The Resistant Whiplash Case

Patients who have experienced cervical trauma from whiplash dynamics often have perplexing symptoms. This leads some doctors who do not evaluate function to conclude that poor response to therapy is psychogenic and often related to the patient's conscious or subconscious effort to gain in the medicolegal process. This attitude is aptly demonstrated by one author's comment after a short description of headache due to whiplash dynamics: "But many do not respond until the legal process has been concluded, and even then they may refuse to give up their symptoms."¹

The standard orthopedic and neurologic examination often does not find a cause for the bizarre symptoms about which some patients complain. Manual muscle testing is a method for evaluating the function of the nervous system; it often reveals the cause, giving an understanding of the patient's many complaints. The therapeutic requirement may fall outside the expertise of the usual orthopedic specialist or neurosurgeon.

Manual muscle testing is the method of testing functional neurology in applied kinesiology. Normally there is predictable facilitation and inhibition of muscle function. A common cause of many whiplash symptoms is neurologic disorganization. This was recognized early in applied kinesiology and was termed "switching," which describes the change of test results from that which would be expected. A common cause of neurologic disorganization in whiplash cases is different signaling coming from the visual righting, labyrinthine, and head-on-neck reflexes. This neurologic mechanism was described by B. Spector⁴ in 1948 as the underlying cause of some types of vertigo and nausea, but he provided no therapeutic approach for correction.

The visual righting, labyrinthine, and head-on-neck reflexes are responsible for evaluating and maintaining the body's orientation in space. If all three reflexes are not providing the same information about the body's orientation, this neurologic disorganization produces the misdirected effort known as dysponesia.⁶ This happens when one reflex is indicating the head is level and another that it is tilted.

The head-on-neck reflexes come from the equilibrium proprioceptors located in the upper cervical ligaments and can be disturbed by subluxations or fixations of these vertebrae. The visual righting and labyrinthine reflexes may be disturbed by cranial faults as a result of either the whiplash dynamics or a blow to the head during the accident.

Neurologic disorganization due to equilibrium proprioceptive dysfunction can readily be examined by applied kinesiology methods. Entrapment of cranial nerve III, IV, or VI may be responsible for disturbed binocular function² leading to disorganization from the visual righting reflex. This is observed by simply having the patient visually track the examiner's finger around a circle. An eye saccade, which means a jerky movement, is indicative of poor binocular activity. A positive test is when a previously strong muscle testing weakens following the eye motion. Proper cranial correction will eliminate the positive test and improve binocular activity.⁵

When a previously strong muscle weakens with a change in head position, there is probably disturbance in the labyrinthine or head-on-neck reflexes. Cranial fault correction will improve the labyrinthine reflex, while correction of an upper cervical fixation or subluxation will eliminate the head-on-neck reflex dysfunction.

Eliminating disorganization between the equilibrium proprioceptors, when present, is paramount in obtaining optimal results in the whiplash case. Failure to recognize this problem and correct it is often the reason a patient is labeled as being a malingerer or having a psychoneurotic overlay to his condition.

References

1. Dalessio, D.J. Revision of "Posttraumatic headache," in Wolff's Headache and Other Head Pain, 4th ed., ed. D.J. Dalessio. New York: Oxford Univ Press 1980.

    

2. Magoun, H.I. "Entrapment neuropathy of the central nervous system. Part II. Cranial nerves I-IV, VI-VIII, XII." JAOA Vol 67. March 1968.

    

3. McCouch, G.P.; Deering, I.D.; Ling, T.H. "Location of receptors for tonic neck reflexes." J. Neurophysiol May 1951; Vol 14.

    

4. Spector, B. "Neuroanatomic mechanisms underlying vertigo and nausea." Bull N Engl Med Center August 1948;10(4).

    

5. Walther, D.S. Applied Kinesiology, Volume II-Head, Neck, and Jaw Pain, and Dysfunction-Stomatognathic System. Pueblo Co: Systems DC, 1983.

    

6. Whatmore, G.B.; Kohli, D.R. The Physiopathology and Treatment of Functional Disorders. New York: Grune & Stratton, Inc. 1974.