Whiplash is the colloquial term for a neck sprain strain injury that comes about from the head and neck being “whipped” back and forth as the result of a short-lived acceleration and deceleration of the body. Perhaps the most common event that can create this is a car collision; specifically a rear end car collision. Other things that can cause it are roller coaster rides and other amusement park rides; bungee jumping; horsing around and similar types of accidents.
Let’s discuss whiplash from a car accident. You’re sitting in traffic, and all of a sudden you hear a loud screech and feel something powerful crash into the back of your car. You hear crunching metal, and maybe even shattered glass. Your back sinks into your car seat as your car is thrust forward from the impact, and your body suddenly stops and reverses direction. You instinctively grip your steering wheel and stiffen your arms to protect yourself, which braces your torso somewhat but because of the flexibility of your neck and the weight of your head, your neck bends back sharply and recoils violently forward, then back again until it rests. In that split second, your neck muscles, not having enough time to react do not protect your cervical (neck) spine and suffer microtears. Swelling sets in; then soon after, neck stiffness. Depending on the force of the impact and other factors such as the speed and mass of the car that struck you; the amount of denting/deformation of your car, and your body type other areas can experience injury as well. This includes the upper shoulders, mid and lower back, jaw, wrists, knees and ankles. Most pain in a whiplash, however, is centered in the neck, upper shoulders and upper back.
I made a video on what to do for whiplash that illustrates a good home care procedure to alleviate the pain and rehab the neck. If you’ve suffered a whiplash injury to your neck, and were cleared by the emergency room of any red flags, the goals will be:
Reduce pain and swelling
Reduce scar tissue build up by doing gentle, active stretches, even during the pain period
Restore joint (verbebral) biomechanics and neck range of motion
Strengthen surrounding muscles in the neck
Restore proper neck curvature
You’ll also want to get enough protein (whey protein is the best, followed by eggs and fish), foods high in anti oxidants, and drink enough fluids during your injury rehabilitation. Taking 2000 mg Vitamin C is also a good idea, as it has shown to be helpful in wound regeneration. Lastly, get out in the sun and expose your neck and back for about 20 minutes. Sunlight stimulates Vitamin D synthesis and may have other beneficial effects on the cellular level.
If you were in a car accident and want extra reassurance, find a chiropractor who has experience treating soft tissue injuries. Don’t just go with the office that has the loudest advertising– make sure you are comfortable with the office and the doctor first after asking a lot of questions. I have treated whiplash injuries in San Francisco for over 15 years and have had great success. One of my most useful pieces of equipment for treating acute sprains and strains such as whiplash is the Solaris phototherapy unit, which uses therapeutic light between 660-800 nm wavelength. Light at this frequency actually speeds up wound healing at the cellular level by increasing ATP production (basically, increasing cellular metabolism, which includes waste removal). Once the pain and swelling is down, I initiate manual therapies to restore joint biomechanics and to rehabilitate the surrounding soft tissues to reduce the risk of chronic pain.
If you happen to live or work near San Francisco and were injured in a car accident, you can contact my office at (415) 627-9077.
If you use your hands in a repetitive fashion at work or at play and notice your hands and wrists are feeling achey and fatigued, it’s partly because the muscles in your hand are out of balance. Usage of the hands is predominantly a flexion action, where the flexor muscles of the arm contract to bend the fingers inward. This is true for gripping and typing.
So what happens is that the extensor muscles of the arm, which are the ones that straighten out the fingers and bend the wrist upwards, are “overwhelmed” by the action of their reciprocal muscles, the flexors (flexor digitorum, flexor carpi ulnaris and radialis). The action of the joints in a flexor-dominated repetitive activity puts excessive wear to the same, small area on the joint surfaces and can gradually lead to stiffness and pain in the hands. And, it de-conditions the extensor muscles over time; meaning, makes them weak and less responsive. That explains the fatigue factor.
The solution is to do exercises for the extensor muscles to counteract the amount of flexion you do. A simple yet effective exercise is to use a thick rubber band (like the ones that hold together broccoli in the grocery store) and place it around your fingertips and thumb. Open your hand (extend your fingers till they are straight at the knuckles), about one repetition per second. Do about 50 every hour, four hours per day; depending on how much you use your hands. What you’re trying to do is work the extensors as much as your flexors to ensure both groups are getting an equal amount of work out. This will keep the hands strong and resistant to weakness and pain from frequent use.
Thoracic outlet syndrome is a condition where the neurovascular (nerves, blood) structures that service the arm get compressed outside of the spine (a peripheral neuropathy). The compression can come the collarbone, the scalene muscles at the base of the neck, an apical tumor or other mass. Thoracic outlet syndrome can be unilateral (one side) or bilateral (both sides).
