Acupuncture and Whiplash

The term whiplash (neck pain from an acceration/deceleration injury) in Traditional Chinese Medicine (TCM), encompasses pain and discomfort or weakness in one or both sides of the upper thoracic, cervical spine and head regions. The nature of pain could be stabbing, burning, and/or contracting, and is often associated with stiffness and numbness.

Whiplash is caused by a physical trauma which usually causes injury to the soft tissue of the neck and upper back, and often, even to the mid back and lower back. Traumatic injury can lead to acute stagnation of Qi (energy) and blood in the local channels and collaterals of the above areas. The nature of pain is usually sharp, stabbing and fixed. It is also often aggravated with activity and movement and ameliorated by ensuring free circulation of the Qi and blood in the body.

Over the years, acupuncture has developed an excellent reputation as a treatment for relieving pain. Many doctors are starting to refer patients for acupuncture after a whiplash injury and most patients are starting to take more responsibility of their own health and are starting to seek out acupuncture and chinese medicine treatment for themselves.

Acupuncture can help Whiplash in the following ways:

• relieves pain completely, or significantly (gives the patient as much relief as possible)
• improves the patient’s ability to deal with their whiplash injury
• helps regulate an individuals emotions i.e. depression, anxiety, fear, worry and sadness are common emotions someone may feel after a whiplash injury
• increases an individual’s energy levels
• helps an individual deal with their activities of daily living (ADL’s), by increasing the ability to perform tasks that have become difficult since the injury
• enhances the patient’s quality of life
• reduces reliance on prescription medication and prevents associated side effects.

The basic premise about pain in Chinese Medicine is: ” If there is free flow, there is no pain; however, if there is a disruption in the free flow of Qi and blood circulation, then pain occurs. The circulation of Qi and blood in the body should be constant, just like the coming and going of the ocean’s tide.

Qi is the commander of blood, whereby Qi circulation leads to blood circulation.  Similarly, Qi stagnation causes blood stagnation. During a whiplash injury, Qi stagnation and blood stasis occur, leading to damage of the tendons and muscles, along with abnormal joint movement. The longer that the stagnation of Qi and blood persist, the more complications are seen. The body fluids are also affected which results in Turbid Phlegm obstructing the free flow in the meridians. In such cases, blockage occurs in the channels and collaterals, followed by numbness, pain, diminished skin and muscle sensitivity, joint pain etc.

Also, if a whiplash injury persists and becomes chronic, then this will end up affecting the liver and kidneys. In TCM, since the liver stores the blood, and the kidneys store the essence, any deficiency of the liver and kidneys will affect the tendons and bones due to lack of nourishment. This leads to chronic neck pain, lower back pain, or pain in other joints. Other symptoms include weakness of the body, feeling tiredness, poor concentration, dizziness, tinnitus, thin tongue coating and deep, weak pulse.

For whiplash occuring during a car accident, the ten most reported symptoms with their estimated prevalence, are: neck pain (97%), headache (97%), TMJ (82%), shoulder pain (65%), anxiety (55%), back pain (42%), depression (41%), visual symptoms (blurred vision) (35%), and dizziness (23%)⁽¹⁾. Clinical investigation often reveals cervical strain, muscle tears, and/or rupture of ligaments, cervical disc herniation, cervical spine fracture and cervical facet-joint injury. Acupuncture has been found to be very effective in alleviating all of the symptoms mentioned above and helping to accelerate the healing process in all of the conditions listed.

One study by Rabl V, et al, focused on the effect of acupuncture on 153 patients suffering from pain, edematous conditions, and impaired movement following traumas sustained in accidents. Following a standardized acupuncture program, there was a significant improvement in all nine groups within the total sample of patients.⁽²⁾

Even auricular acupuncture was found to be effective at alleviating symptoms post whiplash.  This was demonstrated in a study of 30 whiplash patients by Hertz H, et al.⁽³⁾

Another study focused on 27 patients and an associate control group of 25 patients, who were treated with either a combination of non-steroidal anti-inflammatory drug and myorelaxation or with physiotherapy only (Fattori, et al⁽⁴⁾.  Through the use of computerized static posturography the postural changes after acupuncture treatment, were evaluated. Acupuncture was specifically performed on the following points: bilaterally Tianzhu (BL 10) and Fengchi (GB 20), twirled manually for 20 seconds. The study demonstrated a considerable difference between the two groups with respect to the reduction of the CE (close eye) and CER length of the statokinesigram just before each session of acupuncture; the frequency oscillation on the sagittal plane in CER was reduced in the study group, however, in the control group there was a progressive increase of CE and CER length values. This big difference between groups clearly supports the use of acupuncture for balance disorders due to whiplash injury.

Since 1998, we have witnessed the effectiveness of acupuncture on a variety of whiplash patients, seeing a hastened recovery for a large percentage of them and a significant reduction in symptoms, of pain, headache, fatigue, depression and dizziness.

