Avoiding Whiplash: Have you adjusted your car’s head restraints lately?

Most parents wouldn’t consider moving the family car an inch without the kids safely buckled up. Educational campaigns have made us aware of the necessity of seat belts and specially designed infant and booster seats for the littlest passengers, and of keeping kids under 12 in the back seat away from airbags.

But there’s one area where we’re largely clueless, claims car safety advocate, Dr. Arthur Croft: head restraints. Most of us (80 percent of drivers) never adjust them; most of us never even consider them. We call them “head rests” and think of them as just that — not a vital safety feature. But improper use of head restraints results in about 3 million whiplash injuries per year — and half of these people, says Dr. Croft, will have long-term problems: from “minor aches and pains that won’t go away, to headaches and back pain. And 10 percent will become disabled.”

The sobering facts are that proper adjustment of the head restraint is simple, and the safety repercussions are huge. “We keep looking for new data or a new phenomenon, but it’s just as basic as that,” stresses Dr. Croft, who became concerned about whiplash years ago when a family friend and her daughter were involved in a car crash, walked away feeling fine, and had problems for years afterwards.

A chiropractor by training, Dr. Croft is also a trauma epidemiologist and is Board-certified in chiropractic orthopedics; he has focused on whiplash injury for the past 23 years. He has written several books on the subject, produced DVDs, developed the widely used whiplash (WAD) grading system, and is founding director of the Spine Research Institute of San Diego.

Since 1969, head restraints have been mandated in cars sold in the U.S. There has been no requirement, however, to make them effective. The latest news is that every car manufactured after 2007 will have better head restraints, conforming to the current European standards (where national health policies dictate strong measures against whiplash and its resulting financial repercussions). Dr. Croft is hopeful this will go a long way toward reduction in whiplash injuries in this country, but until then — and going forward — here are the facts:

• The top of the back of the head should be in line with the top of the head restraint, and the gap between should be no more than about two inches. Alternately, the middle of the back of the head should be in line with the middle of the head restraint.

• Head restraints are easy to adjust — they go only up and down. If you’re tall and can’t adjust to the above, the head restraint should be pushed up as high as it will go.

• Crash testers tend to use dummies in a car that crashes into a wall. But many crashes are impacts from behind. The head will be forced backward and ideally, into the head restraint, easing the impact. Without a head restraint at its proper height, the head will remain motionless initially, while the seat back accelerates the torso forward. The shear force directed through the spine as a result can damage spinal ligaments, discs, nerves, and joints. If the head restraint is too low, the head will rotate backwards over the restraint, allowing potentially injurious bending of the neck and damage to ligaments, discs and joints and nerves in the neck.

• Even with proper head restraint use, you can still sustain whiplash injuries. But a good restraint at the proper height significantly reduces the risk of injury.

• The most common peak period for the appearance of whiplash symptoms is about 48-72 hours. Get checked out the day of the crash, Dr. Croft urges.

Kid considerations
Whiplash can manifest itself in several ways physically — pain, headaches, dizziness, balance problems, difficulties with memory or concentration. Children are susceptible to all of these, too. But Dr. Croft urges parents to watch for the emotional aspects of mild traumatic brain injury (MTBI) in kids as well.

“A study of ADHD behavior following MTBI showed up as a small percentage — 7.5 percent. But this was in mild cases. This ‘secondary ADHD’ showed up more frequently in more severe injuries. It’s something to think about,” Dr. Croft poses.

“Another study shows that in about 70 percent of MTBI cases, kids develop maladaptive behavioral disorders,” Dr. Croft continues. “A child may be arguing, hitting, retaliating. The teacher may not have been made aware of a recent accident, and perhaps the parents are not putting two and two together. In kids who play sports, balance may be affecting performance. It could all be related.”

In box:
How does your car rate?

The Insurance Institute for Highway Safety has been regularly evaluating head restraints in hundreds of new passenger vehicles. Restraints are rated good, acceptable, marginal, or poor. In 2005, only 51 percent of restraints tested were rated “good”. Go to: www.iihs.org/research/qanda/neck_injury.html#6 for details of the Institute’s testing system.

To check out how a particular car’s head restraints fared in the Institute’s rear-end crash testing, go to www.iihs.org/ratings, and scroll to “Rear crash protection/head restraint ratings”. Key in car make and model.

Clearinghouse info

The Spine Research Institute of San Diego’s website contains links t0 the leading safety institutes and child-safety tips: www.srisd.com.

Kids in Cars

When parents are asked if they are properly restraining their children in the car, 96 percent believe they are doing so. In fact, 80 percent are not. In these cases, infant, child, and booster seats are not being secured adequately, or the seat belt is too loose.

Studies have also shown that booster seats without a back are no more effective than a seat belt in an accident. But high-back booster seats reduced injury by 70 percent.

Are you securing your child properly? The American Academy of Pediatrics (AAP) has a wonderfully comprehensive guide for parents online at www.aap.org/family/carseatguide.htm.