Whip lash is whiplash
Massage for Whiplash: A primer for Physicians, Therapists, and Medically Savvy Patients
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 damaging muscle, ligament, bone, nerve and connective tissue.
The Symptoms of Whiplash (most common mispelling whip lash)
The most common complaints by a sufferer of whiplash are posterior cervical pain (back of neck) 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. The brain can also become bruised from the Coup/Counter-coup movement of the head, which sloshes the brain forward and backward inside the brain case. Bruising of the brain can have an affect on cognitive functions. A delayed onset of symptoms is common as imbalances and postural compensation patterns take time to play out through the structure.
The Emotional and Social Impact of Whiplash
Whiplash pain can have a direct effect on emotional health and social interactions. Many whiplash sufferers complain that the condition causes a strain on the most important relationships in their lives. When spouses, children, friends and coworkers don’t understand the whiplash victim’s pain or their change in temperament, the social implications are clear. The invisibility of the injury most often leads to the whiplash patient feeling frustrated, angry, disconnected, and misunderstood.
If your emotional and social life is impacted by a whiplash injury, and you are suffering as described, rest assured that there are massage therapists who specialize in soft tissue injuries such as whiplash and who understand the condition and the many symptoms that are affecting your life. In my experience it is common and normal for the patient to feel fragility, guilt, shame, anger, and fear. Feeling dismissed by healthcare providers and fearing not being believed are also common problems. Proper treatment, in most cases, will resolve these issues as pain is defeated and function returns.
Whiplash Pain and Disability
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 impact on the patient’s abilities to perform her/his activities of daily life. As a medical massage provider I have two main concerns for this patient: the initial pain from direct injury to the tissues involved (the mechanical and histological), and the long-term neurological patterns that can be established from non-treatment of the postural deviations caused by muscle guarding. An additional concern is the formation of scar tissue, which, if not properly treated, can be pain-inducing, and can severely restrict the patient’s range of motion in the affected area.
The first issue to be addressed when treating the whiplash victim is 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 muscle guarding, which, if not properly dealt with, can become neurologically habitual, causing health and postural problems years after the date of injury. Massage can reduce inflammation, relieve pain and relax muscles. A qualified medical massage provider can also address scar tissue to encourage maximum elasticity, thereby preventing long-term sensitivity and pain and ensuring the least impact on the patient’s range of motion.
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 newly injured 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 example makes the concept 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 cannot 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) of your arm based upon the range used during the period of load-bearing. Even if you do nothing you will regain your normal range of motion after a few moments because the condition 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 (whip lash)
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 common. I would go so far as to say it is the rule. It has an immediate negative effect on posture and impairs functional 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 in some cases 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. This awareness makes it possible for the patient to make conscious decisions to correct postural deviations that often lead to, or are the result of, pain and dysfunction.
Symptomatic or Problematic?
In whiplash, 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 pain, numbness, and tingling in the symptomatic structures. In whiplash related neck pain, the problematic structures are most often the cervical flexors (muscles that move the head and neck forward), like the longus colli, that cause the reactive head forward posture through muscle guarding. This results in the over-worked cervical extensors (muscles that extend the head and neck backward) becoming very tender and sore. The increased tension in all of the neck muscles puts additional stress on the vertebral disc tissue and nerve roots passing through the foramina (holes or passages in the spinal column).
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 in providing a more effective treatment with a goal of functional postural improvement, and in avoiding the trap of merely chasing away recurring symptoms. Working to increase the patient’s awareness of which muscles are problematic and educating her in how to relax and release those muscles at will, increases the long-term efficacy of the treatment. When the patient has a sense that previously chronic muscle contractions, initiated originally by muscle guarding, are no longer out of her control, you know you have achieved a level of therapeutic success. At that point it is only a matter of time to re-establish functional neuro-muscular habits. 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 so they can resume a fully active life. 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. By defeating pain, headaches, and ROM limitations before neuro-muscular patterns become habitual, balance can be restored to the structures involved, resulting in the best outcome for the patient. Normally, the less time that passes between the date of injury and the first treatment, the more rapidly the patient heals, avoiding the onset of dysfunctional neuro-muscular habits, and ensuring a better outcome. Generally, the less ingrained a neurological habit, the less time it takes to overcome it. If a patient has a whiplash injury that has not been treated for a year or more, massage and bodywork can still help. Healing usually just takes longer, as healthy neuromuscular habits must be re-established in order to restore normal function.
Unfortunately, not all massage therapists have the required training to achieve the desired results in the treatment of whiplash. In the first article in the “Massage forWhiplash” series I write specifically about how to find a well-trained massage therapist and what questions to ask when seeking one (click here to read that article).
If you live in the Bothell, Kenmore, Brier, Woodinville, Lynnwood, or Kirkland areas and need effective treatment for whiplash or whip lash give us a call at (425)424-3730.