The cervical anterior longitudinal ligament (ALL) is a very important neck ligament that can commonly be injured by whiplash. The head and neck snapping backward in whiplash cause injury to the ALL. It is important to understand how and why the ALL becomes injured in whiplash so the many consequences of that injury can be addressed before problems worsen.
What Is The Anterior Longitudinal Ligament (ALL)?
The anterior longitudinal ligament is a thick band that covers the bones and discs along the anterior (front) of the spine. It runs from the cervical spine (neck) down to the sacrum (tailbone) but in this article we focus on the cervical region. The ALL is the only front neck stabilizing ligament and it supports the intervertebral discs and prevents excessive extension of the neck.
How the ALL Is Affected During Whiplash Incidents
The most common cause of ALL ligament injuries is hyperextension injury and whiplash injuries. Whiplash is defined as an injury caused by a severe jerk to the head with a rapid back-and-forth whipping motion of the head and neck, typically in a motor vehicle accident. The back motion typically injures the ALL(1). The C5-6 ALL band is the most susceptible to injury (2).
It is estimated that there are 1,000,000 cases of whiplash per year in the United States. Injuries can be significant and long-lasting, with approximately 50% of whiplash patients reporting chronic neck pain 15 years after the trauma (3).
ALL injuries usually occur in conjunction with other cervical injuries. Facet joints, discs, muscles, tendons, and nerves all can be injured during whiplash.
What Are the Signs and Symptoms of Whiplash Injuries?
After whiplash and ALL injuries, patients usually develop pain and other symptoms rather quickly from the trauma to the tissues.
Immediate Symptoms
The immediate symptoms (4) following an anterior longitudinal ligament injury may include:
- Neck and head pain
- Stiffness
- Periscapular pain
- Numbness and tingling (paresthesia) in the arms and hands
- Dizziness
- Jaw pain
- Sensitivity to lights and sounds (photophobia and phonophobia)
- Cognitive issues
Chronic Symptoms
With whiplash injuries, muscle damage typically completely heals on its own, as muscles have good blood supply and muscle stem cells. However, other damaged structures – such as ligaments including the ALL, discs, facet joints, etc – do not heal as well and have limited blood supply.
Depending on the mechanism and severity of whiplash injuries, these structures may remain damaged, leading to continued pain and symptoms. Injury to the ALL and other ligaments leads to chronic neck instability, which can further cause damage to the neck structures, prolonging symptoms or causing new symptoms due to continued stress on the neck. Chronic symptoms of ALL injuries with whiplash are:
- Pain in the neck or upper back
- Stiffness and spasms in the neck and upper shoulder muscles
- Pain that radiates down the shoulders, arms, fingers, and throughout the body
- Numbness and tingling in the arms and fingers
- Soreness in the neck or upper shoulder area
- Stiffness or difficulties with neck movement
- Pain that gets worse when the neck is extended
- Shoulder pain
- Pain in the arm, forearm, hand, and fingers
- Weakness in one or both arms or hands, or in the fingers
- Headache
- Nausea, dizziness, imbalance
- In severe cases, severe neurologic symptoms, dysautonomia, etc.
Diagnosing ALL Injuries in Whiplash
A board-certified musculoskeletal and spine expert can help to diagnose ALL injuries through a detailed history, physical examination, and imaging studies.
- Clinical examination: Your health practitioner may find tenderness in the anterior of the neck, pain with neck extension, and signs of nerve irritation.
- Imaging techniques:
- An MRI can show damage to the ALL and other structures such as the discs, facet joints, and the spinal cord.
- Flexion and extension X-rays or a digital motion X-ray (DMX) can show movement of the cervical bones in extension, suggestive of ALL ligament laxity.
- CT scans can be used for a more in-depth view of bone anatomy and injuries that may be associated with ALL injuries, such as retrolisthesis.
Treatment Options for Whiplash-Related ALL Injuries
Specific treatment for whiplash-related ALL injuries depends on the severity of the injury and the specific areas injured.
Conservative Methods
In acute injuries, rest and conservative measures to alleviate pain are important to help the body heal. Typical initial treatments include:
- Rest
- Heat and/or ice
- Anti-inflammatory supplements such as turmeric and fish oil
- Mild stretching
- Physical therapy
- Chiropractic care
- Massage
- Medications such as Tylenol or non-steroidal anti-inflammatory drugs
- Working on good posture and neutral spine alignment, with appropriate ergonomics at the individual’s workstation
Surgical Interventions
In cases where conservative methods are inadequate, surgical procedures like spinal fusion or ligament repair may be recommended for extensive ligament damage leading to severe spinal instability or nerve injury.
