The Biomechanics of Whiplash

King, Albert I.

doi:10.1007/978-3-319-49792-1_8

Albert I. King²

1805 Accesses

Abstract

Up until the advent of active safety systems, rearend collisions are a common occurrence, especially on busy urban roads where drivers are distracted, going too fast, and in a hurry. The most common scenario is the impact of a car stopped at a red light or on the roadway by the car behind it. The impacted vehicle is accelerated forward and the seatbacks push the torso of the occupants forward as well. Without a headrest in contact with the head, the head is left behind until shear forces are developed at each cervical vertebral level to bring the head forward along with the torso. This delay results in hyperextension of the head and neck or in whiplash. Many whiplash victims complain of neck pain, some for a few days or weeks, while others develop chronic pain syndromes that are difficult to treat. The problem is aggravated by our legal system which allows plaintiffs to sue for damages without having to pay their attorney in advance. Safety engineers are thus faced with a challenge to prevent this injury. Prior to the availability of an active pre-collision braking and warning system, the only recourse was to install headrests to prevent hyperextension. The federal government required these headrests to be installed in passenger cars in 1969, but complaints of neck pain did not abate. This called for research into the causes of neck pain due to whiplash because it became obvious that it is difficult to prevent an injury if the cause is not well understood. Additionally, without knowing the cause, it is also difficult to treat whiplash-related neck pain. Usually, there is little that can be seen from CT or MRI scans to indicate the source of the pain.

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Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
Albert I. King

