The Pathophysiology and Mechanism of Acute and Chronic Whiplash Injury: A Narrative Review

Donghwi Park 대한통증연구학회 2022 International Journal of Pain Vol.13 No.1

Patients with whiplash injuries usually complain of neck, shoulder, or back pain; dizziness; headache; vertigo; paresthesias; and cognitive or psychological symptoms. However, to date, whiplash injury also remains one of the most poorly understood motor vehicle injuries. The source of initial symptoms among patients with whiplash injuries is often unclear. It is generally assumed that the symptoms of patients with whiplash injuries have an organic basis. This review briefly summarized the pathophysiology and mechanisms being investigated by many researchers to potentially explain whiplash injury. Each anatomical area described is injured during a whiplash exposure if the impact during whiplash injuries exceeds that tissue’s tolerance. For each anatomical area affected during whiplash injuries, continued research is necessary to better understand the pathophysiology and mechanisms of whiplash injuries. A better understanding of each potentially injured anatomical area during whiplash injuries will help improve the management of whiplash injuries.

경추부 편타성 손상에서의 적외선 체열 진단의 유용성

팽성화,표세영,김무성,정영균,정용태 대한척추신경외과학회 2009 Neurospine Vol.6 No.4

Objective: The name of whiplash Injury derives from the etiopathogenic description of the sudden sharp whipping movement of the head and neck, symptoms are varied, manifesting as neck pain, occipital pain, dysesthesia, and weakness of arm, and so on. But there is no objective diagnostic tool for the evaluation of its symptoms. The purpose of the study is to visualize the symptomatic region before and after treatment and comparing the images obtained by infrared study. Methods: From march 2006 to June 2008, 20 patients diagnosed as whiplash injuries were examined by digital infrared thermographic imaging system (DITI, DOREX, USA). The male-to-female ratio was 14:6 and their ages were ranging in age from 20 to 67 years, with mean age of 38.5 years. We evaluated thermal change (ΔT) in lesion area(neck and shoulder) and also compared thermal difference (ΔT (2wk-I)) after pre- & post- treatment. Results: Initial DITI was 34.28 ± 2.90 on anterior neck, 34.29 ± 2.98 on posterior neck, 33.42 ± 2.93 on right shoulder shoulder (Lt), and 33.59 ± 2.81 on left shoulder. DITI after 2weeks treatment was 33.60 ± 2.88 on anterior neck, 33.78 ± 2.99 on posterior neck, 32.79 ± 2.78 on right shoulder, and 33.05 ± 2.74 on left shoulder. The thermal difference of lesional area on the initial treatment and after treatment (ΔT (2wk-I)) was 0.68 ± 0.45 on anterior neck, 0.51 ± 0.36 on posterior neck, 0.63 ± 0.32 on right shoulder, and 0.54 ± 0.64 on left shoulder, and these result were statistically significant (p<0.05). Thermal difference (ΔT) was neck 0.34 and shoulder 0.33 on initial injury, and 0.39, 0.31 after 2 weeks respectively. This finding was symmetrical and below ΔT 0.5 based on pathologic body temperature. Initial VAS (Visual Analogue Scale) of Neck was 7.9 ± 0.78 and after 2 weeks was 3.6 ± 1.21 the initial VAS of shoulder was 7.4 ± 0.52 and after 2 weeks was 3.2±0.97. There was statistically significant (p=0.001). Conclusion: Therefore DITI was perceived as a reliable tool in the objective assessment of treatment effect after sustaining whiplash injuries, in clinical practice. Objective: The name of whiplash Injury derives from the etiopathogenic description of the sudden sharp whipping movement of the head and neck, symptoms are varied, manifesting as neck pain, occipital pain, dysesthesia, and weakness of arm, and so on. But there is no objective diagnostic tool for the evaluation of its symptoms. The purpose of the study is to visualize the symptomatic region before and after treatment and comparing the images obtained by infrared study. Methods: From march 2006 to June 2008, 20 patients diagnosed as whiplash injuries were examined by digital infrared thermographic imaging system (DITI, DOREX, USA). The male-to-female ratio was 14:6 and their ages were ranging in age from 20 to 67 years, with mean age of 38.5 years. We evaluated thermal change (ΔT) in lesion area(neck and shoulder) and also compared thermal difference (ΔT (2wk-I)) after pre- & post- treatment. Results: Initial DITI was 34.28 ± 2.90 on anterior neck, 34.29 ± 2.98 on posterior neck, 33.42 ± 2.93 on right shoulder shoulder (Lt), and 33.59 ± 2.81 on left shoulder. DITI after 2weeks treatment was 33.60 ± 2.88 on anterior neck, 33.78 ± 2.99 on posterior neck, 32.79 ± 2.78 on right shoulder, and 33.05 ± 2.74 on left shoulder. The thermal difference of lesional area on the initial treatment and after treatment (ΔT (2wk-I)) was 0.68 ± 0.45 on anterior neck, 0.51 ± 0.36 on posterior neck, 0.63 ± 0.32 on right shoulder, and 0.54 ± 0.64 on left shoulder, and these result were statistically significant (p<0.05). Thermal difference (ΔT) was neck 0.34 and shoulder 0.33 on initial injury, and 0.39, 0.31 after 2 weeks respectively. This finding was symmetrical and below ΔT 0.5 based on pathologic body temperature. Initial VAS (Visual Analogue Scale) of Neck was 7.9 ± 0.78 and after 2 weeks was 3.6 ± 1.21 the initial VAS of shoulder was 7.4 ± 0.52 and after 2 weeks was 3.2±0.97. There was statistically significant (p=0.001). Conclusion: Therefore DITI was perceived as a reliable tool in the objective assessment of treatment effect after sustaining whiplash injuries, in clinical practice.