Surgery is sometimes required immediately but in other cases should only be a last resort if all else fails. Surgery has many inherent risks such as risks of infection, nerve injury, failure of the bones to fuse, and hardware misplacement.
The Centeno-Schultz Protocol for ALL Injuries
At the Centeno-Schultz Clinic, we are experts in the diagnosis and treatment of orthopedic musculoskeletal problems, including neck and ALL injuries.
We focus on regenerative therapies that allow the body to heal itself. This typically involves the precise injection of orthobiologics (substances that stimulate self-repair) into damaged tissues under ultrasound and/or fluoroscopic guidance.
We have created the injection technique for safely and precisely targeting damaged ALL ligaments utilizing ultrasound and X-ray guidance.
Additionally, we take a comprehensive approach to thoroughly addressing all damaged structures of the neck, typically termed a functional spinal unit approach. We collect data on our specific protocols in a registry and update that monthly Regenexx Patient Outcome Data. We also have peer-reviewed published studies on the use of orthobiologics for cervical problems (5-6). The most common orthobiologics used for whiplash and ALL injuries are:
Prolotherapy
Prolotherapy is the injection of an irritant solution that causes small damage to tissue, thus initiating a healing response. The most common solution is a hypertonic dextrose solution.
This is basically a sugar water solution that has a higher osmolality than your body’s tissues, so it causes stress to the tissue by drawing water out of the cells, initiating stress/injury and then a healing response. The healing response is small, so it often requires multiple treatments but can work very well for mild cervical ligament and tendon injuries.
Platelet Rich Plasma (PRP) Injections
PRP is made by taking your own blood, centrifuging (spinning) it to separate the components, and concentrating the platelets. The concentrated platelets can then be injected into areas of tissue injury to initiate a healing response. Platelets have growth factors, cytokines, proteins, exosomes, etc. that mediate the healing response.
PRP can be used to treat mild to moderate ligament tears of the ALL and other structures. This is the most common orthobiologic used for these injuries.
Bone Marrow Aspirate Concentrate (BMAC)
BMAC contains stem cells as well as many other cells that can be powerful healing cells. Similarly to PRP, bone marrow can be collected, spun down, and concentrated then injected into the patient’s damaged tissue as well. BMAC containing stem cells is a more powerful healing agent and can be used for more moderate to severe ligament injuries of the ALL and other structures.
Explore Alternatives for ALL Injuries in Whiplash
If you’re seeking innovative therapies that harness the body’s natural healing abilities, look no further. At the Centeno-Schultz Clinic, we specialize in cutting-edge treatments like prolotherapy, PRP injections, and BMAC to address ALL injuries effectively. Our comprehensive approach and data-driven protocols ensure you receive top-notch care for your cervical issues.
Don’t let neck injuries hold you back – take the first step towards recovery with us today. Visit the Centeno-Schultz Clinic and experience the difference for yourself.
Experience relief from whiplash with our safe and effective ALL Injury Treatment.
References:
- Pastakia K, Kumar S. Acute whiplash associated disorders (WAD). Open Access Emerg Med. 2011;3:29-32. Published 2011 Apr 27. doi:10.2147/OAEM.S17853.
- Stemper BD, Yoganandan N, Pintar FA, Rao RD. Anterior longitudinal ligament injuries in whiplash may lead to cervical instability. Med Eng Phys. 2006;28(6):515–524. doi:10.1016/j.medengphy.2005.09.011
- Squires B, Gargan MF, Bannister GC. Soft-tissue injuries of the cervical spine. 15-year follow-up. J Bone Joint Surg Br. 1996 Nov;78(6):955-7. doi: 10.1302/0301-620x78b6.1267. PMID: 8951014.
- Sterner, Y., & Gerdle, B. (2004). Acute and chronic whiplash disorders – a review. Journal of Rehabilitation Medicine, 36(5), 193-210.
- Williams C, Jerome M, Fausel C, et al. (October 08, 2021) Regenerative Injection Treatments Utilizing Platelet Products and Prolotherapy for Cervical Spine Pain: A Functional Spinal Unit Approach. Cureus 13(10): e18608. doi:10.7759/cureus.18608
- Centeno CJ, Elliott J, Elkins WL, Freeman M. Fluoroscopically guided cervical prolotherapy for instability with blinded pre and post-radiographic reading. Pain Physician. 2005 Jan;8(1):67-72. PMID: 16850045.