There has been soooo much controversy (mostly by insurance carriers) over the injury mechanism that occurs in rear-end auto collisions. Some insurance companies have tried to deny that anyone gets injured at all, labeling patients as fakers and doctors as collaborators. Most insurance companies downplay the injuries and attribute the pain to simple strained muscles. The tactic is often labeled as DENY, DELAY, DEFEND, and it is NOT supported in any of the clinical literature on this subject. Integrity Chiropractic docs have known better for years, even since they were in chiropractic school, and have studied these injuries for over a decade.

Published research in 1995 and 1996 by Barnsley et al. indicates that the source of the pain in a majority, 60% of whiplash patients, is the zygapophyseal (facet) joints, rather than the muscles. (1,2) The most common levels of zygapophyseal joint pain found in this study were at the C2/3 (headache and upper neck pain) and C5/6 levels (lower neck, shoulder and upper back pain).

These researchers used clever anesthetic injections into the facet joints under fluoroscopic guidance (special imaging) to determine the source. Injury to the soft tissue structures of the zygapophyseal joints (ligaments and joint capsules) are not easily seen with x-ray, CT scans or MRI. While these injection investigations are not required in the clinical environment to treat most patients, facet blocks can be helpful in chronic pain cases and can be performed by interventional pain specialists to prove these injuries in a medico-legal environment.

While insurance adjustors like to Deny, Delay, Defend, It is common knowledge in the research community that many people in low speed collisions are injured and that a large number of these patients continue to report symptomatology for years after their accidents …we mean to say … CRASHES. (3,4) These patients continue to have pain long after their cases are settled, thus dispelling the myth that we are dealing with “litigation neurosis.” AKA “fakers”(5,6)

Barnsley, et al. reviewed the studies that have followed up on whiplash patients for a period of time after the injury and have come up with a conservative estimate of between 14 to 42% of whiplash patients will develop chronic neck pain and 10% who will have constant, severe pain indefinitely. (7)

Mechanism of the whiplash injury and how the zygapophyseal joints and other spinal structures are injured.

While training with the Spine Research Center of San Diego and the Center for Research Into Automotive Safety and Health with Dr. Art Croft, Dr. Leatherman has gained a very detailed education and understanding of these injuries. One of the published research findings Dr. Croft presented in the coursework was by Kaneoka et al (8) provides a demonstration of how these injuries occur. The researchers utilized cineradiography of human volunteers while undergoing a simulated rear end collision and found an unusual pattern of movement of the cervical (neck) vertebrae.

The lower cervical segments rotate around an abnormally high instantaneous axis of rotation. In particular, C6 starts to extend before the rest of the spine. This results in an s-shaped configuration of the spine as C6 extends and the rest of the spine initially flexes. Then, as the rest of the cervical spine extends, this results in an extreme rotational torque at the C5/6 level. This results in a stretching of the anterior longitudinal ligament and forces the inferior facet of C5 to collide with the superior facet of C6. This may result in impingement and inflammation of the folds of synovial tissue between the zygapophyseal joints (facet synovial fold impingement syndrome). And Giles has previously demonstrated that these synovial folds are pain sensitive. (9)

‘In conclusion, we now have evidence that the anatomical structures most commonly injured in low speed whiplash injuries are the zygapophyseal (facet) joints and we have a mechanism to explain how this injury occurs. And such a joint injury cannot always be expected to heal within 6 weeks and could explain why some whiplash patients continue to experience pain for long periods of time after their accidents and why they have a higher incidence of degenerative spinal changes in the cervical spine years later.’

Since Integrity chiropractors Dr. Leatherman and Dr. Bak can specifically treat the zygapophyseal joints with chiropractic manipulative techniques, as well as CBP extension traction techniques, we may be the most qualified professionals to treat these injuries. (10) In fact, several researchers have hypothesized that one of the most important benefits of manipulation is freeing up entrapped folds of synovial tissue between the zygapophyseal joints. (11,12)

Moreover, there is a great agreement in the literature on the effectiveness of chiropractic adjustments on pain originating from the facet joints. (13) If you have been injured in a Crash, if you have acute or ongoing neck pain, headaches, or low back pain, Integrity Chiropractic is here to help.

References:

  1. Barnsley L, Lord SM, Wallis BJ, Bogduk N. The prevalence of chronic cervical zygapophyseal joint pain after whiplash. Spine. 1995; 20:20-5.
  2. Lord SM, Barnsley L, Wallis BJ, Bogduk N. Chronic cervical zygapophyseal joint pain after whiplash. A placebo-controlled prevalence study. Spine. 1996; 21: 1737-1745.
  3. Macnab I. Acceleration extension injuries of the cervical spine. In Rothman RH, Simeone FA (eds): The Spine, ed 2. Philadelphia, WB Saunders. 1982; Vol. 2: p.648.
  4. Foreman SM, Croft AC. Whiplash Injuries. Baltimore: Williams and Wilkins, 1988, p.323.
  5. Mendelson G. Not “cured by a verdict.” Effect of legal settlement on compensation claimants. Med J Aust. 1982; 2: 132-4.
  6. Mendelson G. Follow-up studies of personal injury litigants. Int J Law Psychiatry. 1984; 7: 179-88.
  7. Barnsley L, Lord SM, Bogduk N. Whiplash injury. Pain. 1994; 58:283-307.
  8. Kaneoka K, Ono K, Inami S, Hayashi K. Motion analysis of cervical vertebrae during whiplash loading. Spine. 1999. Vol. 24: 763-770.
  9. Giles LGF, Harvey AR. Immunohistochemical demonstration of nociceptors in the capsule and synovial folds of human zygapophyseal joints. Br J of Rheumatol. 1987; 26: 362-364.
  10. Fortner MO, Oakley PA, Harrison DE. Cervical extension traction as part of a multimodal rehabilitation program relieves whiplash-associated disorders in a patient having failed previous chiropractic treatment: a CBP® case report. J Phys Ther Sci. 2018;30(2):266–270. doi:10.1589/jpts.30.266
  11. Bogduk N, Jull G. The theoretical pathology of acute locked back: a basis for manipulative therapy. Man Med. 1985; 1:78-82.
  12. Giles LGF. Pathoanatomic studies and clinical significance of lumbosacral zygapophyseal (facet) joints. JMPT. 1992: 15:36-40.
  13. Hestbaek L, Kongsted A, Jensen TS, Leboeuf-Yde C. The clinical aspects of the acute facet syndrome: results from a structured discussion among European chiropractors. Chiropr Osteopat. 2009;17:2. Published 2009 Feb 5. doi:10.1186/1746-1340-17-2