Upper Cervical Therapy of Whiplash Injury
- Top view of model of compiled atlas and axis (left), as it was found in computed tomography (right): Chronic torticollis of 10-yaer-old child. Below: Axis, above: Atlas. On the left side, the atlas is positioinned obliquely and dorsally to the axis. In the atlantoaxial joint, a rotation of the head to the left of approximately 20 ° is apparent. The position of the atlas offset to the back is probably caused by pression of the sprained left posterior digastric muscle exerted via the oblique upper cervical muscles.
Whiplash injury or the whiplash trauma consists of a strain of the left posterior digastric muscle, so that it remains permanently extended, leaves its original position at the outer end of the posterior arch of the atlas and nests itself further inwardly on the lower transverse cervical muscle (Musculus obliquus capitis inferior). The involvement of both muscles (digastric and upper cervical muscle) causes increased tension on the upper cervicals and places the atlas obliquely with respect to the axis. In accidents with head involvement, the left atlas process is positionned extremely dorsally compared to the axis (see figure). For that reason, the young woman in the cited paper held her head so badly turned to the left after the accident. In addition, due to the tension exerted on the transverse cervical muscles (Musculi obliquii capitis superior et inferior) and the resulting oblique position of the atlas with respect to the axis, a continuous stretching of the left and right vertebral arteries is also created. Expansion and extension of a soft tube reduces throughput: Henceforth, the position of the head - viewing up or down - or rotations - the jerk - cause basilar hypoperfusion. The faster and the more extreme the head is moved, the more likely is dizziness to occur due to vertebral artery stretching and contiguous perfusion disorder. Not least, tinnitus, sudden hearing loss, and vertigo, but probably also persistent insomnia are partly based on the upper cervical asymmetry caused by vertebral-artery blood-supply reduction (basilar ischemia).
If the condition persisted for a long time, an imbalance between left and right muscles is generated: The left upper cervical muscles are as if in a plaster bed and stunted, the right ones cramp. This state of the art is perpetuated down the entire back: In that way, neck stiffness and paraesthesia in the arms can be produced, because the brachial plexus in the interscalene hiatus is pressurized. The twisting- and blood-perfusion possibilities to suffer on a long term basis under the strain of the left posterior digastric muscle are far from being ennumerated. There can - at the same time! - appear the following symptoms:Visual disturbances (flicker, flash, box)
- Headache, dizziness, drowsiness, disorientation
- Not feeling properly present, standing next to oneself
- Vertigo, unsteady gait, numb legs
- Chronic ear pain, ear pressure, tinnitus, hearing reduction, hearing loss
- TMJ pain, abnormal sensations in the face, tingling
- Neck pain, shoulder pain, back pain, numb back
- Muscle twitching, tremors, palpitations
- Numbness of the hands and feet with formication
- Tingling, paraesthesias in the whole body
- Insomnia
The latter is the authentic, slightly edited list of a patient with chronic whiplash, or rather the generalized 'upper cervical asymmetry syndrome'. The latter consists of a variety of symptoms that may be perceived but with difficulty as a unity, if one was unaware of upper cervical asymmetry. The aforementionned symptom diversity obtains a common denominator and treatability: The upper cervical muscles, teared on a long term basis by whiplash on the left side, need some time after the rearrangement of the left posterior digastric muscle to achieve the msucle tone that will restore blood flow through the vertebral arteries in the long term. The harmonization of muscle tone between left and right ensues automatically, but can and should be activated and promoted by vibratory stimulation.
(1) A young female patient (* 1992) with severe whiplash injury reported after treatment (23/3/2010), that she felt that her condition had improved 'a bit'.
I have the feeling that the head is lighter that the head rotates easier and as thouph it was generally getting a little better.
A month later, the mother came the laconic but very specific message that her daughter is 'healthy'. In fact, the enormous vitality reduction, which had been a cause of great concern, faded away to everybodies' delight as time passed by. Thus, the rearrangement of the left posterior digastric muscle had been the major therapeutic measure.
(2) A female patient (* 1968), who had for several years suffered severely from the effects of whiplash injury occurred in 2008, was treated on 3/11/2010. In the medical history, the following was noted:
Whiplash injury in 2008, protrusions C2-C3, C3-C4, L5-S1, sacroiliac joint pain pain, leg length discrepancy, sacroiliac joint inflamed on both sides. Now it feels 'like a TENS unit' in the upper cervical spine, in the lower cervical region 'stabbing pain' -> pain, opiates patch, Lyrica, formerly Amytriptillin. Chronic pain, except at night, very tired (Patient: 'I would describe battery being totally empty.")
