanism of cognitive symptoms related to a whiplash neck injury – NeuroTalk Support Groups

  https://www.neurotalk.org/traumatic-brain-injury-and-post-concussion-syndrome/249793-mechanism-cognitive-symptoms-related-whiplash-neck-injury.html

  The most likely problem is reduced vertebral artery blood flow to the brain stem and part of the brain from inflammation. […] Chronic sleep and blood flow problems can cause atrophy of the brain cells over time. […] Then there is the direct physiological damage to axons (diffuse axonal injury) that reduces the function of the communication structure in the brain. […] The inflamed joint tissue acts like a blood pressure cuff and squeezes the blood vessels. […] Lack of quality sleep, sleep apnea, and such limit the brains ability to detoxify and properly oxygenate. […] The injury is believed to be to the myelin sheath that insulates the axons. […] When nerves in the neck get inflamed, they can cause muscle spasms that can also reduce blood flow. […] Chronic sleep problems like untreated sleep apnea can take decades to slowly atrophy the brain.

• #31 The Long-Term Effects of Whiplash: Causes & Treatment

  https://www.cognitivefxusa.com/blog/long-term-effects-of-whiplash

  Whiplash can also affect the autonomic nervous system (ANS). […] However, whiplash can cause the SNS to stay activated most of the time, leading to symptoms such as chronic pain, fatigue, headaches, high blood pressure, digestive issues, problems sleeping, and mood changes. […] If whiplash damages these nerves, they might relay incorrect information about your position and movement to the brain, which in turn affects the vision and vestibular system.

• #32 The Long-Term Effects of Whiplash: Causes & Treatment

  https://www.cognitivefxusa.com/blog/long-term-effects-of-whiplash

  Whiplash can cause physical and neurological damage that results in long-term symptoms. […] The same sudden movement of the head can also cause a traumatic brain injury (TBI). […] After whiplash, the upper vertebrae (C1-C2) and lower vertebrae (C6-C7) often get „locked up” or „stuck,” which causes the middle of the cervical spine (C3-C5) to become hypermobile. […] After whiplash, however, when the ligaments in the neck become overextended and disrupted, the cervical instability and misalignment discussed above occur. […] Long-term effects of whiplash can come directly from the neck injury, from vestibular and vision dysfunction, from autonomic dysregulation, and more. […] Its impossible to determine what causes long-term symptoms after whiplash, but common causes include: Cervical instability and misalignment, Neurovascular coupling disruption, Dysfunction of the autonomic nervous system, Breathing difficulties, Vision, Vestibular, and Proprioception problems.

• #33 Pathophysiology behind prolonged whiplash associated disorders: study protocol for an experimental study | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-019-2433-3

  There is insufficient knowledge of pathophysiological parameters to understand the mechanism behind prolonged whiplash associated disorders (WAD), and it is not known whether or not changes can be restored by rehabilitation. […] To improve future rehabilitation, a greater understanding of the mechanisms underlying whiplash injury and their importance for treatment success is required. It is also important to investigate if pathophysiological changes can be restored by rehabilitation. […] Fatty infiltration in the deepest dorsal neck muscle multifidus occurs in the early stage following a whiplash injury and has also shown to be present in individuals with chronic WAD. […] The mechanism behind the development of fatty infiltration needs to be investigated. […] The mechanisms behind chronic WAD and whether pathophysiological findings can be restored are largely unknown. Understanding the mechanisms and improved diagnostics are important key factors for future improved rehabilitation.

• #34 The pathology of whiplash: Neck sprain | British Columbia Medical Journal

  https://bcmj.org/articles/pathology-whiplash-neck-sprain

  Studies in survivors of injury showed that similar injuries were found in severe WAD patients. […] The consistency of the disc and facet pathology observed in postmortem studies of fatal injuries, experimental injuries in cadavers, and in living primates points to the reality of the type of lesions that can occur in severe neck sprain. […] Although these lesions can be visualized in some patients, they may also exist with severe WAD where imaging studies are normal. […] Clearly, normal imaging does not exclude organic pathology.

