Massage for Whiplash: A primer for Physicians, Therapists, and Medically Savvy Patients
By BJ Erkan, Bothell Integrated Health
Massage for Whiplash
Prescriptions of medical massage for whiplash are becoming more common due to the fact that many patients with this condition respond very well to manual therapy. The injury commonly known as “Whiplash” is also known in medical circles as Cervical Acceleration/Deceleration (CAD)syndrome, and the wide range of symptoms that can result from such an injury are included in the more comprehensive category of Whiplash Associated Disorder (WAD) . When you mention whiplash most people think of being rear-ended in a car. The car moves forward, initially leaving the heavy, unsupported head behind, and when at the end range of extension for the spine the head is “whipped” forward.
The Symptoms of Whiplash
The most common complaints by a sufferer of whiplash is posterior (backside of the body) neck pain and cervico-genic headaches (headaches generated by the neck). Other common symptoms include shoulder pain, upper back pain, numbness in the neck, numbness in the shoulders, numbness in the arms, jaw clenching, jaw and head pain other than headaches, Temporo-Mandibular Joint (TMJ) pain, postural deviations (especially head forward posture with protracted shoulders), mid-back pain, and low-back pain.
Whiplash Pain, Disability, and Emotional Duress
The intensity of pain that results from a severe whiplash is always surprising to the patient, especially if the patient hadn’t previously “believed in” whiplash. Whiplash often has a significant psychological impact, as well as an impact on the patient’s abilities to perform her/his activities of daily life. As a medical massage provider I have two concerns for this patient: the initial pain from direct injury to the tissues involved, and the long-term neurological patterns that can be established from non-treatment of the postural deviations caused by muscle guarding.
Whiplash injuries can have both a short-term and long-term impact on the accident victim. The initial concerns involve the mechanical injury to the muscle, bone, ligament, nerve, and tendon tissue and the resulting pain, inflammation, and muscle guarding. The diagnosis is usually cervical-thoracic-lumbar sprain/strain. The management of inflammation and pain is the main focus for mainstream medicine. It is my experience that most attending physicians will prescribe anti-inflammatory, pain killer, and muscle relaxant medications and send the patient on their way. The long-term concern is the effect of the neuro-muscular guarding that can become neurologically habitual, causing health and postural problems years after the date of injury.
Examples of How Muscle Guarding Habits Become Problematic
An example often used to illustrate these kinds of neurological habits is the person with an injured knee. The knee hurts due to tissue damage and the inflammatory response. The person walks with a limp as he shifts his weight off the injured leg. The injured tissue heals, the pain and inflammation are gone. The person continues to limp out of neurological habit, affecting their posture for the rest of their life. Of course, not all knee injuries result in life-long limping, but the concept is easily understood.
Another example: have you ever walked around with an arm load of heavy groceries for 20 minutes or so, and after you set it down you can not quite straighten your arm out? This phenomenon is known as temporary sensory-motor amnesia (coined by Thomas Hanna). The cerebellum temporarily recalibrates the dynamic range of motion (ROM) based upon the range used while loaded. If you do nothing you will regain your normal range of motion after a few moments because it is temporary. If you contract muscles for hours a day in a limited ROM the cerebellum will eventually recalibrate and make this the new default ROM leading to permanent limitations.
What that Means for Whiplash Sufferers
Now it is necessary to extend this understanding to severe spinal pain centered in the neck. Head forward posture due to muscle guarding after sustaining a whiplash injury is extremely common. I would go so far as to say it is the rule. It has an immediate negative effect on posture and the efficiency of musculo-skeletal balance. If the guarding muscles are not addressed in treatment the effect of the neurological habits may well be life-long establishing permanent sensory-motor amnesia.
The longer the dysfunctional neurological habits are uncontested, the more pervasive they become. Over time the imbalance of forces acting on the structures involved can actually change the shape of bones and discs. Most conditions involving disc degeneration, and arthritis, are recognized as sites of previous trauma. The effect of the permanent increase in muscle tension from unrelenting muscle guarding reduces range of motion and tissue health over time eventually leading to degenerative disc disease, stenosis, and even spinal fusion.
What Can Massage do for Whiplash?
It is my experience that massage rendered by a qualified, experienced therapist can greatly aid in effectively defeating dysfunctional neurological habits such as an imbalance caused by antalgic posture. Addressing the muscles responsible for postural deviation is the key, not just to alleviating or preventing long-term residual pain and dysfunction, but also in raising patient awareness in order to make it possible for the patient to make conscious decisions to correct postural deviations.
Symptomatic or Problematic?
The muscles, ligaments, joint capsules, tendons, discs, and nerves that are generating the pain may only be symptomatic and not problematic. The muscles creating the postural imbalances are usually the problematic elements causing pains, numbness, and tingling in the symptomatic structures. The problematic structures are most often the cervical flexors (muscles that move the head and neck forward), like the longus colli, that are guarding and causing the reactive head forward posture.
A vast majority of whiplash victims report feeling the symptoms in the posterior neck. The treating therapist must fully grasp the relationship between the symptomatic and problematic structures. This understanding will guide the therapist’s treatment choices to provide a more effective treatment with a goal of functional, postural improvement and avoiding the trap of merely chasing recurring symptoms. When the patient has a sense that previously chronic muscle contractions, initiated originally by muscle guarding, are no longer out of his control, you know you have achieved a level of therapeutic success. Conscious cortical (referring to the cerebral cortex) control of the body is a reasonable and achievable goal.
Massage, Whiplash and Anterior/Posterior Balance
In treating whiplash, understanding the role of anterior (front of the body) muscles in the neck and torso and how they can be the source of pain in the neck and upper back is essential. In my opinion it is less a matter of strengthening and more a matter of balancing muscle tone and restoring joint flexibility. Once a patient is out of the active pain phase, and a noted weakness exists, strengthening is reasonable. The ultimate goal is to get the patient to a pain-free state and moving normally again. As the late Thomas Hanna stated “Movement is life. Diminished movement is diminished life.”
Massage Can Speed the Healing of Whiplash
A massage practitioner with the proper knowledge and training can greatly decrease the healing time and improve the outcome for the whiplash patient. Normally the less time that passes between the date of injury and the first treatment the more rapid the healing and the better the outcome. Generally, the less ingrained a neurological habit the less time it takes to overcome it.
Unfortunately, not all massage therapists have the required training to achieve the desired results in the treatment of whiplash. In the next article we will talk specifically about how to find a well-trained massage therapist and what questions to ask. Whether you are a sufferer of whiplash, or a physician looking for useful information on how to help your whiplash patients, my hope is that you will find these articles useful.
We Can Help
If you seek massage for whiplash and you live in the Bothell area North of Seattle, give Bothell Integrated Health a call at 425.424.3730 and we will put our whiplash expertise to work for you.