It is apparent that the whiplash injury had had aftermaths consiting in cervical kyphosis, head and shoulder protrusion and severe pain in the lower cervical region. This means that the very skewed position of the upper cervicals due to increased digastric pressure had caused enhanced twisting of all spinal segments and pressure on exiting spinal nerves. The inflammation of the facet joints of the sacrum represent the most painful culmination of this development
The patient commented her condition after upper cervical therapy as follows:
Ihren Zustand nach erfolgter Kopfgelenktherapie kommentierte die Patientin folgendermaßen:
I feel just great, I can not see my shoulders any more, they are very far behind where they, usually they were quite at the front. Yes, I feel soft and warm, and .. . just a great feeling.
The patient was very surprised that the shoulder protrusion had been abolished. She reportedly felt the increased blood flow to the neck region as warming and very pleasant. Another appointment on 3/23/2010, she reported the following:
In the last two weeks an awful lot has changed for me, I've become more upright, my shoulders are very far behind. I have no pain in the upper shoulder area any more, which is such a cool, liberating feeling. Yes, the whole spine is under way, especially the sacroiliac joint, and I hope that in the next few months I would find relief, but otherwise I'm fine.
The patient reported a relief from pain in the upper part of the spine, and that the resolution of shoulder protrusion had been permanent. Howebverf, in the lower part of the spine, she reported to still feel pain. Nevertheless, she was confident and hoped that the painful situations would regress over time. Consequently, the rearrangement of the left posterior digastric muscle was indicated for this patient, as this allowed the whiplash injury to recede and a long-term recovery process to be set in motion.
- Written spontaneous expression after treatment: "I do not believe. Warm + soft, I do not see my shoulders any more."
(3) A patient (* 1955), who probably had suffered for several decades greatly from the effects of a serious bicycle accident ocurred in his youth, was treated on 7/1/2010. The following medical history was noted:
Hearing loss for years, alternately, left worse. 2 days ago, at night, sudden left-sided ear noise (hum) for a few hours, then right-sided noise intermittently. (...) Myopia (contact lenses), almost constantly tensions in the cervical spine / neck, occasionally also lumbar problems. No headache. Bicycle crash in youth -> Septplasty.
Presumably, the whiplash injury in the youth (bicycle accident), which had even required surgery of the nasal septum, had led to hearing loss on a long term, because the blood flow ratios were reduced due to the extreme skewed angle of the upper cervicals (latent basilar ischemia). After therapy, the patient experienced intensified inner ear noises ("Since yesterday, droning, halliges noise."), which required an appointment on the next day. This symptom did recede in the course of the day and then there was a steady decline in symptoms.
Interpretation: The loud noise shortly after therapy indicated that the weakened upper cervical muscles could not hold the required lymph and blood flow initially. The fact that the symptoms disappeared, points to the symmetric and gradually strengthening upper cervical muscles. Quite probably, more often than expected, long-term effects of whiplash injuries express in form of hearing loss, but the cause-effect relationship remains unfortunately speculative.
(4) The following case shows that hearing loss after whiplash injury can emerge dramatically at a young age: A slim young man (* 1990), had - he reported that only after serious inquiry - suffered repeatedly severe head trauma in the course of wrestling. Medical history was recorded on 16/06/2010 as follows:
Ten months ago tinnitus, vestibular failure on the left side and afterwards on the right side, then almost deaf on the right side, afterwards on the left side. Sudden hearing loss which did not recover. Since then symptoms worsened every week. No explanations for the process, psychological component (?). HBOT therapy had been marginally sucessfull, but only briefly. Depression. Anisokury. Jaw cracking on the left while moving sideways and while biting, no jaw pain, had been a wrestler.
The wrestling matches had probably contributed to a very oblique position of the upper cervicals, the left posterior digastric muscle was repeatedly and continually strained and shifted inwardly, so that motion-dependent blood-supply reduction through the vertebral arteries had very much increased. Tinnitus, loss of balance, sudden hearing loss, deafness are likely signs that basilar ischemia had been too strong. Permanent damage to the hearing and equliibrium systems can occur under these circumstances. Upper-cervical asymmetry caused deafness could probably be avoided, if the connection of whiplash and basilar ischemia was well known.