• #35 Cervical Spine Injury Mechanism of Whiplash | Goodman Chiropractic Clinic

  https://www.goodmanchiroclinic.com/articles/cervical-spine-injury-mechanism-of-whiplash/

  As we saw earlier, compression can have a dramatic effect on ligament strength. […] The sheer force is 241 N with the standard seat around 110 ms when the rebound of the torso has occurred, which is roughly 1.6 times greater than the value of 152 N with the rigid seat. […] The S-shaped curve phenomena becomes more pronounced in the flexion position, putting more stress on the lower segments of the cervical spine. […] The axial compression that occurs at 100 ms is worse in the flexion position. […] In this regard, more attention should be paid to the cervical spine alignment than any other parameter affecting the occupants seating position when considering parameters for the evaluation of neck injuries. […] Matsumoto et al in a recent study conducted on the relationship between cervical curvature and disc degeneration reported that the lordosis position accounts for 35% or so of the cause of such injuries among female occupants younger than 40, while kyphosis accounts for 65% or so. […] This may explain the higher minor impact neck injury incidence for occupants with the kyphosis position.

• #36 Whiplash-related injuries – Human Kinetics

  https://us.humankinetics.com/blogs/excerpt/whiplash-related-injuries?srsltid=AfmBOopM4x47KrUmBt-oc8QX4L-mlPbYJBkgwfC35BYV5m6s6CF1YwPE

  Although usually viewed as a sagittal plane injury caused by a rear-end impact, whiplash can also result from lateral or frontal forces with their own unique injury pattern. In addition, motion of the neck is not confined to a single plane. If a driver is looking to the side at the moment of impact, for example, the injury mechanism involves a combination of hyperextension and rotation. In this case the pre-impact rotation enhances the effect of the impact as the cervical structures are prestretched, which may enhance the injurious effect of the impact forces. […] At first glance, whiplash might appear a simple injury mechanism. However, in an individual accident there is likely to be a complex interaction between different forces depending upon the speed and direction of impact and the attitude of the head and neck (Barnsley et al. 1994, p. 288). In addition to the cervical musculature, spinous ligaments, intervertebral discs, vertebral bodies, and facet (zygapophyseal) joints, the brain and even the temporomandibular joint can be involved (e.g., Davis 2000; Ito et al. 2004; Panjabi, Ito et al. 2004; Pearson et al. 2004). Various mechanisms and potential injury sites are shown in figure 8.18. Whiplash-associated disorders can manifest as both clinical and psychosocial symptoms (Eck et al. 2001). Possible symptoms are listed in table 8.4.

• #37

  https://kcspineandsport.com/blog/cervical-spine-injury-mechanism-of-whiplash

  Matsumoto et al in a recent study conducted on the relationship between cervical curvature and disc degeneration using 495 subjects reported that the lordosis position accounts for 35% or so of the cause of such injuries among female occupants younger than 40, while kyphosis…accounts for 65% or so.

• #38 How to reduce the risk of whiplash in car accidents

  https://theconversation.com/how-to-reduce-the-risk-of-whiplash-in-car-accidents-58799

  Reactive seats that move the head restraint closer to the head by the pressure of the torso in the event of a rear-end crash are known to reduce whiplash injuries which can also be alleviated by reducing the relative motion between the head and the torso and absorbing the impact energy. This relative motion is reduced by allowing the seat back to move backwards slightly and then to rotate backwards. During this process, a part of the seat mechanism is allowed to elastically deform to also absorb the impact energy. […] The results from the simulation, based on a rigid human model positioned in driving posture, showed that the integration of a reactive head restraint and car seat would be very effective in reducing the occurrence of whiplash. These mechanisms are designed to be reactive that is, they will only operate when the vehicle receives a rear-end collision.

• #39 Evaluation of surface electromyography of selected neck muscles during the whiplash mechanism in aware and unaware conditions due to safe punching in kickboxing | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-023-06563-y

  The results demonstrated a significant difference between the normalized EMG activity of the SCM muscle in the two conditions. […] In addition, muscle injuries, especially the stretches caused by contraction, are a function of the pre-activation, strong stretching, and initial length of muscles, all of which are related to the loss of contractile force. […] Some studies have reported a neuromechanical delay between the neck muscle activation and head motion in the incidents which may cause a whiplash mechanism such as car accident and head trauma during sports. […] The greater intensity and extent of impact, as well as shorter stimulus time can be addressed as the factors enhancing the EMG amplitude. […] Awareness of an impending event alters the injury risk and kinematic response of head during a car collision or sports impact.

