The aftershocks of whiplash can be psychological as well as physical, but osteopathy can handle both, says Dr Harald Gaier.
While taking my 16-year-old daughter to school, I stopped behind a row of cars at a red light. Suddenly my car was hit from behind. First, my head hit the seat headrest and then, with my body held by the seatbelt, my neck and head were both forcibly thrown forward as I smashed into the car in front. The same thing happened to my daughter. My car doesn't have airbags, though I heard later they wouldn't have helped much anyway. I went to my osteopath straightaway, and he clicked my neck and applied some gentle traction to it as well. I felt better immediately, but my daughter, who watched what he was doing, refused any osteopathic manipulation-it frightened her-so I didn't force her.
Unlike me, my daughter had neck pain and problems in her arms and fingers for about four months after the accident. That's now gone but, for the last three years, she has had recurring nightmares, headaches, dizziness, sleeplessness, anxiety and constant extreme tiredness. Worse, this girl who was once placid and friendly has become an exceedingly irritable person that everyone wants to avoid. She's been prescribed a succession of drugs that haven't helped. Can you offer any advice?
C.M., via email
Your severe neck sprain goes by the non-medical term 'whiplash', which accurately describes the injury: your head was savagely pulled back and then forcefully thrust forward-exactly what happens when you crack a whip.
In most cases, conservative osteopathic manipulation with gentle cervical traction works,1 as you found.
But in some whiplash injuries, the ligaments at the front and back of the neck may be torn, so the neck needs to be supported for at least six weeks. To confirm whether ligaments are torn, the osteopath/chiropractor needs to take X-rays of the neck. Tears in the front ligaments are more serious than tears in the back ones, as they are the only support for the fronts of your neck bones. These tears can cause constant instability, interfere with the blood supply to the head, and lead to later damage or displacement of the vertebral discs.2
Impaired blood flow (and even lymph flow) to the brain is frequently seen in whiplash injuries even when no head impact was involved, and can affect the body's own attempts to heal.
Recently, 70 patients (with post-traumatic symptoms like your daughter's) were tested at four and then at eight weeks after head and neck injuries; all showed reduced cerebral blood flow compared with 70 patients with minor, similarly caused injuries, but not to the neck or head. The researchers concluded that this resulted from increased constriction of the blood vessels. Later, repeat testing showed that the patients' post-traumatic symptoms coincided with slower blood circulation in the brain,3 which could have been due to other vascular-related issues.4
Your daughter now appears to be suffering from a post-traumatic syndrome related to whiplash known as 'post-concussion syndrome' (PCS).5 This baffling syndrome, commonly seen after motor, industrial and sports accidents, seems to be a psychophysiological response to a fear of no longer existing (annihilation). The duration of this reaction may be brief, or last for months or even years. Symptoms include fearfulness, recurrent dreams or nightmares, palpitations, headaches, dizziness, insomnia, irritability, anxiety and pervasive fatigue.6
The latest medical definition claims that victims have longings to be cared for, masochistic needs for pain and misery or hostile desires for revenge against, for example, employers, insurers or spouses, or a desire for financial compensation. This stigmatizes sufferers as it portrays them as neurotic or psychosomatic, and works against those seeking insurance payouts and even prevents them getting doctors to take them seriously.7 Over the past two decades, orthodox medicine has treated PCS as a psychiatric problem, handing out antianxiety drugs and antipsychotics,8 as they did with your daughter.
Osteopaths argue that PCS can cause impaired short-term memory, abulia (lack of will and initiative), loss of mental acuity, changed sleep patterns, reduced tolerance to alcohol, and physical symptoms like tremor due to cerebellar disease, double vision, anosmia (loss of sense of smell), stammering, sensitivity to noise and bright light, pain and dysfunction of the temporomandibular joint, and neck and skull pain, with a self-perceived change of sensation in the skin along the arm.9
Healing with osteopathy
The following osteopathic approach has proved successful in treating PCS. In my experience, this approach has avoided any psychiatric treatments, as the psychological issues generally disappear along with the physical ones.
1- First, give the practitioner full information on the accident, which should be followed by physical examination and perhaps X-rays.
2 -The examination and/or X-ray studies will reveal the precise nature and extent of damage to the neck bones, and whether there is loss of any intervertebral spaces or changes in the normal neck curvature.
3 - Lateral X-rays of the neck in full flexion and extension can determine whether ligaments have been torn; if so, wearing a soft neck collar for a given period may be recommended.
4- Some patients show evidence of side-bending/rotation, and cineradiography (making a movie during fluoroscopy) can help detect abnormal movements (although the high cost may not be worth it over plain X-rays coupled with normal physical observation by the practitioner).10
5- Once other risk factors have been eliminated, the practitioner may proceed with conservative manipulation and gentle neck traction.
Hoag JM, ed. Osteopathic Medicine. St Louis, MO: McGraw-Hill Book Company, 1969: 391-3
Stoddard A. Manual of Osteopathic Practice, 2nd edn. London: Hutchinson, 1974: 122-3
Lancet, 1966; 2: 178-80
Clin Electroencephalogr, 1984; 15: 214-21
Richardson JTE. Clinical and Neuropsychological Aspects of Closed Head Injury. London: Taylor & Francis, 1990: 205
Am J Insanity, 1904; 60: 373-441
Psychol Med, 1973; 3: 304-18; Rev Med Li`ege, 1991; 46: 305-13; J Neurosci Nurs, 1993; 25: 249-53
Minerva Chir, 1990; 45: 1309-14
J Am Osteopath Assoc, 1963; 62: 739-50; 1975; 74: 400-10
Arch Surg, 1962; 85: 974-81
Harald Gaier, one of the UK's leading experts on alternative medicine and a registered naturopath, osteopath, homeopath and herbalist, practises at The Allergy and Nutrition Clinic, 22 Harley Street, London. Visit his website at www.drgaier.com.
If you have a question for our Medical Detective, write to us at the usual address or email:firstname.lastname@example.org.