(5) Male patient (* 1984) was treated on 2/13/2008. Medical history resulted in the following:
'Ever since': nausea, trouble while reading. Since the 17th year of age (2001) worsening of symptoms, especially nausea, gradual increase of burning eyes, inability to read long texts, dizziness, sleep disturbances (maximally 4 hours sleep, then several hours awake, second sleep again urgently needed).Tinnitus (loud beep) with certain head movements. Known: ventouse birth, left elbow fracture due to falling from the balcony of 3 m height at the age of six. Oblique head position tending to the right. Height: 196 cm. By means of imaging method, compression of the spinal cord in rotation was observed. Unable to work since graduation since 3 years.
The patient had therefore the following symptoms, which were probably initiated at birth and had been enshrined by a fall from the balcony as a child:
- Keeping head still in order to read is only possible for short periods of time.
- Inadequate lymphatic supply of eye (eye irritation)
- Massive sleep disorder shows up lack of trophic supply of sleep center.
- Motion-dependent tinnitus is probably due to upper cervical asymmetry.
- Skewed position of the head to the right as a result of upper cervical asymmetry
The symptoms are to be understood in the light of an accident occurred in childhood, which extremely aggravated upper cervical asymmetry: For a whole lifetime, a massive disturbance of the lymphatic and blood circulation supply had been prevailing through the vertebral arteries. Each one of the symptoms can be construed as a result of that reduced blood supply.
- Horizontal rotation (first value), flexion in extreme rotation (third value) before (top) and after (bottom) treatment. The value in the middle is the lateral flexion in extreme rotation.
During the treatment it was noticeable that the patient showed above average flexion in both directions (left 28 °, right 20 ° degrees) in horizontal extreme rotation (left 72 °, right 58 °). While rotating, the head bobbed several times in a significant way, especially while turning to the right. This points at an uneven load on the ligamentous structures. After the digastric muscle rearrangement took place, an increase of rotation (left 80 °, re 70 °) tooke place. Furthermore, flexion in extreme rotation (left 28 °, re 20 ° -> li 12 °, re 15 °) as well as lateral flexion in extreme rotation (10 ° right -> re 0 °) were reduced significantly. This means that the skewed position of the atlas over the axis ceased and that a symmetrical state had been reached. The above-mentioned ligamentous structures are loaded less in the symmetric state. The patient confirmed the change in writing the following:
No mucus in the throat, breathing is easier, head movements easier.
At follow-up appointment on 06/24/2008, the following was noted:
Meanwhile, no significant change. In the foreground: dizziness, burning eyes, difficulty staying asleep (bed time 10-11 h, when only 4 hours sleep -> visual field defects). Crunching while the turning head , pain at the end of movement. - The ear beeping motion-dependent, possibly a little less.
The catamnesis shows that, in such a lengthy case, the digastric muscle rearrangement does not directly lead to a symptomfree state. Rather, a lot of patience and upper cervical therapeutic care is necessary until the physiological conditions have normalized.
(6) patient (* 1977) was treated on 2/17/11. In the medical history, the following was noted:
In 1998, head-on car accident with damage on left side of head. Since 4 years, increasing neck pain, then, in addition, headache, usually bilateral, often lasting three days, increasingly under stress, then a few days without pain. Pulsating pain, abnormal facial pallor with headache. Strong painkillers. With headache, patient's eyes do not close properly due to pain in the eye area. Pain increase combined with pressure-sense, and later pulsing. Feeling relief while protruding head. While looking upwards, disagreable feeling, pain release.
The serious accident at the age of 21 years initially seemed not to have any long-term consequences. Only at the age of 30 years, the upper cervical muscles were increasingly no longer able to compensate for the accidental sprain of the left posterior digastric muscle: Persistent neck pain and headache (twisting component) and a pulsating pain (related to blood perfusion) appeared. The level of suffering is very high, symptom-free periods are but very short. The fact that arterial blood is coming up through the heavily twisted upper cervicals (C1/C2) but with difficulty, is proved by the conspicuous facial pallor during headache. The patient reported that keeping his head in a protruding position was causing mitigation of pulsating sensation, however, looking upwards would rather spark headache. In prevailing upper cervical asymmetry, it is likely that extension has a blood-circulation reducing effect, whereas flexion increases blood circulation.
In the second session on 2/24/11 the following was noted:
At the day of treatment, again quite severe headaches as well as head&neck-pain, since then no more headache, but pain in the neck area.
- Angle measurements before and after upper cervical therapy: First column: horizontal rotation (L, R), second column: lateral flexion (SL, SR), third column: flexion / extension (B / S). First line: before digastric muscle rearrangement, second line: after muscle rearrangement, third line: after vibratory massage, fourth line: second appointment.
