In this era of high speed travel, as well as the pressure of earning a livelihood in a highly industrialized society, anal[ too frequent insult to bodies is the whiplash injury. I have been concerned at the increasing number of people who have come to me in my role as a roller, who have been the recipient of this type of injury. The purpose of this article is to focus your attention on this phenomenon. The label “whiplash” is not a specific diagnosis medically, nor is it descriptive of the injury itself, rather it describes the mechanics of the injury.
An appropriate definition of whiplash is: a sudden involuntary and unexpected thrust of the head and neck in any direction, as well as the rapid return in the opposite direction with the resultant injury to the soft tissue.
The comprehension of the basic movements involved are crucial to the appropriate restructuring that must occur before the individual is out of his particular painful situation. The movements are basically extension and flexion. We do not need to go into a great deal of discussion about these terms, suffice it to say that extension refers to backward movement of the head and neck, and the forward movement of these structures is referred to as flexion, which is the appropriate movement of both head and neck. In either of these situations, there is no strain upon the surrounding tissue. Where there is normal movement, there is also the possibility of aberrant or abnormal movement patterns. In the cervical spine, the abnormal movement pattern exists in a condition of hyper-flexion or hyperextension. In simpler terms, this means that the head is violently pitched forward or backward beyond its normal range of motion. When this occurs in either instance, excessive strain is brought upon the adjacent tissue.
Several times we have alluded to the term “soft tissue.” At this point it would be appropriate that we look at what we mean by this label “soft tissue.” Soft tissue covers all the structures that are not bony in nature. This means that it is inclusive of muscles, ligaments, tendons, vascular and nervous tissue as well as the fascial wrappings of these structures. Most of us recognize that the fascia is the very basic supportive tissue of the body, and we are also cognizant of the intricacies of the wrappings in the cervical region. There are a variety of ways that the coverings become involved in the situation we label whiplash. All soft tissue has the inherent quality of elasticity. In retrospect fascial tissue is also elastic, providing movement between adjacent tissues. With this consideration of fascia, one can readily appreciate its significance in the whiplash phenomenon. When the head and neck are thrown into either hyper-flexion or hyper extension, these wrappings attempt to prevent further injury, by becoming glued to the wrappings of adjacent structures.
As has been stated before, the basic injury is to the soft tissue. We have also noted that there are many varieties of soft tissue; the ones most often affected are the ligaments, and fascial wrappings of the cervical muscles.
The most crucial ligaments affected are: the anterior, posterior longitudinal, interspinous, supraspinous, ligamentum nuchae and flava. As we understand the function of the anterior and posterior ligaments more fully, we are better equipped to understand why they are so crucial in the whiplash situation. The function of these ligaments is to support the vertebral bodies. The remainder of the cervical ligaments are also recipients of the injury. Inappropriate alignment occurs when there is a loss in the vertical positioning of these elements due to the complication of these structural relationships.
The nature of the ligament is such that it is both plastic and flexible. When they are stretched beyond their elastic limit, they undergo an insult which is described as a strain. When for one cause or another, there is a disordering of the ligamentous continuity, it is described as a sprain. The prime recipient of injury due to hyperextension is the anterior longitudinal ligament. Most of the remaining ligaments in the cervical region are injured by hyper-flexion. To give some scope to the complexity of the relationships in this region, take note that there are approximately sixty-five different ligaments offering support to the cervical articulations.
As we all know, healing occurs with scarring. This is no different when healing is required of ligamentous tissue. These once elastic tissues now become invaded by non-elastic fibrous tissue. This invasion of fibrous tissue, results in a greater range of motion in the joint than there was prior to the injury. In some instances traumatic arthritis may be the sequel to this relaxed unstable cervical articulation. From the anatomical point of view, the horizontal plane of the upper cervical region is subjected to a partial or total dislocation under “normal” conditions, and this becomes grievously aggravated in the whiplash phenomenon.
Under normal conditions, the range of motion in this area is fifty degrees in extension, sixty-five degrees in flexion, and fifty-five degrees in bilateral rotation -that is rotation to the right and left, and forty degrees in left and right lateral bending.
Illustration of strain and sprain in cervical region
A frequent complication arising from the whiplash syndrome involves both the cervical and brachial plexi. The motor components of the cervical plexus enervate the larger muscles which support and permit movement of the head. The four lower cervical nerves unite to form the brachial plexus, which is responsible for enervating the muscles of the shoulder girdle, arm, forearm, and hand.
The radial, ulnar, and median nerves are the three main divisions in the arm arising from the brachial plexus and they service the upper extremity. Briefly, then let us look at the areas they service, as well as the muscles they enervate. The radial nerve distribution enervates the extensors of the arm and fingers. The ulnar nerve, on the other hand covers the entire little finger side of the arm, enervating the smaller and more delicate muscles of the hand and fingers. This nerve is the most frequent recipient of trauma. In contrast, the median nerve, enervates the large flexor muscles of the fingers and aids in providing sensation to the hand.
