Considerations for Car Crash Injured Patients
Chronic pain affects 1/3 of the American adult population and it has been found to be due to injury to the joints of the spine (facet joint). Many of these people wind up trying chiropractic care. Integrity Chiropractors are consistently researching the mechanism of injury, the affected anatomy, the physiological pain mechanism and ways to promote healing and resolution. That being said, what do you know about your joints? What do you know about injured tissues? Better yet, what does your doctor know about it?
A 2013 paper published in Neuroscience Letters illustrates once the facet joints are damaged, neurological consequences arise, including over-excitability of pain nerves and irritation of the Central Nervous System (brain and spinal cord)! (1) And that’s not all, this happens in the first day after the injury and helps explain why patients after a motor vehicle crash have sensation changes and hypersensitivity, helping us identify injuries so we can help our patients.
The joints of the spine have been found to be primary pain generators in other research as well. “The cervical zygapophyseal joints may be a primary source of pain in up to 60% of individuals with chronic whiplash associated disorders (WAD) and may be a contributing factor for peripheral and centrally mediated pain (sensory hypersensitivity). Sensory hypersensitivity has been associated with a poor prognosis.” (2) WOW … it is very important for injured patients and treating clinicians to understand these issues … too much pain nerve firing leads to chronic pain syndromes. (Zygopophyseal = facet = spinal joint)
Key Points of the 2013 Study Quoted and Summarized
“This study investigated the development of hyperalgesia and neuronal hyper-excitability in the spinal cord at either 6 hours or 1 day after a painful cervical facet capsule stretch.” (The investigations of increased pain and increased nerve firing were done very quickly after the initial injury to the joint to document early changes)
“Neuronal hyper-excitability in the dorsal horn develops within 1 day after a mechanical facet joint injury, corresponding to the development of behavioral sensitivity. These results suggest that neuronal plasticity indicative of central sensitization develops early after facet joint injury and plays a role in the development of the behavioral sensitivity that persists at later time points in this model.” (Sensitivity of the nerves to drive pain mechanisms starts the second day after injury. This increased recognition of the pain mechanism actually teaches the spinal cord and brain to experience grater pain for a sustained period of time and with less input from the body)
“The facet capsular ligament is innervated by proprioceptive and nociceptive mechanoreceptors with projections largely to the same spinal level as the facet from which they originate.” (The ligament that holds the joint together has receptors that convey information to the brain about balance, movement, body awareness and pain)
“Increased peripheral neuronal input to the spinal cord can be sufficient to produce long-lasting central sensitization via increased excitability of dorsal horn spinal neurons, leading to hyperalgesia (increased pain sensitivity) and allodynia (painful response to normally non-noxious stimuli) that can be initiated as early as minutes or hours after the insult.” (Very quickly the nervous system learns to promote the pain experience and then exaggerates it as well which persists even when the pain receptors are not being fired. This is NOT good as your brain is learning the pain state as its new normal.)
“Nonetheless, taken together with the literature, the increased spontaneous activity in the spinal cord at 1 day after painful facet injury suggests that the etiology of pain and central sensitization following mechanical joint injury may be similar to peripheral neuropathic injuries.” (So, this tells us that pain radiation and sensory changes can happen without nerve compression. This is huge because some physicians believe that you can’t irritate a spinal nerve without compression.)
“This study suggests that dorsal horn hyper-excitability, a sign of central sensitization, develops very early after a persistent painful facet capsule injury, paralleling the onset of behavioral hypersensitivity. These findings suggest there is a critical and short time between injury and the development of persistent elevated spinal responses.” (So a central nervous system CNS insult is initiated very quickly after a spinal joint injury. This insult increases the pain experience and promotes the ongoing promulgation of that pain experience.)
Here Are My Final Thoughts
At Integrity Chiropractic we see injured spinal joints on a daily basis and have literally been through hundreds of hours of postdoctoral training in sports injury and auto crash injuries. Neck joints are the most easily injured in crash mechanism, but these issues are found not only in the neck but also in the low back. (3,4)
Excessive cervical facet (neck joint) capsular ligament stretch (such as what are found in crash injuries to the spine) induces persistent increases in neck pain. We have seen this corroborated in multiple papers in the literature. (3,5,6) And by the way, there are specific x-ray procedures utilized, as well as specific measurements utilized to document these injuries. Dr. Leatherman and Dr. Bak perform these on every injury patient at Integrity Chiropractic. An MRI is NOT the gold standard to diagnose these injuries.
Dorsal horn (region of the posterior spinal cord where the pain fibers are the nerve roots are found) hyper-excitability develops between 6 and 24 hours after facet injury. What does that mean? Your pain experience is being exponentially modified and increased by the spinal cord and brain very quickly. Seeking care early from a properly trained Chiropractor can help reduce this.
The development of mechanical pain increase (pain from movement of the injured joints), happens at the same time as the increases of the spinal pain transmission from the original injury mechanism.
Joint injury, and the ligaments that surround it, create pain and inflammation, the central nervous system learns to promote this pain experience even at rest even and without movement of the injured tissue. (1,7) This is bad deal for those in car crashes and a central reason why they need active based care such as chiropractic, functional and structural rehab.
Chiropractic adjustments, specific active resistive exercise protocols as well as structural spinal curve remodeling to target the ligaments are key to healing from these injuries.