Help for neck injury clients
In some patients whiplash injury can lead to long-term, and sometimes debilitating neck pain. While enduring chronic neck pain can interfere with even the basic aspects of life, and can feel overwhelming to those of us unlucky enough to have sustained such an injury, it is important for patients to understand that, in many cases, there is good reason to expect that well managed medical treatment can produce enduring pain relief. Over the last several decades, the medical field has developed treatment methods which, in many cases, allow practitioners to accurately identify the source of a patient’s neck pain, and then successfully treat such pain, without resorting to long-term, chronic pain medication.
Our personal injury lawyers are experts at handling whiplash neck injury cases. At its most basic level personal injury law is about fairness. People who suffer from chronic neck pain following a car accident are all too often ignored and even mistreated by the insurance companies that are supposed to provide aid. Our lawyers work to make sure those of us who suffer chronic neck pain as a result of someone else’s wrongdoing receive fair treatment under the law.
Whiplash Neck Injuries
The term “whiplash” describes both a mechanism of injury and the symptoms caused by that injury. The most common cause of whiplash is a rear-end motor vehicle collision. Side and front impact collisions can also cause whiplash. The most common symptom of whiplash is neck pain. Associated headaches are also common. Other symptoms can include referred pain, dizziness, ringing in the ears, vision changes, fatigue, poor concentration or memory and difficulty sleeping. If chronic pain remains after multiple months, patients can experience depression.
Most people who are in a motor vehicle collision do not experience neck pain. Moreover, of the people who do have neck pain following a collision, only about one third of those people experience long-term neck pain that will not resolve. Typically, if a patient’s neck pain has not gotten better after 6 months, such pain can be expected to endure absent appropriate treatment.
Anatomy of the Neck
The neck is the uppermost portion of the vertebral column which extends down through the back. The vertebral column is a complex system of bones linked by joints and stabilized by strong ligaments which run along its length. The cervical spine (neck region) supports the head, protects the spinal cord and nerves, and allows for movement. The major structural support in the neck is the column of vertebral bones separated from one another by the intervertebral discs. In the rear of each vertebra are two facet joints, one on each side. The facets connect one vertebra to another while allowing for smooth motion. All of these structural components have nerve supplies, and injury to any one can cause pain.
MECHANISM OF INJURY
In the typical whiplash injury, the force of a motor vehicle collision pushes the body one way, leaving the head to be dragged along by the neck. This motion and the injury it causes takes just fractions of a second. The abnormal motion has the potential to injure facets, disks, and ligaments. Facet joints undergo a pinching motion, with compression in the rear and distraction (pulling apart) in the front, usually coupled with shear. The anulus (outer lining) of the disk and longitudinal ligaments can be disrupted by the same abnormal motion.
Facet injuries can include bony impingement; capsular strains and tears; synovial pinching; and direct trauma injury resulting in contusion, intra-articular hemorrhage, and damage to subchondral bone. Disk injuries can include strains or avulsion of the front portion of the disk anulus, tearing of the rear portion of the anulus, and disk herniation. Each of these structural injuries has the potential to cause both acute and chronic neck pain.
Causes of Chronic neck pain
Neck pain that is chronic (long-term) in nature is usually due to a problem with the facet joints, the intervertebral discs, or both.
Medical research has shown that facet joint pain is the most common cause of chronic neck pain following a motor vehicle collision. Such pain may occur alone or in conjunction with disc pain. In a whiplash injury, it is not uncommon for a patient to experience injury to the facet joints on multiple levels. One cannot determine if a facet joint is the source of pain by looking at it on an X-ray or MRI scan. The only way to tell if the facet is the source of pain is to conduct a diagnostic test. One of the most common diagnostic tests is known as a “medial branch block (MBB).”
Injury to the intervertebral disc can also cause chronic neck pain. Of patients with chronic neck pain, about 25% have pain resulting from a disc. A person with disc pain can also have pain from a facet joint. The outer wall of the disc is known as the annulus. The annulus can be pinched or torn during a whiplash and cause pain that is communicated to the brain via peripheral nerve endings located in the annulus. The disc usually heals, but in some people the disc does not heal. A disc that does not heal may get weaker and cause pain even during normal activities. Disc injuries can also lead to pain when they bulge or herniate and push on the spinal cord or other spinal nerves.
Potential treatment for chronic neck pain runs the full gamut from the most conservative care of short rest, heat, and pain alleviation to extensive surgery in the spinal canal. For the most part, the therapy chosen depends on the pathology being treated.
Physical therapy is often the first treatment prescribed for a patient with chronic neck pain. Effective rehabilitation requires strengthening exercises and training in body mechanics. Exercise alone is rarely curative, and can sometimes actually lead to increased pain.
There is evidence that exercise directed toward strengthening the neck and shoulder-thoracic area can reduce pain and improve function in some patients with chronic neck pain. For reduced pain to endure, the patient must continue exercises indefinitely. Strength training and endurance training have been shown to be more helpful than stretching and aerobic training. Intensive exercises are more helpful than light exercises but not necessarily more effective than ordinary activity. There is some evidence that a multidisciplinary program can reduce pain, improve range of motion, improve function, and decrease disability. Rehabilitation programs should be directed toward strengthening the muscles that are usually weak; including the anterior muscle group, the interscapular muscles, and the posterior neck muscles.
Level I medical evidence supports radio-frequency neurotomy (RFN) as an effective treatment for chronic neck pain that arises from facet joints. RFN is appropriate for patients who have been diagnosed with facet joint pain. RFN is a method that deadens the peripheral, medial branch nerves responsible for conducting pain from the facet joint to the brain. The best indication for RFN is significant pain relief following controlled anesthetic blocks of the medial branches of the nerve supply to a specific facet joint. Complete pain relief can be achieved in many patients with pure facet joint pain. Patients with facet mediated headache can also obtain dramatic and sometimes complete relief. Some patients may have other pain generators in addition to the facet joints, such as pain emanating from and intervertebral disc. Relief from RFN has been shown to last a median of between 270 and 400 days, after which pain recurs because the nerves regenerate. Repeat RFN is usually effective in relieving recurrent pain.
Surgical intervention may be considered for patients with severe pain, significant impairment, who have not improved sufficiently with high-quality nonsurgical care. Surgery may also be indicated where there is damage to the discs, or other physical components, or where there is pressure being placed on the spinal cord or other nerves.