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SOMATIC RESEARCH overstretching. The overstretching of the sternocleidomastoid, longus capitus and coli, and scalenes, combined with forceful contractions in the same muscles, result in muscle strain injuries. Ligamentous lesions are best explained through the shearing forces. As the lower neck begins to extend, the neck assumes an S-shaped curve. Gradually, the upper neck is forced to fl ex, which results in the loss of cervical lordosis.12 The rapid hyperextension/ hyperfl exion, especially when combined with rotation (looking into the rearview mirror upon impact), results in compressing and shearing forces strong enough to tear facet capsules, annular fi bers of vertebral discs, capsular ligaments, and nerve roots, and can cause vertebral fractures and vertebral artery lesions.13 It is the trauma to the paravertebral ligaments, discs, and nerves that results in cognitive and neurological dysfunction and primarily contributes to chronic pain.14 To illustrate the point, I'd like to share a story. Chiropractor Dan Murphy spoke at a whiplash seminar that I attended recently in Seattle. He told the story of a patient who had been complaining of severe headaches since an MVC. He placed the X-ray of the patient's head on the overhead projector, showing a pen lodged in the man's brain. The man's head was slung so far forward that the pen in his shirt pocket went right up his nose and embedded in his brain. And it occurred so quickly that he was completely unaware of what had happened. I no longer question the magnitude of an overstretching injury resulting from a car collision. Brain trauma is another component of WAD, and not just from pens. Overstretching of the neck that occurs during whiplash places extreme traction forces on the spinal cord. These forces can cause contusions at the base of the brain, as the spinal cord is stretched beyond capacity and the brain is pulled Whiplash clients often complain that it feels like their head will fall off, increasing the intensity of the muscle guarding associated with inflammatory conditions. into the foramen magnum. Concussions can also occur as the head is whipped from hyperextension into hyperfl exion. Inertia—the principle that an object in motion will remain in motion until acted on by another force—explains the brain's collision with the skull as the head changes direction before the brain catches up with the shift. In other words, you can get a concussion without the head hitting anything inside the car. Temporomandibular joint disorder (TMJ) is a common concomitant dysfunction of a whiplash injury, also explained through the principles of inertia.15 The jaw is moving through space with the head, but as the head reverses direction, the jaw continues to move forward. The force with which the jaw catches up with the head, due to the stretch refl ex and magnifi cation of acceleration, can crack teeth, tear masseters and pterygoids, and dislocate jaws. Other factors potentially increase the severity of a whiplash injury, such as the size and speed of the vehicles (bigger cars hit harder), the acceleration over time, or G-force, as well as the friction created by road conditions (wet roads allow for greater acceleration). Gather this information to better understand the mechanisms in play that may have complicated the client's injury. It is important to understand that energy can be transformed into several things during a car crash: noise, tire marks, car damage, or physical injury. Less car damage can mean more physical injury; things are not always what they appear on the surface. While the presence of any of these things may increase the odds of acute injury, none of them infl uence the chances of suffering from chronic WAD.16 Today's car manufacturers are making strides in decreasing the risk of injury, but there are still issues.17 Safety and comfort features can have contradictory results. Seat belts have decreased death rates but increased soft-tissue trauma; by stabilizing the body, they increase the movement of the neck and head. Shoulder harnesses increase trunk torsion as one shoulder is stabilized and the other rotates around the strap. This can result in thoracic trauma and explain the increasing occurrence of shoulder surgeries. Visceral lesions can be caused by submarining: the seat belt slips over the iliac crest and penetrates the abdomen. Air bags save lives, but can cause head injuries as the head bounces on the air bag, especially with shorter people. Comfortable car seats are springy, resulting in knee injuries as hyperextension loads the 118 massage & bodywork september/october 2011