According to a report published by the National Highway Traffic Safety Administration (NHTSA) in 2018, over 6,700,000 motor vehicle crashes are reported each year. And those are just the incidents that the police know about! So the number is actually much higher.
The most common problem that results from a car crash is injury to muscles that move various joints, the ligaments that hold those joints together, and the joints themselves. When such injuries occur in the neck, they are commonly referred to as whiplash injuries (so named because the injuries are caused by a whip-like motion of the head on the neck).
Whiplash and Concussion: Same Mechanism
Whiplash injuries occur because muscles, ligaments and joints cannot easily withstand the forces they are placed under as a result of the crash. So, something has to give, and this causes tears in these tissues. Tears to ligaments are called sprains and tears to muscles or muscle tendons (which attach muscle to bone) are called strains. However, it’s important to understand that the same mechanism of injury that causes whiplash injuries can also cause concussion. In fact, over the past 10 years, there’s been a growing awareness among health care professionals that concussion due to car crashes is much more common than most people have realized.
You might think that you have to hit your head to get a concussion. However this is not necessarily true. A blow to the head causes a concussion because the energy of the blow causes acceleration of the head, and along with it, the brain within the skull. This same acceleration can result from the whiplike motion of the head on the neck in a car crash (see Fig. 1). Whether you receive whiplash injuries or both whiplash injuries and concussion depends on the forces generated during the collision. It takes greater force to produce whiplash and a concussion.
Fig. 1. The acceleration of the head on the neck that occurs in a motor vehicle collision not only damages soft tissues of the neck but also accelerates the brain within the skull, which may--depending on the amount of force generated--cause a concussion.
What is a Concussion?
Concussion is a form of brain injury that causes a temporary disturbance in normal brain functions. In the best circumstances, the symptoms of concussion last 10-14 days, although it can take 30-45 days for the brain to recover fully. Children and those with a prior history of concussion or who have problems with anxiety and depression often take longer to recover. It’s extremely unlikely, in most cases, for a concussion to cause “permanent damage” to your brain. However, the likelihood of lasting damage increases if you sustain another concussion before your brain has fully recovered from the first injury. This is most relevant in return-to-play decisions for an athlete involved in contact sports. Nevertheless, it is something to be aware of and is a striking reminder of the fact that the absence of symptoms does not necessarily mean you have achieved full recovery.
How Do You Know if You Have a Concussion?
There is no one test that can be used to diagnose a concussion.The diagnosis is made based on physical exam findings by a qualified healthcare provider and the presence of various symptoms. You should suspect a concussion after a blow to the head or body or acceleration of the head on the body due to a car crash or even a bad fall if you experience one or more of the symptoms shown in Table 1:
Table1. The common symptoms associated with concussion (by category).
When Should You Go to the Emergency Room?
The majority of concussions do not require a visit to the emergency room. However, there are certain warning signs--or red flags--to be aware of. These red flags, shown in Table 2, suggest a more serious injury such as a skull fracture or a brain bleed. In their presence you should go to an emergency room immediately.
Table 2. In the presence of these warning signs it is necessary to get to the nearest emergency room as soon as possible.
What to Do and Not to Do When You Suspect You Have a Concussion
Here’s a list of action steps to take when you suspect you have a concussion:
Whiplash and Concussion Share Similar Clinical Characteristics
Immediately after a car crash, it may not be apparent whether you have sustained a whiplash injury and a concussion or just a whiplash injury. The reason for this is that the two conditions share similar characteristics clinically. The following common signs and symptoms can occur with both types of injuries:
Problems of thought and emotion
Balance problems and dizziness
Abnormalities in the control of eye movements
Abnormalities in blood flow to the brain
This is why it’s wise to seek help from a chiropractic physician or other provider who knows how to assess and manage both concussion and whiplash injuries based on objective findings.