Whiplash Injury from a Traditional Chinese Medicine (TCM) Perspective

In TCM, whiplash injuries are viewed as one or a combination of three types of tendon problems: (1) “Jing Wai (tendon deviated)”, (2) “Jing Zhou (tendon in abnormal position)” and (3) “Jing Jie (tendon knotted)”.  At a further level, each separate problem can be described and categorized by three types of observable symptoms: (1) Yangming Type (inability and/or difficulty with neck rotation), (2) Shaoyang type (discomfort with holding the neck and feeling of pulling sensation during neck rotation) and Taiyang type (muscle tightness and spasm of the neck). These three conditions are considered to be musculo-tendino channels lesions and each have very specific acupuncture points associated with them.

TCM dictates that energy (called “Qi” and pronounced as “chi”) travels throughout the body in meridians. Qi is the life force that animates the body, being responsible for the energy source to all organs, cells, tissues and structures in the body. During a strain and/or sprain, Qi is shocked, then moves quickly, causing congestion and stagnation. When this Qi stagnation occurs, blood circulation is impeded, leading to blood coagulation (blood stasis).

This then leads to a disorder of all body fluid metabolism. This, in turn, gradually causes the body to produce Turbid Phlegm, which then blocks enery flow in certain meridians. In the case of whiplash, the energy blockage is the reason behing typical patient complaints of pain and numbness of the neck and extremities.

Another possible result of whiplash is the formation of blood clots which decrease blood circulation and ultimately impair liver function. If left untreated for a long time, even the kidney is affected,which leads to kidney Insufficiency. This, in turn, causes neck pain, muscle weakness, blurred vision and vertigo.

If Qi and blood stagnation are present for an extended period of time, the symptoms of fatigue and chronic pain will develop.

TCM Treatment for Whiplash Injuries

When providing acupuncture treatment for whiplash, regarding the selection of specific acupuncture points to be used, one must consider several factors:

1. the specific meridian system affected, which is usually the musculo-tendino meridian system
2. pattern differentiation
3. local symptoms reported and observed
4. the effectiveness of acupuncture pointe combinations including both distal and local points
5. the combination of acupuncture points in body meridians and auricular acupuncture points
6. the combination of acupuncture with stretches, Tui Na therapy, and a variety of physiotherapeutic treatment modalities such as joint mobilization, myofacial technniques, energy work and soft tissue work.

Treating the Musculo-Tendino Meridian System with Acupuncture

Often, right after whiplash, the client is very limited in their neck range of motion. Limited neck rotation as mentioend previously is regarded as a Yangming Type lesion which is treated by using the Luozhen (Ex.) point. If neck side flexion is restricted and the client has difficulty holding the neck straight and feels a pulling sensation with neck rotation, then it would be considered a Shaoyang type of lesion and Waiguan (SJ5) is selected as a point.  Finally, if there is increased muscle spasm and tightness with limitations of neck flextion and extension, it would be considered a Taiyang type lesion and Houxi (SI 3) is used.

Pattern Differentiation and Acupuncture

In the Acute Stage (two to five days), there are two types of problems, Qi Stagnation and Blood Stasis.

(1) Qi Stagnation

Symptoms include : neck (unilateral or bilateral), shoulder and upper back pain, soreness and heaviness in the upper extremities (which is usually worse with cold and better with heat), temporal and occipital pain, moving or wandering pain, neck muscle tension, limited neck range of motion, fluctuating emotions, headaches, insomnia, feelings of by anxiety and sometimes even panic. Patients usually present with a slightly purple hue on their tongue and palpation often reveals a wiry pulse.

Acupucture point selection for this condition would include : Neiguan (P6), Taichong (Liver 3), Fengchi (GB 20), JianJing (GB21), Waiguan (TW5), Zulinqi (GB41), JiaJi points between C5-C7.

If there is referred pain to the back of the shoulder, the acupuncture point SI 4, can be very effective (the source point) and SI 12  is often used to harmonize the collaterals and relieve the pain. If there is insomnia and/or anxiety, H7 is very helpful. If there is depression, Liver 14 is very effective.  If dizziness is reported, the Wangu (GB 12) point can help. Other effective points may include : Tianzhu (BL 10), Bingfeng (SI 12), Jianwaishu (SI 14), Jianzhongshu (SI 15), Hegu (LI 4), and Lieque (LU 7).

Electrical stimulation of points with an acuscope and heat to the are with a heat lamp, complement a treatment session well.

(2) Blood Stasis

Symptoms include : stabbing and burning pain in the neck and upper extremity, pain in a fixed location, which is increased at night and intensified with pressure, numbness or a tingling sensation in the fingers, headache and vertigo. Patients usually present with a dark and purple tongue with a blue hue to spots at the sides of the tongue.  Palpation often reveals a wiry or choppy pulse.

Acupuncture point selection includes: Hegu (LI4), Sanyinjiao (SP6), Houxi (S13), Waiguan (TW5), Dazhui (GV14), Shenmai (BL62), Fengchi (GB20), Jianjin (GB21) Feiyang (BL58), JaiJi points C5-C7.  If there is severe pain at night, add BL17 to circulate the blood and eliminate blood stasis. If neck is stiff, add GB34 to relax the tendons and relieve the stiffness. If there is restlessness due to severe discomfort, add BL15 and H7 to calm the mind.

