Research regarding whiplash or whiplash associated disorders (WAD) classically focuses on neck pain; however, the data show acute thoracic spine / mid-back pain (MBP) occurs in 66% of WAD injures with 23% still complaining of MBP at one-year post-injury.
It’s easy to visualize how the cervical spine or neck can be injured in an automobile collision (or sport-related collision or a fall) as the head, which weighs an average or twelve pounds, whips back and forth in a “crack-the-whip” like manner, often well beyond the normal, physiological range of motion. This same stretching (eccentric loading) followed by compression (concentric loading) also occurs in the mid-back, which can injure ligaments, joint capsules, neural structures, and more. Also, the thoracic spine contributes to 33% of flexion and 21% of rotation IN THE NECK, making the mid-back a vital spinal region that facilitates neck movement and function!
In WAD cases, mid-back pain often hides in the shadows of a more obvious and often more serious neck injury, as the brain typically perceives pain from the greatest source. Additionally, the neuronal input to the sensory cortex of the brain (the area of the brain that perceives pain) is most highly represented from the head, hands, and feet and less from the mid-back or torso.
The seat belt may also contribute to injury—both to the anterior chest region including rib cage, sternum, breast tissue, abdominal organs, as well as to the mid-back. The oblique angle of the chest-restraint is an important factor when discussing the mechanism of injury, as it causes trunk/torso rotation during the rebound or flexion phase of WAD. Another mechanism of injury includes blunt trauma, of which the driver is especially at risk due to the close proximity of the steering wheel and the chest. This can lead to contusion or bruising, fracture, and/or injury to the abdominal and/or chest organs (heart and lungs).
Obviously, the speed of impact, angle of the collision, bracing of the person (or lack thereof), and overall physical condition of the patient can greatly affect the outcome of WAD-related injuries. The importance of assessing the whole person is essential in obtaining an accurate diagnosis and establishing a comprehensive treatment plan for the WAD patient.
Chiropractic management focuses on the entire person, frequently uncovering complaints in other spinal regions as well as in the extremities in WAD-related injured patients. Moreover, treating postural issues such as a short leg, ankle pronation, oblique pelvis, forward head posture, protracted shoulders, and more is vitally important in obtaining satisfying patient outcomes!