Sequence of events in whiplash phenomenon
Now, with the ground work laid as to some anatomical considerations, let us look at the various kinds of incidents that may lead to injuries of the whiplash type. Any sort of fall that would elicit violent and forceful movement of the structures in the neck, including a sudden pull on the arms as well as a sudden blow to the head. We are all too well aware of the frequency of whiplash injuries as a result of automobile accidents. The injury derives its name from the analogy to the lash of a whip. The thoracic area, or chest is the relatively immobile handle, while the cervical spine and associated structures become the highly mobile portion of the whip. I he head is analogous to the knot at the end of the whip, which is lashed about as the whip is manipulated.
Let us look at some of the more usual signs and symptoms that could he indicative of such an injury. One of the most frequent is a headache, mild or severe. The severity of the headache may mimic that of the migraine variety. In either event the mechanism involved is the same. The vascular network that is responsible for transporting blood to and from the head is affected, along with the occipital nerve in some instances. The location may be either unilateral or bilateral, while its character may range from a dull sensation to an extremely sharp and stabbing phenomenon. The frequency of involvement may he anywhere from continuous to intermittent. Another rather usual occurrence is the myofascitis which accompanies such a trauma, from the middle portion of the shoulders either upward into the neck, or downward into the middle of the back. Recalling the compensatory mechanism, it is apparent that unless something is done to intervene in this situation there will he a continual involvement of the fascial structures of the neck.
There are many vague complaints that usually accompany such an injury. There may be heaviness of the shoulders and neck along with a sense of tiredness. On movement you may encounter “noises” in the neck. However, a much more characteristic symptom of this insult is the myofascitis of the erector spinae muscles, with particular emphasis upon those in the cervical region. There may also be a restriction of movement, followed by a sharp shooting pain. The organs of special sense are not immune from the effects of such an injury. One often comes across cases of tinnitis (ringing in the ears), and diplopia (double or blurred vision) as well as pain behind the eyes, tearing, and photophobia (sensitivity to light); infrequently one finds deafness and vertigo (dizziness).
Any phenomenon that can affect the nervous system so profoundly, will also have its impact on the gastrointestinal tract. In response to this impact, the G.1. system will exhibit nausea, lightheadedness, vomiting, diarrhea, as well as a shortness of breath with possible cardiac palpitation. The degree to which these symptoms are present is witness to the severity of the impact.
There may be other numerous complaints. The individual may report lapse of memory, vasomotor distress in both hands and feet, tremors, and insomnia. It is not infrequent that a radiculitis (radiating pain along a nerve pathway) follows such an injury. Most frequent of these radiculitis syndromes is one where there is a sharp shooting pain referred upward through the back of the neck into the occipital or frontal area of the head, and radiating downward into the clavicular region and on to the arm.
The man who comes in dramatizing such an injury, very definitely needs no words to tell his rolfer his dilemma. As a rolfer looks at him his attention is drawn to the instability of the relationship between head and neck. He is also cogent of his inability to handle movement of the head appropriately. It either moves too freely, or it moves as a total block, that is several cervical segments move together, with a subsequent drawing of the neck downward into the shoulders and binding movement. There is an involvement of the trapezius muscle, the splenius cervicis and capitis, the levator scapulae and the deeper intrinsic muscles of the back. The scaleni muscles may also be affected.
However, we must remember that not all of the problem is confined to the neck and head. Many times you will find that the problem has become anchored in the lumbar spine. For a moment recall the similarity of these two areas. As the lumbar spine becomes involved, it contributes to the overall rigidity and immobility of the spinal column. This is in response to a sense for survival and protection against further injury.
When attention is directed to the neck and head alone, some relief will he forthcoming. The inappropriateness of the lumbar spine to support the changes that have been initiated in the head and neck permits the relief to be only temporary.
The main reason that rolling is able to be so dramatic in its results, is that no more than a sideways glance is given to the symptoms of the client. More time and attention are devoted to the reality of how the man is organized and balanced in space. The more familiar and understanding of the total goals of rolling we become, the more apparent it is that doing something locally for such a situation as a whiplash, only fosters greater discomfort. The needs of the individual are to have support built in, or rather fostered from the fascial components in the legs, pelvis, lumbar area, and continued up thru the neck and head. As the appropriateness of these relationships is realized, the greater possibility for the receding of many of the distressing symptoms. Those of us how are fully committed to rolling (Structural Integration) know that as the man becomes organized and balanced as well as supported by the earth, the entire incident of the whiplash has the opportunity to be erased and the man can proceed with a more normal and healthy living.
About the author: Richard Demmerle, associate of Dr. Rolf, graduated from a small junior college in Pennsylvania. He served two years in the Army Medical Corps. and after his honorable discharge he returned to school and graduated from the Los Angeles College of Chiropractic in 1960.
Dr. Demmerle holds licenses in various states as a chiropractic physician, however his main focus is the continual recognition of rolling as a major approach to health. In 1970 he assisted Dr. Rolf in a class taught in Florida. and in 1973 he taught his first class on the west coast. Last summer, he taught the first class in rolling on the east coast, in Glassboro New Jersey.
He has taken the principles of rolling and applied them to areas where rolling had never been entertained as a method worthy of consideration. The areas include corporate management, brain injured children, polio and cerebral palsy as well as muscular dystrophy and other mesodermic situations.
He currently appears in the Who’s Who in New Jersey for the year of 1975.The Effect of Rolfing on Whiplash Injuries