편타성 손상

박문수,문성환,김태환,오재근,양명호 대한척추외과학회 2016 대한척추외과학회지 Vol.23 No.1

Study Design: Review of the literature. Objectives: To present an overview of current research on whiplash injury. Summary of Literature Review: There are controversies over the definition, symptoms, and treatment of whiplash injury. Materials and Methods: Review of the relevant literature. Results: Symptoms of whiplash injury caused by an acceleration-deceleration force may present as widespread pain involving the neck or trapezius muscles, the interscapular area, the shoulders and arms, or as suboccipital headaches. Accompanying symptoms may include neurologic symptoms such as sensory dysfunction, motor weakness, or deep tendon reflex loss; non-specific symptoms such as dysphagia, dizziness, visual disturbances, tinnitus, deafness, memory loss, or temporo-mandibular joint disorders; and psychological symptoms such as depression, acute stress syndrome, or fear avoidance. The most important factor that facilitates spontaneous resolution of whiplash injury, which is a self-limiting disorder, has been shown to be prevention of the acute-to-chronic pain transition. Yet in spite of this knowledge the efficacy of several treatment methods for whiplash injury remains controversial. Conclusions: The appropriateness of treatment for whiplash injury should be evaluated on the basis of up to date academic research on its diagnosis and natural history. 연구 계획: 문헌 고찰. 목적: 편타성 손상에 대한 최신 지견의 소개. 선행 문헌의 요약: 편타성 손상의 정의, 증상, 치료에 대하여 논란의 여지가 있었다. 대상 및 방법: 관련된 문헌의 고찰. 결과: 편타성 손상은 경추부에 가속-감속 기전에 의하여 충격이 가해지면서 골 또는 연부조직에 손상이 발생하여 경부 근육, 승모근, 견갑골 사이의 등, 어깨와 팔의 통증, 후두하 두통이 나타난다. 감각 기능 이상, 근력 저하, 심부건 반사 소실 등의 신경학적 징후와 현훈, 기억소실, 연하곤란, 시각 장애, 이명, 청력상실, 측두-하악 관절장애의 비특이적 증상, 우울증, 급성 스트레스 장애, 공포 회피증 등의 정신과적 증상을 동반할 수 있다. 편타성 손상은 자연 치유된다고알려져 있고, 만성 통증으로의 진행을 막기 위해 다양한 치료방법이 사용되나, 치료 효과에 대해서는 연구자마다 다른 결과를 보고하고 있다. 결론: 편타성 손상의 진단 및 자연경과에 대한 학문적 진보에 따라 이에 적합한 치료가 필요할 것이다.

The Effectiveness of Infrared Thermography in Patients with Whiplash Injury

Lee, Young Seo,Paeng, Sung Hwa,Farhadi, Hooman F.,Lee, Won Hee,Kim, Sung Tae,Lee, Kun Su The Korean Neurosurgical Society 2015 Journal of Korean neurosurgical society Vol.57 No.4