Other effective points include : Tianzhu (BL 10), Dazhui (GV 14), Geshu (BL 17), Hegu (LI 4), Houxi (SI 3), Baxie (Ex.). Sometimes, auricular points can also be used for cases of intense pain and even cupping can be helpful to calm things down.

Chronic Stage

(1) Turbid Phlegm Blockage

Symptoms include : history of whiplash injury, neck stiffness accompanied by a pulling sensation, upper extremity heaviness, numbness in the finger tips, dizziness and nausea, and neck pain aggravated by humidity and changes in barometric pressure. Patients usually present with a thick and sticky coating on the tongue and palpation often reveals a slippery pulse.

Acupuncture point selection includes: the cervical Jiaji points, Jianyu (LI 15), Shousanli (LI 10), Hegu (LI 4), Neiguan (PC 6), Zhongwan (CV 12), Pishu (BL 20), Sanjiaoshu (BL 22), Fenglong (ST 40), Sanyijiao (SP 6), and sometimes cupping over the posterior trapezius muscle.

(2) Liver & Kidney Insufficiency

Symptoms often include : a history of whiplash injury, soreness and weakness in the neck, tinnitus, vertigo, blurring vision, hot flashes, a dry throat, insomnia, dream-disturbed sleeping, irritability, poor sitting and standing tolerance, soreness in the waist and in the knee joints, finger numbness and muscle spasms, along with tightness in the upper and lower extremities. Patients usually present with redness on their tongue, and less coating. Palpation often reveals a wiry and rapid pulse.

Acupuncture point selection includes: Jiaji (Ex.) points on the cervical spine, Jianjin (GB 21), Tianzong (SI 11), Sidu (SJ 9), Zhigou (SJ 6), Baxie (Ex.), Geshu (BL 17), Ganshu (BL 18), Shenshu (BL 23), Shenmai (BL 62), Xuanzhong (GB 39), and Sanyinjiao (SP 6). The Sishencong (Ex.) point is used for vertigo and the Yanglingquan (GB 34) point is used for spasm and tightness of the extremities.

(3) Qi & Blood Deficiency Type

Symptoms often include : a history of whiplash injury, a lingering soreness and achiness in the neck region, tiredness and fatigue, pale complexion, soft or inaudible speech, poor appetite and a loose stool. Patients usually present with a pale tongue color with thin coating, and palpation often reveals a deep and thready pulse.

Acupuncture point selection includes: Jiaji (Ex.) points on the cervical spine, Jianyu (LI 15), Jianliao (SJ 14), Quchi (LI 11), Shousanli (LI 10), Hegu (LI 4), Guanyuan (CV 4), Qihai (CV 6), Zusanli (ST 36), and Sanyinjiao (SP 6).

Acupuncture Treatment of Local Symptoms

(1) Neck pain

Depending on the speicific location of pain, there a variety of points that can be used:

• Pain of the lateral part of vertebra: Tianzhu (BL 10)
• Pain due to the injuries of the supraspinous and interspinous ligament: Shuigou (GV 26) or Houxi (SI 3)
• Pain due to spasm of levator scapula: Jianwaishu (SI 15) and Quyuan (SI 13)
• Pain due to spasm of the trapezius muscle: Jianjin (GB 21), Tianliao (SJ 15) and Xinshu (BL 15)
• Pain due to spasm of the sternocleidomastoid (SCM) muscle, Fengchi (GB 20), Futu (LI 18) and Hegu (LI 4)
• Difficlutly with cervical extension/flexion: Dazhu (BL 11) and Houxi (SI 3)
• General stiffness: Fengchi (GB 20) and Jianwaishu (SI 15)

(2) Shoulder pain

• Referred pain in the scapular area: Jugu (LI 16)
• Pain in the anterior aspect of the shoulder: Jianyu (LI 15)
• Pain in the lateral aspect of the shoulder: Jianliao (SJ 14)
• Pain in the posterior aspect of the shoulder: Naoshu (SI 10)
• Difficulty with raising the arm: Binao (LI 14)

(3) Headache

• Occipital headache: Yuzhen (BL 9), Kunlun (BL 60)
• Temporal or migraine headache: Shuigu (GB 8), Zulinqi (GB 41)
• Frontal headache: Yangbai (GB 14), Hegu (LI 4)

(4) Temporal mandibular joint (TMJ)

If a patient complains of discomfort or pain around the temporo-mandibular joint, the Xiaguan (ST 7) and Ermen (SJ 21) acupuncture points can be used.

References

1. InjuryResources.com
2. Rabl V, et al, he effect of Standardized Acupuncture Program in the Aftercare of Accident Patients, Unfallchirugie, 1983, 9(6):308
3. Hertz H, et al, Treatment of Whiplash Injuries of the Cervical Spine with Acupuncture, Aktuelle Traumatol 1983, 13(4):151
4. Fattori B, et al, Acupuncture Treatment of Whiplash Injury, Int Tinnitus, 2004:10 (2), p.156-160