Whiplash 101

Ligament injury refers pain see chart

 By Amy Price PhD

The ligaments act like duct tape to hold our bones and joints together.  When ligaments lose their elasticity the bones and joints move too much and irritate the structures around them. Ligaments provide boundaries for movement.  For example when we bend our fingers backwards the ligaments will stop us from pushing them too far back and breaking the bones. It is this way with most of the joints in our bodies. The ligaments cause them to work within a safe range of motion. When one of the ligaments is torn or stretched, the excess movement will cause pain and swelling. In an injured joint and you may notice more popping, cracking or even a grinding feeling.  The joint may have become unstable.

 In the neck and spine, ligaments are crucial for holding vertebrae together. Spinal ligaments are especially vulnerable to overstretching or tears in a car wreck.  If you experience these symptoms after a wreck you may want to be examined for a ligament injury:

•             popping, cracking, or grinding in the neck with movement

•             pain or spasms that get much worse with activity

•             Numbness or tingling into the hand(s) or feet that gets worse with activity or accompanied by popping, cracking, or grinding.

 Flexion-extension x-rays, or digital motion x-rays can be a good way to help diagnose ligament instability.  A good physician will want to test the spine segment by segment to test for stability and this is  an essential step for enabling accurate treatment. The diagram above shows some of the ways ligament pain is referred in the neck area. For referred pain in other body areas look at our dermatome pages

Treatment usually proceeds as follows:

•             Specially trained medical practitioners such as Chiropractors or Osteopaths can mobilize any stiff segments that may be overloading the unstable segment

•             Posture Training can improve stability, injury can increase tightening of muscle structures which can cause guarding of the painful area. This throws posture off balance and  can aggravate instability.

•             Strengthen any weak, deep supporting muscles (like multifidus) that may be allowing too much movement. Core strength exercise like modified Pilates with the guidance of a trained physiotherapist can be helpful

•             Don’t be talked into mobilizing or manipulating an unstable segment as this can bring a temporary improvement but over time can make things worse. Sometimes bracing is used and while this may seem like a good solution to reduce pain initially prolonged bracing can cause further weakening of the surrounding muscles and later slow recovery.

•             Prolotherapy may prove helpful, adult stem cell therapy using your own cells has been reasonably successful in initial trials.

•             Surgical stabilization is sometimes used when no other treatment brings improvement.

By Amy Price PhD

Radio Frequency Ablation (Denver Pain Management ,2009)

Radiofrequency (RF) and pulsed radiofrequency (PRF) neurolysis are techniques used to treat chronic pain that is transmitted through the sensory nerves. RF neurolysis utilizes heat to destroy selected nerve fibers, which block pain transmission through the neural pathway. These techniques are used when intermittent anesthetic injections no longer provide extended pain relief.

Chronic cervical, lumbar and sacral pain  can come from your facet joints.  These pain signals can be interrupted by blocking the nerve to the facet joint with an anesthetic injection  this is very temporary (facet block), For longer lasting relief the nerve can be  heated using a radiofrequency wave (radiofrequency ablation) . This can often prevent the neural transmission of pain. The nerve to the facet joint is sometimes referred to as the “medial branch” and therefore a facet nerve block is also referred to as “medial branch” block.  These blocks are performed as a part of a diagnostic workup for back or neck pain. Relief following a precise injection of local anesthetic confirms the facet joint as the source of pain.

 Radiofrequency neurolysis is a procedure in which sensory afferent nerve fibers are selectively destroyed with heat produced by radio waves delivered through an electrode.  Treatment objectives are to eliminate pain, reduce the likelihood of recurrence and prolong the time to recurrence by selectively destroying pain fibers without inducing excessive sensory loss, motor dysfunction, or other complications. Radiofrequency (RF) neurolysis carries  the potential risk of neuritis (nerve inflammation). Histological studies have revealed indiscriminate destruction of both small and large fibers following RF treatment.

 Pulsed radiofrequency  is thought to be a less destructive alternative to standard RF in that it applies RF energy with a pulsed time cycle that delivers short bursts of RF current instead of a continuous RF flow. By pulsing the electrical current, the needle remains relatively cool (up to 42 degrees celsius compared to temperatures of 60-69 degrees celsius with continuous RF) so that the tissue cools slightly between each burst, reducing the risk of destroying nearby tissue and preventing any long-term damage to the nerve. The reasoning behind this is transmission of impulses across small unmyelinated fibers is disrupted while larger fibers remain protected by the myelin sheath.

 Some researchers show short term success with pulsed radio frequency in comparison to radio frequency lesioning. However others are reporting success rate of over nineteen months. It would seem that results could be altered by the skill of the spine care practitioner it is crucial to choose carefully.