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Appendices

Questions for Chapter 8

8.1.
Whiplash is a difficult biomechanical problem. One of the following hypotheses is likely to be valid:
1. [ ] (i)
  Pain is due to impingement of the facet capsule by the facet joint surfaces
2. [ ] (ii)
  Pain is due to a transient increase in pressure in the spinal canal
3. [ ] (iii)
  Pain is due to neck shear and relative vertebral body rotation, causing facet capsule stretch
4. [ ] (iv)
  Pain is due to injury to the extensor muscles of the neck
5. [ ] (v)
  Pain is due to extensor muscle stretch during head rebound after whiplash
8.2.
In a mild rearend collision (less than 15 km/h), the neck undergoes a variety of motions. Select the incorrect answer:
1. [ ] (i)
  Initially the upper cervical spine is in flexion and the lower cervical spine is in extension
2. [ ] (ii)
  There is no axial compression of the neck
3. [ ] (iii)
  The facet capsules are stretched to over 50% in some cases
4. [ ] (iv)
  Towards the end of the impact, the entire cervical spine is in extension
5. [ ] (v)
  Without a headrest, a shear force is transmitted across each vertebral level to move the head forward
8.3.
Intractable neck pain following a rearend impact could be due to one of the following reasons. Select the correct answer:
1. [ ] (i)
  Injury to the neck muscles
2. [ ] (ii)
  Disc rupture caused by the rearend impact
3. [ ] (iii)
  Pain coming from the facet capsules
4. [ ] (iv)
  Damage to the nerve roots and the dorsal root ganglion
5. [ ] (v)
  Severe hyperextension of the neck
8.4.
Neck injury is a multi-faceted problem . Only one of the following is valid:
1. [ ] (i)
  The injury mechanism is the same for all directions of impact—Disc rupture
2. [ ] (ii)
  Tolerance to whiplash is not the same as that due to a compression-flexion load
3. [ ] (iii)
  The headrest has been effective in preventing whiplash injuries
4. [ ] (iv)
  Airbag deployment in front of an out-of-position occupant imposes a severe compression load on the neck
5. [ ] (v)
  In side impact, neck injury is more common than head injury
8.5.
For neck injury, only one of the following is valid:
1. [ ] (i)
  The injury mechanism is the same for all directions of impact—Disc rupture
2. [ ] (ii)
  Tolerance to whiplash is the same as that due to a compression-flexion load
3. [ ] (iii)
  The headrest has been effective in preventing whiplash injuries
4. [ ] (iv)
  Airbag deployment in front of an out-of-position occupant imposes a severe compression load on the neck
5. [ ] (v)
  Whiplash pain is not necessarily an injury
8.6.
For neck injury due to whiplash , only one of the following is NOT valid:
1. [ ] (i)
  Disc rupture does not occur
2. [ ] (ii)
  Tolerance to whiplash is the same as that due to a compression-flexion load
3. [ ] (iii)
  The headrest has not been effective in preventing whiplash injuries
4. [ ] (iv)
  Airbag deployment in front of an out-of-position occupant can impose a severe tensile load on the neck
5. [ ] (v)
  Whiplash pain is not necessarily an injury
8.7.
Several hypotheses have been proposed as the cause of neck pain due to whiplash. Select the correct answer:
1. [ ] (i)
  Injury to the nerve roots and dorsal root ganglia because of pressure in the spinal canal
2. [ ] (ii)
  Injury to the synovium of the facet joints due to facet impingement
3. [ ] (iii)
  Injury to the posterior neck muscles due to head extension
4. [ ] (iv)
  Injury to the facet capsules of the cervical vertebrae due to shear
5. [ ] (v)
  Injury to the intervertebral discs due to compression of the neck
8.8.
High-speed X-ray data of neck motion during whiplash provided some important results. Select the incorrect answer:
1. [ ] (i)
  There is relative rotation between adjacent vertebrae
2. [ ] (ii)
  There is relative translation between adjacent vertebrae
3. [ ] (iii)
  There is no compression of the neck
4. [ ] (iv)
  There is significant facet capsule stretch
5. [ ] (v)
  Initially the upper cervical spine is in flexion and lower cervical spine is in extension
8.9.
Work on whiplash has included the following studies. Select the incorrect answer:
1. [ ] (i)
  Development of headrests that can prevent neck shear
2. [ ] (ii)
  A more detailed study of the facet capsule to determine if it is actually torn
3. [ ] (iii)
  A more detailed study of muscle response to whiplash
4. [ ] (iv)
  A neurophysiological study of the pain response of soft tissues of the neck
5. [ ] (v)
  Testing of volunteers in cars simulating severe rearend impacts
8.10.
The reasons why the pressure hypothesis for whiplash injury is suspect are:
1. [ ] (i)
  Pressure down the spinal canal should affect all levels of the cervical spine and yet only the lower cervical spine is frequently painful after whiplash
2. [ ] (ii)
  Pressure on the nerve roots can cause numbness in the upper extremities but not pain
3. [ ] (iii)
  Pressure on the dorsal root ganglion cannot cause neck pain but can cause upper extremity pain
4. [ ] (iv)
  Pressure on the nerve roots that lasts for less than a second should have no effect on these roots
5. [ ] (v)
  All of the above
8.11.
The reasons why the muscle hypothesis for whiplash injury is suspect are:
1. [ ] (i)
  Extensor muscles cannot be injured during head flexion
