Resolving Whiplash Injuries with Active Release – Part 7

Whiplash injuries and Exercise

Exercise is a critical component in rehabilitating whiplash injuries. Initially, exercises should be performed within as much of a pain free range-of-motion as possible. This will help to insure that no abnormal neurological motor responses are created, and tissue repair is fully completed. It is very important to remember that injured tissue needs time to remodel, without the right exercise the possibility of re-injury is very high. See our Blog on “Exercise and Tissue Remodeling”

If you are looking for a series of exercise specifically designed to rehab the neck after a whiplash injury check out our kinetic chain series of exercise books. We have achieved great results with the “Jaw to Shoulder” book in the treatment of whiplash injury patients. This book covers several of the main areas commonly injured in a hyper-extension hyper-flexion injury.

Nerve Flossing Exercises

In addition to the Active Release procedures a certified ART practitioner will use there are also several nerve flossing exercises that can be performed at home to help reinforce the treatments. These exercises are just like flossing your teeth, except the tooth floss is a nerve moving through an area of restriction.

When nerves are entrapped your body goes to great lengths to protect these nerves. Muscle function is reduced, including the amount of force that certain muscles can generate. This creates muscle imbalances and abnormal neuromuscular responses. The nerve flossing exercises help to restore normal neuromuscular patterns, increase strength, range-of-motion and restore normal motion patterns. Click on the image for an example of some nerve flossing exercises. 

Bottom line, Whiplash (hyper-extension hyper-flexion injuries) can be treated very successfully with a combination of Active Release Techniques, and exercise.

For more information about our publications go to www.releaseyourbody.com. 

If you would like more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)

Resolving Whiplash Injuries with Active Release – Part 6

Research has shown that individuals with abnormal neurological signs, such as those seen with peripheral nerve compression syndromes (entrapment neuropathies), are more likely to develop chronic neck problems.

The nerve compression associated with a whiplash injury can cause several physiological changes to peripheral nerves especially if this compression is left untreated for a long period of time.

Symptoms of a nerve entrapment syndrome

Peripheral nerve entrapment syndromes usually involve both motor and sensory nerves. Entrapment of sensory nerves creates pain and paresthesia. Paresthesia is a sensation of tingling, pricking, increased sensitivity, or numbness. Motor nerves allow the brain to stimulate muscle contraction. Entrapment of motor nerves causes weakness, decreases muscle function, and muscle atrophy (wasting away).

The exact symptoms of nerve entrapment will vary depending on the location of the nerve entrapment. If a patient has these symptoms they should be closely monitored and treated as soon as possible.

Treating Nerve Compression Syndromes

Usually, addressing nerve compression syndromes can be a difficult problem to deal with. Considering the potential problems, such as myelin sheath damage, that can occur if these syndromes are not treated soon enough, early intervention become critical.

Fortunately there are specific protocols that ART practitioners can use to release these entrapments. It is important to note that nerve compression that occurs during a traumatic incident such as a whiplash accident can affect a nerve anywhere along its path. The following list shows examples of common whiplash symptoms, entrapment sites, and the nerves that can be released with the appropriate ART procedure.

The following are only a few examples of symptoms and nerve entrapment sites that ART procedures can address.

Symptom - Neck Pain

• Site of entrapment SCM Muscle – Nerve involved Spinal accessory nerve

Symptom - Headaches

• Site of entrapment Semispinalis Capitis Muscle - Nerve involved Greater occipital nerve

Symptom - Shoulder pain

• Site of entrapment Quadrangular Space – Nerve involved Axillary nerve

Symptom - Arm pain

• Site of entrapment Pronator Teres Muscle – Nerve involved Median Nerve

See Part 7 (The last of this series) – Resolving Whiplash Injuries with Active Release will cover treatment and exercises. 