• #40 The Biomechanics of the Cervical Spine during Whiplash Injury | Musculoskeletal Key

  https://musculoskeletalkey.com/the-biomechanics-of-the-cervical-spine-during-whiplash-injury/

  Understanding the true biomechanics of whiplash injury is important in that it can help the clinician in focusing on areas that are most likely to be injured (and painful) after these injuries. […] Recent research findings have elucidated a more precise and accurate understanding of what does occur following whiplash injury, i.e. compressive injuries and deformation of the normal cervical lordosis after rear-end motor vehicle accidents. […] It has become more apparent through these studies that the mechanism of injury to the cervical spine is not, in fact, simply cervical hyperextension or hyperflexion as was once thought. […] It is now felt that this abnormal curvature and compression of the cervical spine is the etiology of the injuries that occur during rear-end collision. […] The abnormal posture that occurs during this S-shaped curve is now implicated as the most likely etiology of injury in whiplash-associated disorder. […] The energy transfer that occurs through this process causes the abnormal cervical spine curvature and compression which leads to the cervical spine injury.

• #41 The Pathophysiology and Mechanism of Acute and Chronic Whiplash Injury: A Narrative Review

  https://www.painresearch.or.kr/journal/view.html?doi=10.56718/ijp.22-004

  This review briefly summarized the pathophysiology and mechanisms being investigated by many researchers to potentially explain whiplash injury. Each anatomical area described is injured during a whiplash exposure if the impact during whiplash injuries exceeds that tissues tolerance. For each anatomical area during whiplash injuries summarized here, continued research is necessary to better understand the pathophysiology and mechanisms of whiplash injuries. A better understanding of each potentially injured anatomical area during whiplash injuries will help improve the management of whiplash injuries.

• #42 Cervical Sprain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK541016/

  The injury occurs in three stages with a rapid loss of lordosis. Both the upper and lower spines experience flexion in stage one. In stage two the spine assumes an S-shape while it begins to extend and eventually straighten to make the neck lordotic again. The final phase shows the entire spine in extension with an intense sheering force that causes compression of the facet joint capsules. […] Studies with cadavers have shown the whiplash injury is the formation of the S-shaped curvature of the cervical spine which induced hyperextension on the lower end of the spine and flexion of the upper levels, which exceeds the physiologic limits of spinal mobility. […] The Quebec task force (QTF) defined whiplash as bony or soft tissue injuries as a result of rear-end or side-impact in road traffic accidents, and from other injuries resulting in an acceleration-deceleration mechanism of energy transfer to the cervical spine. […] Most WADs are considered to be minor soft tissue-based injuries without evidence of fracture.

• #43 Internet Scientific Publications

  https://ispub.com/IJN/8/2/8723

  Although zygapophyseal joint pain is considered to be the basis of the chronic neck pain after whiplash injuries, it cannot be diagnosed clinically or by medical imaging. […] The focus of prevention of whiplash has been on automobile seat design and the use of head restraints often incorrectly called headrests. […] Plausible explanations derived from research highlight the role of zygapophyseal joints in the generation of chronic pain and have established whiplash as a recognised injury predominantly in motor vehicle accidents which can be approached with appropriate treatments.

• #44 Whiplash – Discussion – Eddie O’Grady Physiotherapist

  https://www.physiotherapiststralee.ie/whiplash-discussion/

  Acceleration/deceleration injury to the cervical spine(neck) and back, also known as whiplash, is a common injury due to traffic accidents regularly treated by our physiotherapists in Tralee. […] To simplify the mechanism of this type of injury, think of a whip snapping. This is basically what is happening with your neck during these incidents, the head jolts swiftly forward first, then snaps backwards. It is being propelled swiftly with great force in one direction, then there is a recoil swiftly in the opposite direction. […] With whiplash the patient may not feel any pain immediately after the accident, however symptoms can increase gradually in the 48 hours after injury. Muscles, joints, ligaments and neural tissue can all be affected depending on the level of injury. […] A multimodality approach to treatment as early as possible has shown good results in best evidence practice. This includes very specific therapeutic exercises, manual therapy, postural education and the use of drugs most notably non steroidal anti-inflammatories and muscle relaxants. […] It is extremely important to try to return range of movement to the neck as soon as possible after the accident once adequate safety checks have been performed. The neck stiffens up quite quickly when immobilized for even short periods of time.

• #45 Anterior Longitudinal Ligament Injuries in Whiplash

  https://centenoschultz.com/understanding-anterior-longitudinal-ligament-injuries-in-whiplash/

  In cases where conservative methods are inadequate, surgical procedures like spinal fusion or ligament repair may be recommended for extensive ligament damage leading to severe spinal instability or nerve injury. […] The most common orthobiologics used for whiplash and ALL injuries are: […] PRP can be used to treat mild to moderate ligament tears of the ALL and other structures. This is the most common orthobiologic used for these injuries. […] BMAC containing stem cells is a more powerful healing agent and can be used for more moderate to severe ligament injuries of the ALL and other structures.

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