Don’t Look Back if You’re Rear-ended!

Key Points from Dan Murphy

A rotated head posture at the time of vehicular rear impact is correlated with a higher incidence and greater severity of chronic radicular symptoms than accidents occurring with the occupant facing forward.

1. The greatest potential for cervical ganglion compression injury is at C5–6 and C6–7.
2. In patients with a stenotic foramen, the injury risk greatly increases and spreads to include the C3–4 through C6–7 ganglions and nerve roots.
3. Chronic radicular symptoms such as neck, shoulder, upper-back, and arm paresthesias have been documented in whiplash-injured patients.  These symptoms have been associated with dorsal root ganglion and nerve root compression within the cervical intervertebral foramen.
4. The Spurling test, which couples cervical extension, rotation, lateral flexion and compression, is valid in the clinical diagnoses of cervical radiculopathy.
5. A rotated head posture at the time of rear impact caused significantly greater neck pain and increased the risk of chronic symptoms.
6. Cervical ganglion and nerve root injury is exacerbated if the head is rotated at the time of rear impact.
7. Clinical and epidemiological studies have documented increased chronic radicular symptoms, including muscle weakness and neck, shoulder, upper-back, and arm paresthesias, in individuals whose heads were rotated at the time of a rear-impact collision compared with individuals who are facing forward. 
8. Foraminal width narrowing due to head-turned rear impact can potentially compress the cervical ganglia and nerve roots causing injury and leading to chronic radicular symptoms, especially in individuals with stenotic spines.   [Key Point]
9. Analysis of the present data suggests that a head-turned rear impact may cause cervical ganglion or nerve root injury that leads to chronic radicular symptoms. 
10.Increase in nerve injury and symptom severity leads to a worse clinical prognosis, including increased chronic radicular symptoms.
11.The increased ganglion impingement observed in the present study, in conjunction with the residual joint instability documented in a previous head-turned rear-impact study explains the increased severity and duration of radicular symptoms associated clinically with rotated head posture, compared with head-forward rear-impact collision. 
12.Compression injury at these spinal levels may cause pain and paresthesias in the periclavicular region, anterior and posterior neck, deltoid and trapezius muscles, and dorsal arm, forearm, and hand.

A 1978 graduate of Western States Chiropractic College, Dr. Dan Murphy is on the faculty of Life Chiropractic College West, and is the Vice President of the International Chiropractic Association. For more information, visit

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