Vertebral instability is a common injury in patients with chronic pain following whiplash trauma. There are many potential injuries from whiplash and injured ligaments are one of the most common.
Many soft tissues can be injured, in-fact, everything except bone is soft tissue. Whereas muscles play a key role in joint mobility, ligaments’ key function is joint stability. Ligaments attach to bones and limit joint mobility. When ligaments get injured the joints they are designed to stabilize move beyond their normal limits. Most people are aware that injuries to the ligaments in the knee such as an ACL (Anterior Cruciate Ligament) tear will lead to instability, excessive motion, and pain in the knee. The spine has many ligaments that play a similar role in the spinal joints as the ACL does in the knee.
The most common spinal ligamentous injuries from whiplash are sub-failure injuries. These are injuries where the ligaments are stretched, damaged, and partially torn but not to the point of complete failure. Unlike muscles which typically heal in a few weeks or months, ligaments can take 12-18 months to fully recover and they will never be the same strength or provide the same stability as the original ligaments.
Healthy ligaments are 75% collagen protein, normal ligaments are primarily composed of type I collagen fibers which are thick and densely packed. After a ligament is injured, the ligament rebuilds with type III college, which is smaller in diameter, less densely packed and less well organized. This leaves the ligament weaker and more prone to future injuries. The new ligament laxity leads to excessive motion in the joint, pain and eventually osteoarthritis.
DIAGNOSIS OF LIGAMENT INJURIES FROM WHIPLASH
MRI is effective in detecting severely damaged ligaments and complete tears, however, MRI is unable to detect ligaments that are stretched and lax. X-rays can be used to identify changes in joint structure and signs of instability, however, they are not best diagnostic tool available. Cineradiography such as DMX (Digital Motion X-ray) or fluoroscopy shows the functionality of the joint through full range of motion picking up instability and joint dysfunction that is frequently missed on standard x-rays and also giving a better idea of the severity of joint laxity and instability.
A recent study published in the International Journal of Environmental Research and Public Health demonstrated the effectiveness of measuring unstable joints in symptomatic patients following a whiplash injury compare to non-symptomatic and not injured patients. The study found “DMX examination of the cervical spine is a highly accurate test for identifying patients with symptomatic ligamentous instability after whiplash trauma.” The study identified the difference in abnormal joint mobility in injured patients compared to normal joint mobility of uninjured patients.
This study demonstrated:
- Intervertebral instability is a common finding people with chronic neck pain after a whiplash injury.
- Intervertebral instability is an uncommon finding in uninjured populations.
- Identifying two or more joints with laxity and abnormal motion is a highly accurate diagnostic test for identifying chronic neck pain patients after whiplash trauma.
What this study tells us that likelihood that someone who is injured in a whiplash trauma and dealing with chronic pain has unstable joints is very high. It also tells us the likelihood of an uninjured person, not in chronic pain having unstable joints is very low.
STRATEGIES FOR OPTIMIZING LIGAMENT REPAIR
Immobilization and rest have frequently been prescribed following a ligamentous injury. However, immobilizing a joint has detrimental consequences such as adhesion buildup, decreased collagen synthesis, and disorganization of connective tissue. Joint mobilization has been shown to help joints heal more effectively. Joint mobilization has also been shown to be effective in decreasing pain, decreasing inflammation, and increasing joint range of motion. The most effective method to increase motion in restricted and injured joints is through specific chiropractic adjustments. Doctors of chiropractic have by far the most comprehensive training in joint manipulation.
Repetitive loading of joints, such as that done with specific mechanical traction, enhances the proliferation of new ligamentous fibers. Controlled movement and loads on the connective tissue instruct the new tissues how to rebuild in a correct organized pattern and the amount and density of the tissue. A multimodal rehabilitation program that included chiropractic adjustments, mechanical traction, and specific exercises is the best overall approach for healing damaged ligament from whiplash traumas.
If you have suffered a whiplash injury, such as being in a motor vehicle collision, you need to be evaluated by expert spine biomechanics and traumatology. Most doctors have not been trained to properly diagnose, document, and treat these injuries. In-fact Dr. Chris Gubbels is the only chiropractor in Fort Collins who has been certified by the American Board of Independent Medical Examiners. Dr. Gubbels also holds advanced training in spine biomechanics & traumatology.
Do not waste your time with unqualified doctors. Call our office at 970-207-446 or click here for a free consultation.