The brachial plexus is a bundle of nerves that eventually form the major nerves of the arm: median, radial, and ulnar. It passes directly underneath the center of the collarbone. The subclavian artery, which becomes the brachial artery, is right next to it and supplies blood to the arm. The collarbone (clavicle) connects your shoulder blade (scapula) to your breastbone (sternum). There is only a few millimeters clearance between the bottom of the collarbone and the ribcage, so proper alignment of these structures is absolutely critical for the nerves and blood vessels to work unobstructed.
Trauma to the shoulder complex, repetitive shoulder movements (like a baseball pitch), a long history of sleeping on your side, and a habit of carrying a heavy bag with a strap over your shoulder, or a history of carrying any other heavy objects on the shoulder such as a 5-gallon water bottle are some of the things that can cause the collarbone to close down on the neurovascular bundle. Symptoms can include numbness down the arm; hand numbness, arm and hand weakness, pins and needles sensation in the fingertips, and poor circulation in the arms (feeling of swelling or fullness).
A cervical rib can predispose one to thoracic outlet syndrome. A cervical rib is a congenital anomaly where a small rib branches from the lower neck vertebrae. A cervical rib can easily obstruct the brachial plexus on that side.
A syringomyelia or syrinx is a slowly expanding fluid filled sac in the spinal cord, usually at the neck level, that places dangerous pressure to the cord; enough to cause muscle atrophy (wasting) of the areas served by the affected neurons. Although syringomyelias are rare, they must be ruled out first.
If you are experiencing upper extremity numbness, see your doctor. You should get referred to an orthopedic specialist who can do some tests to properly diagnose your condition. If thoracic outlet syndrome is suspected, your doctor may order a nerve conduction or needle electromyograph (EMG) study to determine if the nerve is compromised. Typically, physical therapy is prescribed for several weeks. If there is no improvement, surgery may be recommended.
The exercise below can be helpful for some sufferers of thoracic outlet syndrome, especially the type that involves the collarbone pressing down on the neurovascular bundle. It is simple to do, and generally safe. This exercise attempts to lift the collarbone repeatedly off the ribcage, creating more space for the brachial plexus and subclavian artery. Do at least 100 per day for a week; if relief is felt, continue doing as needed. If at any point your symptoms feel worse, stop immediately.
Most people who have general back pain and stiffness don’t question it enough; i.e. wonder why they have it. All they want is for it to go away in the quickest amount of time. A person suffering from back pain will first wait and see if it goes away with rest and time, and if it’s really bad, over the counter medications. If this doesn’t work, he will make an appointment with his primary care physician, who will usually prescribe pain medication and muscle relaxants to address the symptom (not the cause). The patient may be referred for physical therapy, which typically consists of modality application (heat, ice, lumbar traction, electric muscle stimulation and possibly low level laser) and exercises. Some people with lower back pain consult a chiropractor, who will address the problem usually be employing some form of spinal manipulation; and some will seek an acupuncturist.
But what if all these treatment forms are on the wrong track; i.e, they are based on errant assumptions? What if there is more to the back pain than sore muscles and stiff joints?
If you suffer from back pain; particularly lower back pain, it may be the result of dysfunctional nerve signals coming from the brain. The brain controls voluntary and involuntary contraction of your muscles, like a finely tuned machine run by a super fast computer. It’s analogous to a world-class conductor conducting a symphony so that every note, tempo, and timing is perfect.
If the nerve impulses (millions of them occur just standing) are dysfunctional, it can cause certain muscle groups to contract when they aren’t supposed to, forcing joint surfaces together and limiting their movement. It can cause one side to be inactive, resulting in unbalanced muscle tone. Abnormally functioning nerve signals to the muscles can throw off the synchronization of muscle contraction, which would be a big problem right in the middle of moving a heavy piece of furniture.
I believe that most cases of gradually occurring lower back pain are the result of degraded communication between the brain (cerebral cortex and cerebellum) and the musculoskeletal system. Even if the onset of pain was a specific incident such as bending forward to pick something up, it is secondary to a malfunctioning brain-muscle communication.
So, what does one do? Realize that for lower back pain, one shouldn’t simply focus on external means to reduce the pain; whether it be pharmacological (drugs) or manual (physical therapy, chiropractic). These methods can help reduce the pain and make you feel better, but if they don’t address the true problem, the pain is guaranteed to return.
Somatics is a form of therapy that treats muscular conditions by attempting to remove emotional or subconscious factors that may be contributing to the problem. The idea here is that the brain’s ability to properly regulate the body’s muscular function has been compromised by an old injury; inactivity, or harmful thought patterns. Somatic therapy addresses the problem by attempting to restore the connection using specific exercises, concentration, and breathing techniques.
If you have lower back pain that just won’t respond permanently to physical therapy or chiropractic, consider Hanna somatic exercises. This technique seeks to restore proper brain-muscle function using deliberate, specific targeted exercises (not your typical strengthening and stretching exercises). The system is taught by Lawrence Gold, a certified Hanna Somatics practitioner and is available on DVD or internet download. A sample of one of the exercises can be found here.
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