Head position in car crash and injury

Published July 20, 2015

Knowing what position your patients head is in is important as studies show that a head turned can increase injury to the cervical spine in a MVC ( I posted this on this site). Here is a study that shows neck injuries greatly increase if the head is turned a little. The clinical implications of this study, for the most part, is this is all your patients in a crash. When was the last time in the real world, a person got hit from behind by another car, and both cars were 100% straight like in a lab AND the driver was looking 100% forward?? Having this info for you and your patients may help in understanding why they may be suffering and may need care.

Traffic Inj Prev. 2015 Oct 3;16(7):698-708. doi: 10.1080/15389588.2014.1003551. Epub 2015 Feb 9.

Out-of-Position Rear Impact Tissue-Level Investigation Using Detailed Finite Element Neck Model.



Whiplash injuries can occur in automotive crashes and may cause long-term health issues such as neck pain, headache, and visual and auditory disturbance. Evidence suggests that nonneutral head posture can significantly increase the potential for injury in a given impact scenario, but epidemiological and experimental data are limited and do not provide a quantitative assessment of the increased potential for injury. Although there have been some attempts to evaluate this important issue using finite element models, none to date have successfully addressed this complex problem.


An existing detailed finite element neck model was evaluated in nonneutral positions and limitations were identified, including musculature implementation and attachment, upper cervical spine kinematics in axial rotation, prediction of ligament failure, and the need for repositioning the model while incorporating initial tissue strains. The model was enhanced to address these issues and an iterative procedure was used to determine the upper cervical spine ligament laxities. The neck model was revalidated using neutral position impacts and compared to an out-of-position cadaver experiment in the literature. The effects of nonneutral position (axial head rotation) coupled with muscle activation were studied at varying impact levels.


The laxities for the ligaments of the upper cervical spine were determined using 4 load cases and resulted in improved response and predicted failure loads relative to experimental data. The predicted head response from the model was similar to an experimental head-turned bench-top rear impact experiment. The parametric study identified specific ligaments with increased distractions due to an initial head-turned posture and the effect of active musculature leading to reduced ligament distractions.


The incorporation of ligament laxity in the upper cervical spine was essential to predict range of motion and traumatic response, particularly for repositioning of the neck model prior to impact. The results of this study identify a higher potential for injury in out-of-position rear collisions and identified at-risk locations based on ligament distractions. The model predicted higher potential for injury by as much as 50% based on ligament distraction for the out-of-position posture and reduced potential for injury with muscle activation. Importantly, this study demonstrated that the location of injury or pain depends on the initial occupant posture, so that both the location of injury and kinematic threshold may vary when considering common head positions while driving.


Chris Gubbels

I’m curious how neck and head posture could effect/diminish muscle activation, specifically muscles that support and protect the head and neck, If these muscle do not function properly with poor head position could the patient have the potential for increased injury in MVC.

    Evan Katz

    Chris, many studies show that injuries occur before the muscles contract. Head position seems to be a big factor.

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