Ligament Failure and Strain-Sprain Reported as Permanent in Whiplash
By: Mark Studin DC, FASBE(C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
When we investigate the aberrant sequela to victims in car crashes, providers often overlook and concurrently underestimate the tissue pathology and resultant biomechanical failures of spinal ligamentous damages commonly known as “strain – sprain.” In addition, the courts have been “blinded” by rhetoric in allowing this pathology to be deemed transient. There is an ever growing body of scientific literature that verifies strain - sprain as permanent pathology, which is the standard being taught in today’s medical and chiropractic academia. In addition, strain – sprain as sequela to whiplash in the majority of cases, renders a 25% whole person impairment based upon the American Medical Association’s Guide to the Evaluation of Permanent Impairment fifth and sixth editions.
Juamard, Welch and Winkelstein (2011) reported:
“…Rear end accelerations have been used to study the response of a variety of soft tissues in the cervical spine, including the facet capsular ligament. For simulations of whiplash exposures, the strains in the capsular ligament were found to be two – five times greater than those sustained during physiological motions of the cervical spine. In a similar but separate study, the facet joints of the cervical spine’s that were previously exposed to a whiplash injury ridden exercise under low – level tension and found to undergo elongations nearly 3 times greater than on exposed ligaments for the same tensile loads. Those capsular ligaments were also found to exhibit greater laxity after the purported injury. Since increased laxity may be linked to a reduction in the joints ability to stabilize the motion segment during sagittal motion, this finding suggests that whiplash exposure may alter the structure of the individual’s tissues of the facet, such as the capsular ligament, and/or the mechanotransduction processes that could maintain and repair the ligamentous structure. Accordingly, such an injury exposure could initiate a variety of signaling cascades that prevent a full recovery of the mechanical properties of the tissues of the facet joint.” (Pg 15)
Simply put, if we focus on the last sentence above, this “prevents a full recovery of the mechanical properties of the tissues of the facet joint,” which is referencing the ligaments of the spine that make up the tissues of the facet joint. In lay terms; it means that once injured, a joint is permanently damaged and it is demonstrable on x-rays with an extension and flexion view that does not have to show a full dislocation. Therein lies the core of the issue. Most radiologists are not trained in the latest literature on biomechanical tissue failures and therefore underreport the pathology.
Last month I attended a presentation by Michael Modic MD, Neuroradiology, a nationally renowned educator in neuroradiology who focuses on spondylolisthesis (vertebral segmental abnormal movements) and I asked a simple question “why don’t radiologist report more on abnormal positioning due to biomechanical failure as a result of ligament pathology” and his answer was “because their training focuses more on disease pathology.” Although I agree that is critical, so are biomechanical failures that lead to chronic degeneration, which is epidemic in our society. Simply look at the posture of our elderly for verification and much of that started with a simple “fender bender” years ago where the strain-sprain was either undiagnosed or deemed transient and not treated.
The above scenario is why the American Medical Association values ligament pathology at 25% whole body impairment. There is also a growing body of doctors who are trained and credentialed in Spinal Biomechanical Engineering that understand how to create a diagnosis and prognosis, along with treatment plans around ligament pathology and fully understand the long-term effects of damaged facet joint tissues. These doctors are currently educating, based upon the current scientific literature their respective radiology communities to be able to diagnose and document the full extent of the injuries sustained.
We must also recognize that there is a significant amount of evidence in the scientific literature that verifies ligamentous damage as permanent and refutes the rhetorical claim of “transient.” In the end, it must be the facts of human physiology verified by science that sets the standards of healthcare and not deceptive rhetoric at any level.