It is well known in medicine that osteoarthrosis occurs more rapidly secondary to trauma. From Kaneoka, Ono, Panjabi, Cholewicki and Bogduk (and others), we know that the cervical spine zygapophyseal joints are injured at low speeds, and damage to these joints causes chronic, recurring pain. We also know that cervical spine ligamentous instability occurs after low speed crashes (damage to anterior and posterior longitudinal ligaments, for example), and that this instability is responsible for chronic pain. Prolotherapy may be a solution for these patients. So I would propose to you that the low speed crashes producing injuries are simply injury thresholds. Since serious spinal cord injuries have been reported at delta V's of 15 mph (rear-end impacts), then the 5-15 mph delta V range would show the full gamut of injuries in between.
It is amazing to me that all doctors learn about referred pain in medical school (i.e., right shoulder blade pain from gallbladder disease, left arm pain from myocardial infarct, low back pain from prostate disease or pelvic inflammatory disease, etc., ad nauseum), but then FORGET ABOUT IT! Bogduk has mapped out referral pain patterns from damaged zygapophyseal joints, following in a long line of research into referred pain by Feinstein and others since the early 20th century. No one has ever refuted any of this work. And yet, we have some insurance company doctors who think that if there are "non-dermatomal" findings in our patients, and if MRI's are negative, that there couldn't be an injury, or worse, we have a malingerer. Nonsense. Medicine has become too spinal disc-centered. God bless Dr. Bogduk for reminding us all that there are MANY OTHER LIGAMENTS IN THE SPINE, that they are OFTEN injured in whiplash crashes, that they cause AS MUCH PAIN as a herniated disc in many whi
plash victims, and that they are USUALLY MISSED by ER doctors, orthopedists, and neurosurgeons/ neurologists. Sad, very sad.
Have you read Kaneoka and Ono's work? Brault and Siegmund's? Bogduk's group's research (and Wallis, Lord, and Barnesley)? Croft's? Freeman's?
In addition, one has to remember that the human volunteers in almost all the recent crash tests were:
robust males
in excellent health
perfectly positioned (not leaning forward or to the side)
without any backset (distance between the head and head restraint)
without head rotation
completely aware of the impending collision
of younger age
Real world occupants have the following risk factors for acute injury:
1) Female gender (12 studies).
2) History of neck injury (one study).
3) Poor head restraint geometry/tall occupant (e.g., 80th percentile male) (2 studies).
4) Rear vs. other vector impacts (16 studies).
5) Use of seat belts/shoulder harness (i.e., standard three-point restraints) (30 studies).
6) Body mass index/head neck index (i.e., decreased risk with increasing mass and neck size) (2 studies).
7) Out-of-position occupant (e.g., leaning forward/slumped) (studies).
8) Non-failure of seat back (3 studies).
9) Having the head turned at impact (one study).
10) Non-awareness of impending impact (3 studies).
11) Increasing age (i.e., middle age and beyond) (5 studies).
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