Railway Spine

railway-train-flip[originally published in KCN, May 2000]

Back in the “Dr. Quinn, Medicine Woman” days people suffering from neck pain following train accidents would likely have been diagnosed, or “labeled” I should say, with the downgrading term “railway spine.”  You see, railway spine was a condition that garnered a lot of suspicion, as the genuineness of the suffering patients exhibited was questionable to some.  Unlike other possible aches and pains a person of this era may have experienced, like falling off his horse, this condition was different, in that it involved a liable party — the railroad company — putting the patient in a position of gaining some extra gold nuggets for his pouch.

Fast forward to Y2K.  Ironically, not a lot has changed — except we don’t use gold as common currency, and the term railway spine no longer exists.  It was retired a long time ago — upgraded to a term most of us are more familiar with:  “whiplash.”  Perhaps this change in verbiage was prompted by the fact that automobiles have replaced trains as our primary method of transportation.  With 6 million injuries per year due to automobile accidents — 50% resulting in whiplash-type injuries — it is a rare day when a patient walks into the doctor’s office with whiplash following an Amtrak incident.

railway-skepticThe skepticism that surrounds whiplash/railway spine is still very prevalent, however.  So much so, that some lawyers, insurance company representatives, and insurance company-hired doctors make their living contending that the condition doesn’t exist, and that people who claim they have it do so purely for monetary reasons.  The fact is, they are wrong.  Our advances in technology in the diagnosis and treatment of this condition have come a long way since the Old West.  If we lift the litigation that surrounds this condition for a moment, and look at it purely from a clinical standpoint, numerous well-designed studies exist that establish its reality — far surpassing the handful of slanted-studies which deny it.

Car accidentSo, just what is “whiplash?”  Simply put, whiplash is a situation, most commonly occurring in automobile accidents, in which the head is suddenly jerked back and forth beyond its normal limits.  This “whip-like” motion can overstretch and tear supporting muscles and ligaments of the head and neck.  It can stretch and irritate the delicate spinal cord and nerve roots.  The cartilage-like pads, known as discs, that are located between each neck vertebrae can bulge, tear, or rupture.  And the joints that guide normal neck movements can become jammed or forced out of their normal position.  If all this sounds like a pain in the neck, it is.  However, the symptoms that can be brought on by a whiplash injury, extend beyond neck pain.  Blurred vision, dizziness, nausea, and pain in the shoulders, arms, and hands, as well as back pain, are some that top the list.  Interestingly, symptoms don’t always appear immediately following the injury — they may take weeks, or in some cases, months to appear.

railway-whiplashOur knowledge of whiplash is expanding all the time.  Thanks to a 1999 study in Japan involving  live volunteers, we’re finding that actual whiplash is a bit more involved than the sudden back and forth jerking I mentioned earlier.  Motion x-rays of these volunteer “crash test dummies” revealed that the neck behaves more like an “S” upon initial impact.  That is, the upper portion of the neck flexes forward while the lower portion extends back — in essence, the bones in the neck are going in opposite directions and are putting more stress on the discs and facet joints than we once thought — a lot more.

Excitingly, these brave volunteers may have uncovered one of the reasons that chiropractic treatment for whiplash injuries is often so successful.  The very nature of the chiropractic approach to the treatment of whiplash focuses on returning normal function and motion back to the facet joints and discs of the neck.  “Why is this finding such a big deal?” you may be wondering.  Because many patients suffering from railway-jomwhiplash injuries undergoing medical treatment are only having their muscles treated with physical therapy and medication, while the dysfunction in their spinal joints remains untreated.  With an estimated 500,000 to 900,000 of the 3 million annual whiplash injuries developing into the debilitating chronic pain phase, there are many whiplash patients that aren’t getting better who could be through chiropractic.  But don’t take my word for it, two relatively recent studies authored by respected medial researchers in the whiplash field exist to back this up.  Both papers, one from the railway-injuryJournal of Orthopaedic Medicine and the other from Injury, looked at people who failed under medical management and were referred to chiropractors for chronic whiplash pain.  The results were awesome!  One study showed 93% of the patients improved with chiropractic care and the other, 74%.  One of the studies even went so far as to say that chiropractic is “the only proven effective treatment for chronic whiplash.”  (Remember, these studies were not written by chiropractors, but medical doctors).

Woman in painChronic pain in whiplash injuries is a major problem, and we are attempting to learn more about it in hopes of controlling it.  Research soon to be published in the Journal of Musculoskeletal Pain finds that the risk factors we have traditionally only associated with the acute aspects of the injury (having the head rotated, being out of position in the vehicle, lack of preparation for the crash, and being struck from the rear) are also risk factors for the development of chronic pain.