If you would like more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)











References

• The Anatomy of the Greater Occipital Nerve: Implications for the Etiology of Migraine Headaches Plast Reconstr Surg. 2004 Feb;113(2):693-7; discussion 698-700.
• Surgical anatomy of the axillary nerve within the quadrangular space. Tubbs RS, Tyler-Kabara EC, Aikens AC, Martin JP, Weed LL,Salter EG, Oakes WJ. J Neurosurg. 2005 May;102(5):912-4.
• Brachial Plexus, MRI Sudhakar R Satti, MD, Interventional Neuroradiology Fellow, Instructor A, Department of Diagnostic and Interventional Neuroradiology, Hospital of the University of Pennsylvania, emedicine http://emedicine.medscape.com/article/345636-overview
• The pronator teres syndrome: compressive neuropathy of the median nerve. The Journal of Bone and Joint Surgery. American Volume 63, no. 6 (July 1981): 885-90. doi:7240329
• Henry M, Stutz C. A unified approach to radial tunnel syndrome and lateral tendinosis. Tech Hand Up Extrem Surg. Dec 2006;10(4):200-5.
• Ferdinand BD, Rosenberg ZS, Schweitzer ME, Stuchin SA, Jazrawi LM, Lenzo SR. MR imaging features of radial tunnel syndrome: initial experience. Radiology. Jul 2006;240(1):161-8
• Kleinman WB. Cubital tunnel syndrome: anterior transposition as a logical approach to complete nerve decompression. J Hand Surg[Am]. Sep 1999;24(5):886-97

Resolving Whiplash Injuries with Active Release – Part 5

Take Care of the Entire Kinetic Chain

Although early intervention is important, it is equally important to have the the practitioner consider all the areas that could be, or are, damaged in a hyper-extension, hyper-flexion injury. The practitioner must look for damage in more than just the neck, and review possible injuries to the patient’s jaw, shoulders, arms, wrists, upper-back, lower-back, hips, and some times even the lower extremities. Areas that have been injured often do not show symptoms for several weeks.

This is often the case with jaw problems caused by whiplash injuries. With whiplash injuries, one in three people who have been in a hyper-extension hyper-flexion accident will develop delayed TMJ problems.

Delayed temporomandibular joint pain and dysfunction induced by whiplash trauma: a controlled prospective study Journal of the American Dental Association August 2007;138(8):pp. 1084-91 Salé H, Isberg A.

From a kinetic chain perspective, jaw motion and neck motion are directly linked to each other. Activation of neck and jaw muscles occurs simultaneously, which synchronized movements of the TMJ, cervical spine, and the atlanto-occipital joints. (The Atlanto-occipital joint lies between the base of the skull (occiput) and the C1 vertebra (atlas)).

Deranged jaw–neck motor control in whiplash-associated disorders European Journal of Oral Sciences, February, 2004; 112: 25–32. Per-Olof Eriksson, Hamayun Zafar, Birgitta Haggman-Henrikson

Thus any injury to neck muscles can directly affect jaw function. When Active Release practitioners consider this type of kinetic chain relationship, it becomes much easier to resolve whiplash injuries. Which leads me to an important point, you need to find an ART practitioner who is certified in biomechanics, as that could make a huge difference in resolving your condition. Practitioners with a strong biomechanics training will have a better understanding of kinetic chain relationships can more easily identify structures that are involved in the injury.

See Part 6 – Understanding Nerve Compression Issues in Whiplash Accidents, where we cover Symptoms of nerve entrapment. 

If you would like to more information or to purchase our books please go towww.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)

Resolving Whiplash Injuries with Active Release – Part 4

Symptoms of Whiplash injuries

The most predominant symptoms after a whiplash accident are:

• Arm pain – This can be due to nerve compression or referred pain from the facet joint or disc.
• Facial pain (either direct or referred pain)
• Headaches – The second most common symptom, headache is usually on one side of the head and begins at the base of the skull (occiput). This pain often radiates to the top of the head and frontal regions.
• Jaw Pain – TMJ problems are common.
• Neck pain – The most common symptom.
• Nerve entrapment syndromes.
• Shoulder blade pain (interscapular pain).
• Shoulder pain (rotator cuff).

