Car Accident Injuries
Automobile injuries are unique, and not many people get a good explanation of what’s happened to them, and it’s important for them to know. On a number of occasions, I have had patients who had a history of sports injuries, which healed in a timely fashion, only to be injured in a car crash years later. Most of them are surprised when it takes them much longer to recover when they are whiplashed. There are good reasons for that, so read on, and you will find out just what has happened to you.
Permanent Ligament Damage!
Ligaments are connective tissue structures which are only found in joints. Joints are formed whenever the ends of two bones come together, and they exist so that that part of the body can move. Ligaments are the structures which give the ultimate integrity, or stability, to a joint, so that it can stay intact and uninjured while a person performs physical activities. For the most part, ligaments have no elasticity, and are of a set length for life, even though a small percentage of their fibers are of a type of connective tissue called elastin, which does have a slight ability to stretch. When a ligament is stretched beyond its normal limits, it will tear, or “sprain.” The term “sprain” is only applied to ligaments. If the ligaments tear completely, this is called a third degree sprain, and surgery is required to put the ligament back together, or the joint will be so unstable that it will dislocate frequently. Lesser tearing in the ligaments is called a grade one or a grade ii sprain, and these do not usually require surgery. However, once a ligament has been stretched beyond its normal limits, it will never regain its normal length, and will forever have slack in it. This is called “ligament laxity.” The ligament will “heal,” after a fashion, with scar tissue, which is technically made of the same substance as the ligament tissue (collagen), but the difference between the ligament collagen and the scar tissue collagen is one of organization. Ligament tissue is highly organized, while scar tissue is very poorly organized.
Lesser tearing in the ligaments is called a grade one or a grade two sprain, and these do not usually require surgery. However, once a ligament has been stretched beyond its normal limits, it will never regain its normal length, and will forever have slack in it. This is called “ligament laxity.” The ligament will “heal,” after a fashion, with scar tissue, which is technically made of the same substance as the ligament tissue (collagen), but the difference between the ligament collagen and the scar tissue collagen is one of degree of organization.
The reason a ligament is strong is because the collagen fibers are highly organized, which results in maximum strength, while scar tissue is highly unorganized, and has no structural integrity whatsoever. Think of it as being about as strong as papier mache. Most people think of scar tissue as being a “nothing” tissue, kind of inert, and not doing much, but the truth is that scar tissue is just as alive as the other tissues in the body, and the catch is that it is loaded up with more free nerve endings which register pain than normal tissue, so it causes all kinds of problems.
In other words, when a ligament is torn, it heals wrongly. In fact, it is a fallacy to use the term “heal” when you refer to ligaments. A better term is “wound repair,” which accurately addresses the fact that the when all wound repair is finished, years down the road, the ligament will have gross histological and functional differences when compared to uninjured ligaments.
Long Term Effects of Whiplash
The human cervical spine has twenty-two major ligaments, and all of them can be injured in a motor vehicle collision. In fact, in the typical whiplash event, in which the human head and neck are whipped forward, and back, and forward again, usually there are more torn ligaments in the neck afterwards than there are ligaments which are still intact. When the ligaments cannot stabilize the joints properly, then the muscles which surround the cervical spinal joints are recruited by the central nervous system to stabilize the joints. They can do this, but this is not their job. The rule of thumb for muscular function is that each individual muscle in the human body has one and only one primary function, and that is what it is intended to do. It can be made to perform secondary functions, like stabilizing unstable joints, but because that is not their primary job, they will fatigue rapidly, which progresses to a burning sensation, and eventually to aching, as the overworked muscles develop trigger points to protect themselves from overwork. Not only do the muscles stabilize the joints so well that they get rid of the excess motion, they also get rid of the normal motion of the joint, which is a really bad thing.
Not only do the muscles stabilize the joints so well that they get rid of the excess motion, they also get rid of the normal motion of the joint, which is a really bad thing. Not only does the joint still hurt, but now the tissues in the joint which do not have their own blood supply- the cartilages- begin to starve on their own waste products, and eventually begin to degenerate and go away. Cartilage cells get their oxygen and nutrition, and get rid of their waste products, through the fluids which bathe them and they depend on the normal motion of the joint to set up a pumping action which pushes the bad stuff out and brings the good stuff in. The tight muscles never do the job of stabilization as it was intended to be done by the ligaments, and eventually, the body lays down calcium in the torn ligaments to stabilize them. These are seen as bone spurs on x-ray exams, and are part of the process of degenerative joint disease, or osteoarthritis. It takes about seven years for bone spurs to be visible on an x-ray following an injury to a ligament.
Diagnosis & Chiropractic Care
Chiropractic care is essential for these injuries. The joints which have torn ligaments need to be left alone, while they are actively inflamed, but other joints with intact ligaments will become fixated, or hypomobile, as a result of the injured ligaments.By manipulating the fixated intact joints, mechanical stress can be taken off the injured ligaments, which enhances the healing response. But in order to do this, you have to know which ligaments are torn, and this is where digital motion x-ray becomes so important not only for diagnosis, but also for designing the perfect treatment plan for the motor vehicle collision victim.
We chiropractors have for years used the diagnosis codes for cervical sprain injuries. Because of this, many people think a sprain is just a sprain, and don’t you just get over that? The answer is no, and if you ask around and poll people who have a history of ankle sprains, their ankle is usually never the same after the ligaments have been torn, and a fair percentage of them have problems with weak ankles, or ankles which sprain easily ever after. Comparing an ankle sprain with a cervical sprain is not like comparing apples to apples either, mainly because of the difference in the amount of damage that occurs in either sprain. With an inversion ankle sprain (the most common type), typically it is the lateral collateral ligament which is torn. That’s one ligament. With the cervical sprain, you have to remember that depending on which level of the spine you are talking about, there are anywhere from five to seven joints at each level, and each one constitutes a separate joint. It is not uncommon to see five sprained ligaments at each level with a digital motion x-ray study, and it would only take one to cause pain, disability, and permanently altered function.
There are other reasons why a cervical sprain is much worse than an ankle sprain, but probably the most obvious one is that the ankle does not have the close anatomical relationship with the central nervous system (the spinal cord) that the cervical spine does. The central nervous system absolutely cannot tolerate any compromise to the system of bones (the spine) which protects it, so it will take extreme measures to protect itself when the ligaments of the spine have been damaged. The best way for the central nervous system to do this is to turn on the pain mechanism non-stop, so that you are always aware of the problem and cannot ignore it. On a practical level, this means that your neck hurts all the time, you have headaches, or you might be dizzy, or all of the above. Because of the nature of ligamentous injury, this can go on for months, or years.