In an effort to actually prevent whiplash, technological improvements are being developed.  Already, both Saab and Volvo have added seat and head restraint improvements to a few models.  Another improvement still in the works is a computer sensor that will warn the driver if they are approaching an object at a dangerous rate, or perhaps more importantly, if they are in danger of being hit by someone else.  Based on research that shows vehicle occupants caught totally unaware do worse in accidents than those that have some awareness, the developers of this technology are hoping that offering a warning, even if railway-bracing-for-imapctonly a split-second before impact, will allow occupants a chance to brace themselves,  minimizing their degree of possible injury.

So what can you do if a crash is about to occur and you’re lucky enough to prepare for it?  Well, the American Chiropractic Association along with Dr. Arthur Croft, chiropractor and prominent whiplash researcher, have some suggestions:

  1. Put your head and your neck all the way back so that you’re in contact with the seat back and the properly adjusted head restraint.
  2. Straight-arm the steering wheel and get a good grip.
  3. Put your foot on the brake as hard as you can (assuming you’re stopped of course).
  4. Look straight ahead, not in the rearview mirror.  Don’t have your head turned at all.
  5. Put your neck back slightly so your eyes are looking level — up at about the top of the windshield.
  6. Scrunch you shoulders up towards your ears and brace.

If you are in an accident, seek chiropractic treatment immediately.  Doing so will decrease the likelihood of a chronic condition setting in, as will following your doctor of chiropractic’s recommendations for care which may include exercise, ice, massage, and work modifications, in addition to a regimen of spinal adjustments.  And don’t fall into the trap of thinking that the severity of injury is related to the amount of damage to the car — sometimes, quite the opposite is true.  When a collision occurs, there is a physical transfer of energy, or force, that must take place.  While a very minor portion of the energy will be dissipated as heat and sound, the vast remainder will be transferred into the body of the automobile and the body of the occupant.  With the advent of low-speed, “no damage” bumpers, which are now the norm on just about every car these days, energy that would normally get absorbed into the crushing of metal, unfortunately gets transferred to the person sitting in the car — causing injury, painful or not.

With the odds of being seriously injured in an auto accident at some point in your life at 1 in 3, the chances of you or someone you are close to undergoing a whiplash are very likely.  Since driving is a risk most of us have chosen to take, give yourself an edge by shopping for a safer car.  The Insurance Institute for Highway Safety has a web site (www.hwysafety.org) which includes ratings on cars with the safest head restraints, air bags, bumpers, and seat belts, as well as lots of other good information which can assist you in making an automobile purchase that just may save your life.  If you are in an accident and suffer a whiplash, remember that chiropractic care can be extremely effective in treating this often times painful and disabling condition.  As for me, I’m considering leaving my car at home — the train is looking pretty appealing.

__________

Sources used for this article:
Chiropractic “only proven effective treatment” for chronic whiplash.  Dynamic Chiropractic. 18(1).  2000.
Khan, Cook, and Bannister.  Asymptomatic classification of whiplash injury and the implications for treatment.      Journal of Orthopaedic Medicine.  21(1):  22-25.  1999.
Krantz.  What are the odds.  HarperCollins Publishers, Inc.  New York.  1992.
Lord, Barnsley, et.al.  Chronic cervical zygapophysial joint pain after whiplash.  Spine.  21(15):  1737-1745.  1996.
Murphy.  commentary on Lithuania whiplash study (Lancet. 347:  1207-1211).  appearing in Whiplash, spinal trauma, and legal perspectives of the chiropractic personal injury case, by Addler, Giersch, and Murphy.  1997.
Murphy.  Vehicle damage and passenger injury.  The American Journal of Clinical Chiropractic.  January  1996.
Squires, et. al.  Soft-tissue injuries of the cervical spine.  The Journal of Bone and Joint Surgery.  78-B(6):  955-957. 1996.
Swartzman, et. al.  The effect of litigation status on adjustment to whiplash injury.  Spine.  21(1): 53-58.  1996.
Whiplash and chiropractic:  new horizons.  Journal of the American Chiropractic Association.  37(2):  8-19.  2000.
Whiplash and the chiropractic lifestyle.  (brochure)  Back Talk Systems.  1995.
Woodward, et. al.  Chiropractic treatment of chronic whiplash injuries. Injury 1996;27:643-645.
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