2. [ ] (ii)
  Flexor muscles cannot be injured during head extension
3. [ ] (iii)
  Muscle pain is usually in the back of the neck and extensor muscles are in concentric contraction during whiplash
4. [ ] (iv)
  Muscle pain in the front of the neck is usually long lasting and severe
5. [ ] (v)
  None of the above
8.12.
The reasons why the facet impingement hypothesis for whiplash injury is suspect are:
1. [ ] (i)
  The synovium has not been shown to contain nociceptors
2. [ ] (ii)
  The cartilaginous articular surfaces of the facets are devoid of nociceptors
3. [ ] (iii)
  The facet capsule is too thick for it to be pinched by the facets
4. [ ] (iv)
  There is no histological evidence that there are nociceptors in the synovium at the facet joint line
5. [ ] (v)
  All of the above
8.13.
The reasons why the shear hypothesis for whiplash injury is valid can be one or more of the following:
1. [ ] (i)
  To move the head forward along with the rest of the body, a shear force needs to be transmitted up the cervical spine from C7 to the occiput
2. [ ] (ii)
  The shear will not result in relative translation of adjacent vertebrae
3. [ ] (iii)
  The shear will not result in relative rotation of adjacent vertebrae
4. [ ] (iv)
  The shear will be resisted effectively by the facets because the facet joint line is almost vertical
5. [ ] (v)
  All of the above
8.14.
Several hypotheses have been proposed as the cause of neck pain due to whiplash. Select the correct answer:
1. [ ] (i)
  Injury to the nerve roots and dorsal root ganglia because of pressure in the spinal canal
2. [ ] (ii)
  Injury to the synovium of the facet joints due to facet impingement
3. [ ] (iii)
  Injury to the posterior neck muscles due to head extension
4. [ ] (iv)
  Injury to the facet capsules of the cervical vertebrae due to shear
5. [ ] (v)
  Injury to the intervertebral discs due to compression of the neck
8.15.
In the whiplash study by Deng et al. (2000), the following statement is true:
1. [ ] (i)
  Volunteer test subjects were used
2. [ ] (ii)
  High-speed X-rays at 90 frames/second were taken
3. [ ] (iii)
  All cervical vertebrae were visible in the X-ray videos
4. [ ] (iv)
  The data obtained from this study can be the basis for a whiplash dummy neck
5. [ ] (v)
  None of the above
8.16.
In the whiplash study by Deng et al. (2000), the following parameter was not measured:
1. [ ] (i)
  Relative translation of adjacent cervical vertebrae
2. [ ] (ii)
  Relative rotation of adjacent cervical vertebrae
3. [ ] (iii)
  Surface deformation of the cervical facet capsules
4. [ ] (iv)
  Instant of contact of the head with the headrest
5. [ ] (v)
  Shape of the cervical spine during whiplash
8.17.
In the study by Deng et al. (2000), identify the incorrect statement below:
1. [ ] (i)
  The seatback angles used were 10 and 30 degrees
2. [ ] (ii)
  Bony landmarks were used to measure the stretch of the facet capsule
3. [ ] (iii)
  The X-ray images were acquired at 250 frames/second
4. [ ] (iv)
  The measured facet strain exceeded 60% in some cases
5. [ ] (v)
  Tungsten spheres were used to identify and measure vertebral motion
8.18.
Identify the incorrect statement
1. [ ] (i)
  There have been many volunteer tests to study the whiplash phenomenon
2. [ ] (ii)
  Cadavers were used in the whiplash study by Deng et al. (2000)
3. [ ] (iii)
  Ono et al. (1997) used a high-speed X-ray system that ran at 1000 frames/second
4. [ ] (iv)
  Two separate whiplash studies using a high-speed X-ray unit were conducted at Wayne State University
5. [ ] (v)
  Ono et al. (1997) were not able to provide relative motion data between vertebrae
8.19.
Tolerance of the neck to whiplash
1. [ ] (i)
  can be estimated from the N_ij criterion proposed by NHTSA
2. [ ] (ii)
  does not exist because the symptoms depend on the state of spinal degeneration
3. [ ] (iii)
  is the same for males and females
4. [ ] (iv)
  has been studied extensively by researchers
5. [ ] (v)
  None of the above
8.20.
Headrests are installed above the seatback of car seats. Identify the incorrect statement:
1. [ ] (i)
  They were initially mandated by the NHTSA to prevent hyperextension of the head and neck
2. [ ] (ii)
  They were initially recommended to be placed 10 cm behind the occupant’s head by the Insurance Institute for Highway Safety
3. [ ] (iii)
  They are now adjustable and can be placed very close to the back of the head
4. [ ] (iv)
  They are to be installed in the lowest position possible above the seatback
5. [ ] (v)
  In the Volvo, a mechanical system translates the seatback rearward and reclines it, minimizing occupant acceleration

Answers to Problems by Chapter

Prob	Ans
1	(iii)
2	(ii)
3	(iii)
4	(ii)
5	(v)
6	(ii)
7	(iv)
8	(iii)
9	(v)
10	(v)
11	(iii)
12	(v)
13	(i)
14	(iv)
15	(iv)
16	(iii)
17	(i)
18	(iii)
19	(ii)
20	(iv)

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King, A.I. (2018). The Biomechanics of Whiplash. In: The Biomechanics of Impact Injury. Springer, Cham. https://doi.org/10.1007/978-3-319-49792-1_8

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DOI: https://doi.org/10.1007/978-3-319-49792-1_8
Published: 22 July 2017
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-49790-7
Online ISBN: 978-3-319-49792-1
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