Whiplash may cause facet injury
Whiplash: A Pain in The Facets?
Christopher J. Centeno, MD
As little as ten years ago, medical doctors knew very little about how the human neck got injured in a car crash. We knew about broken bones we could see on x-ray or herniated discs we could see on MRI, but not much else.
A Japanese orthopedic surgeon changed all that by placing medical students on a sled and recreating rear end car crashes (it’s amazing what you can do with students in Japan!) These experiments showed that the neck bones were moving differently than we expected. Up until that time, all medical providers including medical doctors and chiropractors assumed that it was the neck ‘whipping’ backwards that caused the injury. However, this research showed that the joints in the neck were in fact spearing themselves.
These joints (facet joints) were later discovered to have small fractures, tears in the cartilage, and ligament tears that couldn’t be seen on the best x-rays, CT Scans, or MRI’s. This began our modern understanding of what causes most chronic neck pain from a car crash. Never heard of a facet joint? It’s not surprising. This research is still winding its way from the lab to your doctor. There are now hundreds of research papers on this topic. Why is this important? If you or someone you know has chronic neck pain from a car crash, there’s about a 50% chance that this is what’s causing the pain.
There are 14 facet joints in the neck. They are small joints about the size of a finger joint. They control motion in the neck. For instance, one of the reasons you can’t turn your head around 360 degrees is that motion is limited by these joints. When you look up for any length of time, turn your head, or look down to read and then try to bring your head back up, these joints are stressed. If the facet joints are injured, these motions will usually cause pain.
So if you have a bad facet joint or joints in your neck, what can be done? Conservative care such as physical therapy, chiropractic, or massage can help reduce the symptoms and allow these joints to heal. What happens if you’ve tried 6-8 weeks of that type of care and you still have problems?
The next step is usually injecting a small amount of anti-inflammatory into the joint to put out the fire. This helps about half of our patients make gains with physical therapy or chiropractic that weren’t possible before the injection. For the other half of our patients who have joints that are too damaged to help with a simple injection and conservative care, radiofrequency is the answer. This is a treatment that reduces the amount of pain signals the joint can report for about 1-2 years per treatment. One study showed the mean duration of relief from a single RF treatment to be 422 days. For patients who have this type of injury, this treatment is a godsend.
One patient that comes to mind is a great example. This is a woman who ran a ranch in northern Colorado. She had an upper cervical facet injury that caused not only significant pain, but also dizziness (as this particular facet joint provides position sense information to the brain). She couldn’t care for her horses, go horseback riding (her one love in life), or run her ranch.
Her doctors didn’t recognize this problem for a year, so she tried medications, narcotics, chiropractic, physical therapy, massage, and acupuncture without any long-term relief. She was pretty hopeless when we first performed an evaluation. We were able to quickly identify that the right C2-C3 joint had been injured. Radiofrequency treatment took her pain down from an 8-9/10 to 0-1/10 (from miserable to just a slight intermittent discomfort). She now comes in for RF treatments about once a year and between those treatments she’s returned to horseback riding and running her ranch by herself.
So if you have chronic neck pain from a car crash that’s not getting better, you shouldn’t loose hope. There are a host of treatments that can give you long-term relief and give you your life back!