If you’ve been paying attention to the Winter Olympics in South Korea, you might have seen American luger Emily Sweeney crash on her fourth and final run at approximately 68 miles per hour. It was clear that she was initially stunned, but happily was able to get up and walk away on her own. Sometime later, she was being interviewed by a reporter from NBC and stated that she was ok adding that she was also very sore and stiff and was about to get an x-ray of her back. Obviously, we all hope that Ms. Sweeney has no significant, permanent injuries and we all respect her courage and toughness in competing at a difficult sport at such a high level, especially when faced with the prospect of injury. However, in watching her interview, I couldn’t help, but feel that there was some continued suffering in her affect and voice.
If you watch her actual crash, you can’t help but notice the impact of the speed and ice on her body as you see her hit her head and the contortions that follow. Sadly, I see people who have had similar injuries from motor vehicle accidents, falls from horses and other types of sports who suffer from chronic headaches. Many of these people have been diagnosed with “whiplash” which tends to be a basket diagnosis when someone has continued chronic pain, usually headaches, but whose workup including x-rays and MRIs don’t show any pathology and whose etiology remains unclear. Unfortunately, at this point in time x-rays and MRIs (even magnetic resonance neurograms) are often not sensitive enough to pick up injuries in very tiny nerves that can cause significant pain. In the case of neck injuries following which people experience chronic headaches, I believe that many of these symptoms are caused by traction (i.e. stretch) injuries of the various occipital nerves resulting in scar impingement around the nerves or actual tears within the nerves themselves. These tears then heal with scar impacting nerve conduction and resulting in numbness, tingling and/or pain. As a result, these patients end up seeing many different types of doctors who often prescribe many different types of drugs and give many types of injections in the hopes of treating this pain permanently.
However, whenever there is a mechanical injury of a nerve, for example, compression secondary to scar tissue formation, a mechanical solution needs to be found. For these patients, a simple nerve block (i.e. injection of local anesthetic) used in a diagnostic manner, will not only provide temporary relief, but allow the experienced peripheral nerve surgeon to discern which nerve or nerves may be involved in that particular person’s symptoms thereby pointing the way to a potential surgical solution which is often permanent. Sadly, peripheral nerve pathology as a cause for many cases of whiplash or sports concussions with resulting headaches remains very unrecognized. However, some physicians including some prominent neurologists are actually coming around to recognizing that structures outside of the brain and spinal cord can cause debilitating headaches. Happily, they refer these patients to a trained peripheral nerve surgeon for appropriate diagnostic workup and ultimately treatment. Hopefully Ms. Sweeney will not require surgical intervention of any kind, but if she were to experience chronic headaches with no other identifiable cause, I would hope that her trainers and doctors consider the possibility that a stretch injury to a peripheral nerve may be the underlying etiology which will save her and perhaps many others years of suffering.
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