Whiplash injuries also cause:

• Balance problems (often upper cervical related).
• Difficulty sleeping.
• Dizziness (often upper cervical related).
• Fatigue (this can be severe).
• Low back pain.
• Poor concentration, loss of memory.
• Psychological changes, such as depression.
• Tinnitus (ringing, buzzing, whistling, or other noises heard in one or both ears).
• Visual disturbances (sensitivity to light – this can be stress induced, adrenal stress).
• Weakness.

Chronic whiplash and whiplash-associated disorders: An evidence-based approach Journal of the American Academy of Orthopedic Surgeons October 2007;15(10):596-606 Schofferman J, Bogduk N, Slosar P.

Treatment of Whiplash Injuries with ART

Early Intervention

After major injuries such as fractures have been ruled out, treatment can begin. For the first 72 hours ice should be used to reduce pain, inflammation, and swelling. See our section on the correct procedures for icing. After this initial acute stage, implementation of ART procedures should begin as soon as possible.

Early implementation of treatment procedures can prevent acute injuries from becoming chronic problems. In the case of whiplash injuries research has show that 15 to 40% of individuals who have had these injuries develop chronic neck pain. Early intervention can help you avoid becoming one of these statistics.

Chronic whiplash and whiplash-associated disorders: An evidence-based approach Journal of the American Academy of Orthopedic Surgeons October 2007;15(10):596-606 Schofferman J, Bogduk N, Slosar P.

Scar Tissue Forms Fast

Also considering how quickly fibrotic tissue (scar tissue) forms in damaged tissue (7 days), early intervention becomes essential. For example, research has shown that after a hyper-extension hyper-flexion injury a muscle called the anterior scalene often becomes fibrotic.

The anterior scalene extends from the vertebra of the neck to the second rib (TP’s C3-C6 to scalene tubercle first rib, anterior surface second rib).

When this muscle becomes fibrotic it can cause compression on a network of nerves called the brachial plexus. This can create a syndrome called neurogenic thoracic outlet syndrome (NTOS) which creates neck pain, headaches, altered sensation (paresthesias), and weakness in the shoulders, arms, wrists, and hands.

It is interesting to note that brachial plexus compression injuries often do not show up for 7 to 37 days after the injury. If manual therapy procedures, such as Active Release Techniques are implemented soon enough scar tissue formation in areas such as the anterior scalene can often be avoided, along with all the consequences of syndromes such as NTOS.

Diagnosis of thoracic outlet syndrome Journal of Vascular Surgery Volume 46, Issue 3, September 2007, Pages 601-604. Richard J. Sanders MD, Sharon L. Hammond MD and Neal M. Rao BA

Biomechanical and histological evaluation of muscle after controlled strain injury Am J Sports Med 1987 15: 9 Pantelis K. Nikolaou, Beth L. Macdonald, Richard R. Glisson, Anthony V. Seaber and William E. Garrett, JR

Symptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries J Bone Joint Surg (Br) 2001 Mar;83(2):226-9 Ide M, Ide J, Yamaga M, Takagi K

See Part 5 – Resolving Whiplash Injuries with Active Release where we will cover addressing the kinetic chain. 

If you would like more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)

Resolving Whiplash Injuries with Active Release – Part 3

Hyper-Flexion Phase

Next, the car seat springs forward causing the driver’s whole torso to move forward at a high velocity. Physics defines velocity as “rapidity or speed of motion; swiftness.” Keep in mind as your seat moves forward your head is still moving back. This action is similar to the final moment before a spring releases.

Then, almost instantaneously your torso and head are flung forward. This forward motion is so strong that if the driver does not have their seat belt on they could, depending on force of impact, be thrown right out of their seat into the steering wheel or even through the window. This strong forward action causes the driver’s whole spine to flex forward often past their physiological limits. This action can cause a considerable amount of posterior neck, mid-back, shoulder, and even low back damage.

Common areas of damage as the head is thrown forward:

Joints

o Facet joints - These joints are the most commonly injured joints in the neck.

