Head-Turned Postures Increase the Risk of Cervical Facet Capsule Injury During Whiplash

Siegmund, Gunter P.; Davis, Michael F.; Quinn, Kyle P.; Hines, Elizabeth M.; Myers, Barry S.; Ejima, Susumu; Ono, Kishiri; Kamiji, Koichi; Yasuki, Tsuyoshi; Winkelstein, Beth A.

doi:10.1097/brs.0b013e31817b5bcf

Cited by 30 publications

(11 citation statements)

References 20 publications

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“…An earlier study addressed the issue of increased injury susceptibility with head rotation using PMHS motion segments and quasi-static shear loads [37]. That study identified a two-fold increase in ligament strains with 1.5 Nm axial pretorque.…”

Section: Discussionmentioning

confidence: 99%

“…However, injuries to those structures are not likely responsible for the most commonly reported chronic whiplash-related symptoms including posterior neck pain and suboccipital headache. One experimental investigation into the effects of axial rotation on capsular ligament strains in posteriorly directed loading determined increased strains in axially rotated joints [37]. However, that study incorporated static loading of isolated cervical motion segments that does not recreate inertial loading of the head-neck complex during dynamic impacts.…”

Section: Introductionmentioning

confidence: 99%

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Axial head rotation increases facet joint capsular ligament strains in automotive rear impact

Storvik

Stemper

2010

Med Biol Eng Comput

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Axial head rotation prior to low speed automotive rear impacts has been clinically identified to increase morbidity and symptom duration. The present study was conducted to determine the effect of axial head rotation on facet joint capsule strains during simulated rear impacts. The study was conducted using a validated intact head to first thoracic vertebra (T1) computational model. Parametric analysis was used to assess effects of increasing axial head rotation between 0 and 60° and increasing impact severity between 8 and 24 km/h on facet joint capsule strains. Rear impacts were simulated by horizontally accelerating the T1 vertebra. Characteristics of the acceleration pulse were based on the horizontal T1 acceleration pulse from a series of simulated rear impact experiments using full-body post mortem human subjects. Joint capsule strain magnitudes were greatest in ipsilateral facet joints for all simulations incorporating axial head rotation (i.e., head rotation to the left caused higher ligament strain at the left facet joint capsule). Strain magnitudes increased by 47-196% in simulations with 60° head rotation compared to forward facing simulations. These findings indicate that axial head rotation prior to rear impact increases the risk of facet joint injury.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Axial head rotation increases facet joint capsular ligament strains in automotive rear impact

Storvik

Stemper

2010

Med Biol Eng Comput

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“…Maak et al (2006) found that "the dynamic strains of the alar, transverse, and apical ligaments during impact did not exceed the corresponding non-injurious baseline values" while Siegmund et al (2008) reported that an axial rotation "doubles the MPS in the capsular ligament compared to the neutral posture". They also found that capsular strains during the simulated whiplash exposure with the head turned were not significantly different from the maximum principal strain (MPS) associated with partial failure of the capsule.…”

Section: Introductionmentioning

confidence: 99%

Position And Rotation of Drivers Head as Risk Factor for Whiplash in Rear Impacts

2015

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Objective. There is evidence in the literature on whiplash that having the head turned at impact presents an increased risk of injury to vehicle occupants in rear impacts. The aims of this study were to collect exposure data on head position and rotation in a series of nine naturalistic driving trials and to express this in the form of a parametric statistical model that could be used in computer simulations to optimise seat design for the mitigation of soft-tissue neck injury.Method. An instrumented vehicle equipped with an eye-tracker was used to collect digital readings that were complemented with a four-track video recording. The driving trials which each lasted 30-60 minutes were filtered for analysis to periods when the vehicle was stopped, stopping or moving slowly in accordance with accident data that indicated when rear impacts leading to neck injury were most likely to occur, amounting to around 75 minutes.Results. It was found that the t location-scale distribution provided the best fit to the experimental data. The measured interquartile range or central 50% of head movement that the drivers exhibited while most likely to incur neck injury was approximately ±15 mm lateral, ±10 mm longitudinal and ±7.5 degrees left-right rotation. These ranges also provide guidance to the degree of biofidelity required in computer models of the occupants. A manual review of video of the drivers' activities showed that out-of-range head rotation and rapid rotation explained the majority of missing digital readings from the eye-tracker whose operation was based on real-time image processing.Conclusion. Exposure data on head position and rotation measured using an eye-tracker was summarised in parametric form and can be supplemented by models of extreme and rapid head rotation to account for missing data. Future research could aim for technical improvements in the range of measurement of the eye-tracker and proportion of missing readings and consolidate the results with a larger sample of drivers, vehicles and routes.

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“…8 At the same time, biomechanical studies have shown that the direction of the impact, muscle activity (preparation) at the time of impact, 9 existing neck disease, 10 and posture 11 can influence the forces at play on different cervical structures. Therefore, simplistic assessments of susceptibility or likelihood of injury based on speed of impact are unlikely to be valid.…”

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confidence: 99%

Whiplash after motor vehicle crashes

Barnsley

2013

BMJ

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The debate over whiplash injuries over the past 20 years is reminiscent of incandescent globes, generating more heat than light and using important energy. We know that the overwhelming majority of patients with neck pain after motor vehicle crashes recover completely over a few weeks. The problem is the cohort with ongoing symptoms, which often extend beyond the neck and are not associated with clinical or radiological abnormalities. This group of patients are often inextricably involved with insurance claims, and this in itself attracts pejorative views from some practitioners.Studies into the proportion of patients with chronic symptoms and the determinants of these symptoms have varied in design and execution, with a particular problem being the sampling point. Counting insurance claims is fraught with behavioural, motivational, and jurisdictional confounders. Identifying patients as they present to hospital risks including only those with more severe initial symptoms. Police records depend on complete and accurate reporting. Mindful of these limitations, the cohort followed robustly by Gargan and colleagues over 30 years shows that more than a third of patients still have symptoms, but that these symptoms may diminish after 15 years. 1 Although this may be biased towards an overestimate, it still indicates an important burden of illness.Systematic reviews of cohort studies have identified a range of predictors of chronicity. These include non-use of seatbelts, more severe pain at presentation, headache, back pain, immediate neck pain, previous neck pain, and more clinical signs. Psychosocial factors include no education beyond school, female sex, and tendency to catastrophise. 2 However, it is unclear how much of the variability these factors explain. Other studies have suggested that even the expectation of recovery itself affects prognosis, so that those not expecting to recover are less likely to. 3 Notably, settlement of compensation has not been shown to result in recovery. 4

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Head-Turned Postures Increase the Risk of Cervical Facet Capsule Injury During Whiplash

Cited by 30 publications

References 20 publications

Axial head rotation increases facet joint capsular ligament strains in automotive rear impact

Axial head rotation increases facet joint capsular ligament strains in automotive rear impact

Position And Rotation of Drivers Head as Risk Factor for Whiplash in Rear Impacts

Whiplash after motor vehicle crashes

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Head-Turned Postures Increase the Risk of Cervical Facet Capsule Injury During Whiplash

Cited by 30 publications

References 20 publications

Axial head rotation increases facet joint capsular ligament strains in automotive rear impact

Axial head rotation increases facet joint capsular ligament strains in automotive rear impact

Position And Rotation of Drivers Head as Risk Factor for Whiplash in Rear Impacts

Whiplash after motor vehicle crashes

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Position And Rotation of Drivers Head as Risk Factor for Whiplash in Rear Impacts