Whiplash Shares Traits of Achilles Tendonosis

Researchers have discovered that patients with whiplash injuries may share certain characteristics of those with Achilles tendonosis, which may offer insight into potential new treatments for chronic whiplash pain. The study examined the tendons of patients with whiplash, and found signs of pathological neovascularization, or the development of blood vessels in abnormal tissues, similar to what has been found in patients with Achilles tendonosis.

"These findings promise that similar treatments that are now successful with Achilles tendonosis, may be effective in the [whiplash]-painful muscle insertions of the neck," wrote researchers from in Sweden and Nova Southeastern College of Osteopathic Medicine in Florida.

Whiplash injuries occur when the body is subjected to shear forces which stretch, strain, and sometimes tear the ligaments, tendons, and structures of the neck, also called the cervical spine. This may create tiny microtears in the tendons of the neck, causing tendonosis. (Note tendonosis should not be confused with tendonitis which simply refers to the inflammation of tendons due to acute injury or repetitive strain injuries.)

Although many patients with whiplash are able to recover in a matter of weeks, a substantial number suffer from ongoing symptoms, and researchers sought to see whether studies of Achilles tendonosis could offer clues into the mechanisms behind this chronic pain.

Recent studies of chronic pain in the Achilles and patellar tendons have demonstrated the presence of high blood flow in the painful regions of the tendons, but not the non-painful regions of the tendons, using grey scale ultrasound (US) and color Doppler (CD) imaging techniques. Later biopsies revealed that these painful tendons showed signs of pathological neovascularization, or the growth of blood vessels in abnormal tissues. Injections of local anesthetics into these neovessels was found to provide temporary pain relief.

The researchers utilized the same imaging techniques used in the Achilles tendonosis studies to investigate changes in the tendons of patients with whiplash after auto collisions. Compared to healthy controls, whiplash patients had more areas with high blood flow, and the blood flow was intensified at each region examined. Areas of high blood flow were apparent where the tendons entered into the bone (also called the enthesis) at the spinous process, and bilaterally juxtapositioned to the facet joints. Women with whiplash were more likely to have more areas of high blood flow then men, which may correspond to higher rates of whiplash injuries in women.

The authors suggested that this increased blood flow may be a sign of neovascularization, although more research is needed to confirm the results.

Seeking early treatment for whiplash injuries may assist in preventing chronic symptoms tied to tendonosis and muscle degeneration. Chiropractic adjustments, soft tissue therapies, and exercise rehabilitation can all help to heal the damaged tendons and ligaments of the neck after whiplash.


Kalawy H et al. New objective findings after whiplash injuries: High blood flow in painful cervical soft tissue: an ultrasound pilot studies. Scandinavian Journal of Pain 2013; 4(4): 173-179.