Though whiplash associated disorders (WAD) is a term used to encompass the myriad of symptoms associated with whiplash injury, research has largely focused on the neck, and more recently, brain. However, there is another area of the body that often experiences injury during trauma involving the sudden back and forth movement of the head and neck: the thoracic spine, or mid back.
In a large-scale study that looked at the medical records of more than 6,000 whiplash patients, researchers found that two-thirds complained of post-injury thoracic or midback pain and 23% still experienced these symptoms a year later. This can be explained by the mechanism of a whiplash injury that involves forceful stretch loading to the upper back muscles, which affects both the cervical and thoracic spine. More recently, researchers observed microscopic injury to the mid and lower fibers of the trapezius muscle located in the mid back and thoracolumbar region in WAD patients.
Interestingly, the thoracic spine contributes up to 33% and 21% of the movement occurring during cervical flexion and rotation, respectively. Thus, injury that restricts the range of motion of the soft tissues of the neck can place added strain on the mid-back. Likewise, injury to the midback can force the tissues of the neck to work harder to accommodate cervical range of motion. This could worsen existing injuries or even result in a secondary injury to the neck or midback.
A systematic review that included 38 studies and more than 50,000 WAD patients in total revealed the more than 60% had thoracic pain, and about the same percentage had myofascial pain and trigger points in the trapezius muscles. It was also common for WAD patients to have injuries that affect the muscles that attach to the base of the neck/upper back, which could affect the activity of tissues in the adjacent regions, including the thoracic spine. Due to these findings, the authors of the review recommend healthcare providers perform a more extensive clinical evaluation of the thoracic spine when patients present with WAD to prevent chronic pain and to restore function as quickly as possible so that patients can resume their normal activities.
When examining a patient with suspected WAD, doctors of chiropractic will focus on the whole patient as dysfunctional elsewhere in the body can often contribute to the patient’s presenting complaint, including the thoracic region. Once these potential causes are identified, the chiropractor can put together a treatment recommendation to address each to help alleviate pain and disability. This will often involve a multimodal approach that includes manual therapies, specific exercises, nutrition recommendations, and physiotherapy modalities. In more severe cases, the patient may be referred to an allied healthcare provider for treatment that falls beyond the chiropractor’s scope of practice.