Objective : This study aims to visualize the subjective symptoms before and after the treatment of whiplash injury using infrared (IR) thermography. Methods : IR thermography was performed for 42 patients who were diagnosed with whiplash injury. There were 19 male and 23 female patients. The mean age was 43.12 years. Thermal differences (${\Delta}T$) in the neck and shoulder and changes in the thermal differences (${\Delta}dT$) before and after treatment were analyzed. Pain after injury was evaluated using visual analogue scale (VAS) before and after treatment (${\Delta}VAS$). The correlations between ${\Delta}dT$ and ${\Delta}VAS$ results before and after the treatment were examined. We used Digital Infrared Thermal Imaging equipment of Dorex company for IR thermography. Results : The skin temperature of the neck and shoulder immediately after injury showed $1-2^{\circ}C$ hyperthermia than normal. After two weeks, the skin temperature was normal range. ${\Delta}T$ after immediately injuy was higher than normal value, but it was gradually near the normal value after two weeks. ${\Delta}dT$ before and after treatment were statistically significant (p<0.05). VAS of the neck and shoulder significantly reduced after 2 week (p=0.001). Also, there was significant correlation between ${\Delta}dT$ and reduced ${\Delta}VAS$ (the neck; r=0.412, p<0.007) (the shoulder; r=0.648, p<0.000). Conclusion : The skin temperature of sites with whiplash injury is immediately hyperthermia and gradually decreased after two weeks, finally it got close to normal temperature. These were highly correlated with reduced VAS. IR thermography can be a reliable tool to visualize the symptoms of whiplash injury and the effectiveness of treatment in clinical settings.

편타성 목상해(whiplash) 저감시트 개발 연구

이근배(Keunbai Lee),배한일(Han-Il Bae),이인혁(In-Hyeok Lee) 한국자동차공학회 2004 한국자동차공학회 춘 추계 학술대회 논문집 Vol.- No.-

Although whiplash is typically considered as a minor injury of AISI, it has become one of the most important types of injury to occupants due to the frequency of occurrences and the high cost for long-term remedies. In this paper we utilize the finite element simulation method to look into injury mechanism and design the seats mitigating whiplash injury. Based on the anatomical geometry and material properties from opened cadavers test data, we have developed a finite element model of human cervical spine. Using the calibrated seat and developed neck model, we have simulated the sled tests of rear end impacts under the various injury causing conditions. Through these simulations we evaluate the injury level of base seat. With the results of simulation results under various seat conditions we show that it is possible to suggest the guidelines for designing whiplash protective seats by adopting these numerical procedures.

교통사고후유증(交通事故後遺症)(편타성(偏墮性) 손상(損傷))에 대한 침구치료(鍼灸治療)의 접근(接近)

김민아,박용진,Kim, Min-Ah,Park, Yong-Jin 대한침구의학회 2000 대한침구의학회지 Vol.17 No.3

Objectives : This study is to applied effectively to the acupuncture treatment for disorders following whiplash injuries. Methods : This study suggests five various ways and principtes of treating disorders following whiplash injuries by means of acupuncture. First principle is that acupuncture treatment is carried out on acupoint far from cervical spine at acute stage, on the other hand, Extraordinary Vessel and other acupuncture treatment such as five element acupuncture treatment is applied at chronic stage in order to control balance disoders due to cervical pathology. Second is acupuncture treatment will be performed in group of three part of Meridian System-Yangmyung, Taeyang, Soyang-according to cervical kinetic, its characteristic and location of pain. Third is acupuncture treatment could be performed on basis of theory of Eohyel-disorders and disturbance of blood circulation. Fourth is to decrease tension of SCM muscle, because disorders following whiplash injuries has much association to injury of CM muscle and is simillar to tension syndroms of SCM muscle. fifth is taping therapy could control and decrease disorders following whiplash injuries based on spiral balance taping theory. Conclusions : These results suggest that acupuncture treatment for disorders following whiplash injuries will significally decrease pain and control syndrom caused by cervical disorder.

편타성 손상으로 인한 경항통 환자를 대상으로 한 일반침 치료와 간접구 병행치료의 임상적 효과비교연구

김민석,박재연,최유진,윤경진,이참결,이은용,노정두 대한침구의학회 2011 대한침구의학회지 Vol.28 No.6

Objectives : The purpose of this study was to evaluate the clinical effect of indirect moxibustion treatment for patients with neck pain caused by whiplash injury. Methods : From October 2010 to October 2011, 85 patients with neck pain caused by whiplash injury who admitted to Semyung oriental medical hospital were divided into two groups. Group A was treated by general acupuncture, group B by indirect moxibustion and general acupuncture. The efficacy of treatment was measured by visual analog scale(VAS) scores and neck disability index(NDI) scores of before and after 5 days to start treatment. Results : 1. Both group A and B represented effective improvement in VAS and NDI of neck pain caused by whiplash injury. 2. Group B has more statistical effect than group A. Conclusions : Through this research, indirect moxibustion treatment is considered to be effective reducing pain for patients with neck pain caused by whiplash injury.