Posterior Ligaments

o Supraspinous ligament - strong fibrous cord, which connects together the spinous processes.

Posterior Muscles and Nerves

o Erector spinae muscles (Iliocostalis, Longissimus, Spinalis).

· Group of back muscles that runs beside the vertebrae in an almost vertical direction.

· These neck extensors are commonly injured during whiplash accidents.

o Rectus Capitis Posterior Minor muscle

· Individuals with chronic neck pain exhibit muscle atrophy of this muscle as seen of MRI. This can be caused by trauma or compression of the first cervical branches of the spinal nerves (C1 dorsal ramus). This compression occurs because of entrapment within the rectus capitis posterior major muscle.

· Atrophy of this muscle and C1 injury causes symptoms such as: suboccipital headaches with radiation of pain behind the eyes, dizziness, and benign positional vertigo (BPV). With BPV you will feel a sudden sensation of movement, or spinning, when you move your head or hold it in certain positions.

NEUROGENIC ATROPHY OF SUBOCCIPITAL MUSCLES AFTER A CERVICAL INJURY: A Case Study American Journal of Physical Medicine & Rehabilitation, Volume 77(6) November/December 1998, pp 545-549 Andary, Michael T. MD; Hallgren, Richard C. PhD; Greenman, Philip E. DO; Rechtien, James J. DO, PhD

o Suboccipital Triangle – This is an area in the neck at the base of the skull surrounded by the following three muscles

· Rectus Capitis Posterior major

· Superior and Inferior obliques

o All of the suboccipital muscles are extremely important as they contain very high levels of muscle spindle fibers. Muscle spindles provide postural information to the central nervous system. Damage to these structure in experimental animals cause gait disturbances and ataxia (an inability to coordinate voluntary muscle movements)

o The Suboccipital nerve supplies input to the muscles of the suboccipital triangle. Compression of this nerve can occur at the superior oblique muscle.

o Semispinalis (Capitis, Cervicis)

· The greater occipital nerve is located directly under the Semispinalis Capitis. Compression of this nerve is one of the causes of cervicogenic headaches, these are referred to as occipital neuralgias.

§ Occipital neuralgia is a medical condition characterized by chronic pain in the upper neck, back of the head, and behind the eyes. This is sometimes known as C2 neuralgia or Arnold’s neuralgia.

§ Research has shown that about 85% of patients with whiplash injuries have trigger points in the Semispinalis Capitis muscle.

A Distinct Pattern of Myofascial Findings in Patients After Whiplash Injury Archives of Physical Medicine and Rehabilitation Volume 89, Issue 7, July 2008, Pages 1290-1293

o Splenius (capitis, cervicis)

· This neck extensor is commonly injured in whiplash injuries.

Luo Z, Goldsmith W. Reaction of a human head/neck/torso system to shock. Journal of Biomechanics 1991;24(7):499-510

o Transversospinalis (spinalis cervicis, cervical multifidus, rotatores cervical)

· The spinalis cervicis muscle is not present in everyone (inconsistent muscle). Orginates from a ligament in the lower neck (ligamentum nuchae).

· The is some research showing the cervical multifidus msucle can cause increased loading of the joint capsule surrounding the joint in the neck (collision-induced loading of facet capsular ligaments).

· These deep posterior muscles are often injured during whiplash accidents.

Are cervical multifidus muscles active during whiplash and startle? An initial experimental study Gunter P Siegmund, Jean-Sébastien Blouin, Mark G Carpenter, John R Brault, and J Timothy Inglis BMC Musculoskelet Disord. 2008; 9: 80. Published online 2008 June 5. doi: 10.1186/1471-2474-9-80

o Trapezius (upper fibers)

· The third occipital nerve travels under the trapezius muscle until it pierces this muscle and ends up in the lower part of the head (occiput). Compression of this nerve causes occipital neuralgias.

See Part 4 – Resolving Whiplash Injuries with Active Release to review symptoms of whiplash Injuries and treatment strategies. 

If you would like more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)