Had whiplash before? Do you have cervical spine instability?


Motor vehicle accidents (MVA's) are very common. Although often minor, whiplash can occur to the car passengers, whether you were the driver or just a passenger. Whiplash refers to the cervical spine (mostly) and surrounding neck muscles, but it is not isolated to just the neck. Depending on severity it can involve a much greater area of the body. Other areas often effected can include; the entire spine, shoulder and so on. 


Cervical spine instability is not a well defined topic as it is very hard to accurately diagnosed as it occurs during movement, rather than at rest. This means accurate imaging needs to be done whilst the neck is moving, instead of the usual stationary images (xray, MRI, CT scan). 


Cervical spine stability

The cervical spine does a great range of mobility and the upper cervical spine (C0-2) relies on the surrounding ligaments to create this stability. The lower cervical spine (C3-7) has stability from both the surrounding ligaments, facet joints and intervertebral discs (small pillows between the bones). 


This is not to be confused with hyper mobility. Instability is a pathological condition with resulting symptoms. Hyper-mobility is joint with segmental increased mobility but able to maintain stability and function underlay. It also occurs with no previous trauma or condition and potentially no symptoms. Instability can cause ; pain, muscle spasms change in range of motion. It is classified as mild, moderate or severe. Diagnosis is based on the patients case history, physical examination and imaging done whilst the neck is moving vs still. These include; functional CT scans, MRI and digital motion X-rays. By moving your neck during the imaging is shows the lack of stability and displacement during movement which is not evident during static imaging. 


Due to the ligament stability of the upper cervical spine, never let anyone manipulate/'crack' your upper neck. HVLA (high velocity low amplitude) manipulation is strictly advised against and can cause further damage. This is regardless of the practitioners background. Whether you are seeing an osteopath, chiropractor or other health professional, if cervical spine instability is suspected or diagnosed, manipulation of the upper neck is CONTRAINDICATED! As the patient you are always able to say no in a treatment consultation. If they wish to manipulate your neck, you say no, even they try persuade you. Just explain the reasoning. 


How osteopathy can help?

Osteopaths commonly treat neck pain and whiplash related injuries. Sarah will work with you through your case history and examination to decide if you possibly have cervical spine instability. If it is suspected as instability Sarah will refer you initially for X-rays then to a specialist to do further imaging, assessment and recommendation of the appropriate treatment procedure. In the mean time osteopathic (not manipulation) can help. Osteopathic treatment is aimed at getting the rest of your body working as well as a possible. All other areas of your body now have to work harder to compensate for the neck instability and pain, thus can become a problem in themselves. Strengthening exercises to the neck can be given to help improve the stability of your neck. 


What is Prolotherapy?
Prolotherapy is used for acute and chronic musculoskeletal injuries and pain, due to joint instability and ligament laxity. Prolotherapy is a 'regenerative injection' that is based on creating the healing phase in the site of injection. The healing phases include; inflammation, proliferation and remodelling aka the site is inflamed then healing tissues and substances move into the area and start to heal the unstable site. This creates tensile strength, elasticity, mass and load bearing capacity of collagenous connective tissues. The injection works on the joint, tendon and surrounding ligaments. Prolotherapy is commonly used in whiplash patients. If you wish to get a prolotherapy injection this must be referred by your health professional and preformed by a specialist. Osteopaths can refer you for this if it is appropriate.


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