교통사고 후 응급실에 내원한 경항통 환자의 경추 만곡 연구

조준영,이선행,Jo, Jun-Young,Lee, Sun-Haeng 척추신경추나의학회 2011 척추신경추나의학회지 Vol.6 No.2

Objectives : The purpose of this study is to investigate the cervical spine curvature after whiplash injury by traffic accident. Methods : The cervical lateral radiographs of 102 outpatients who visited emergency room in Kyung-Hee university hospital at Gangdong after whiplash injury by road traffic accident were reviewed to measure the cervical spine angle using C1-7, C2-7 Cobb method, Sagittal tangent method, Jochumsen method and the Ishihara index by two oriental medical doctors. For statistics, we used SPSS version 17.0 for windows. Results : Means of cervical angle are $37.63{\pm}11.34^{\circ}$, $12.92{\pm}9.13^{\circ}$, $16.19{\pm}10.62^{\circ}$, $1.78{\pm}3.37$ and $8.51{\pm}9.78$ by C1-C7 Cobb Method, C2-C7 Cobb Method, Sagittal tangent method, Jochumsen method and Ishihara index, respectively. Hypolordosis is most numeral in patients by C1-C7 Cobb Method(n=40; 39.22%), Sagittal tangent method(n=68; 66.67%). And Straight is the most by Jochumsen method(n=54; 52.94%), but Normal is the most by Ishihara index(n=53; 51.96%). And Female has smaller curvature in cervical spine than male significantly by C2-C7 Cobb method and Sagittal tangent method(P<0.05). Conclusions : Whiplash injury tends to make hypolordosis or straight. And female has more vulnerable curvature than male in whiplash injury.

활락탕을 투여한 편타성 손상 증후군 환자 치험 2례

엄봉군,조태영,정영훈,이차로,이재영,안영태,Uhm, Bong-Kun,Cho, Tae-Young,Jung, Young-Hun,Lee, Cha-Ro,Lee, Jae-Young,Ahn, Young-Tae 척추신경추나의학회 2010 척추신경추나의학회지 Vol.5 No.1

활락탕을 처방하여 편타성 손상으로 경부 및 상지에 극심한 통증이 호전된 2례를 통해 편타성 손상의 초기 단계인 경우(1-10 일(日)) 활혈거어지제(活血祛瘀之劑)를 사용하게 되는데 초기 극심한 통증 제어 및 치료에 활락탕이 유효한 효과가 있었음을 확인하였다. 이에 저자는 본원에 편타성 손상증후군으로 입원하여 활락탕을 복용 한 뒤 호전된 2케이스를 보고하고자 한다. Objectives: The Purpose of this study is to investigate the clinical application of Whallak-tang(Huoluo-tang) to two patients with Whiplash injury. Methods: Patients are hospitalized at Dept. of Oriental Rehabilitation, Bu-Chun Jaseng Oriental Medicine Hospital, diagnosed as Whiplash injury and treated mainly with herbal medine; Whallak-tang(Huoluo-tang). This study was measured by NDI(Neck Disability Index) and VAS(Visual Analogue Scale) score. Results: After taking Whallak-tang(Huoluo-tang), the patient's pain was controlled and slept well after treatment. VAS & NDI score were decreased. Conclusions: As seen in this two cases of whiplash injury, Whallak-tang(Huoluo-tang) has a positive effect to control pain with whiplash injury.

교통사고로 인한 편타손상 후 경추 만곡의 변화 연구

정해찬,김한겸,김석,한창,Jeong, Hae-Chan,Kim, Han-Kyum,Kim, Seok,Han, Chang 척추신경추나의학회 2010 척추신경추나의학회지 Vol.5 No.1

Objectives: To investigate the change of the cervical spine curvature after whiplash injury. Methods: Clinical study carried out in 46 patients who already had neck pain and took a cervical lateral X-Ray in Jaseng Oriental hospital. these patients had whiplash injury whitin one year. We followed up the cervical lateral X-Ray after that. Cervical spine curvature was measured using four measuring method. Type of cervical spine curvature was analyzed by Jochumsen method, Ishihara Index. T-test was used. Results: By Jackson's Angle and Cobb's angle, it is tend to be more Iordotic curvature after whiplash injury. In Jochumsen method, Ishihara Index the cervical spine curvature was significantly increased their Iordotic angle(P<0.05). Conclusion: The results suggest that after whiplash injury, patients cervical curvature change more Iordortic curve.