Whiplash

Whiplash occurs due to the forceful or rapid back-and-forth movement of the neck, resulting in neck injury.

It most often occurs due to rear-end auto accidents, but can also be a result of a sports accident, physical abuse, or other trauma.

Typical signs and symptoms include pain, stiffness, and headache.

People generally recover with pain medications and physical therapy. However, some may experience chronic neck pain and other complications.

It may be referred to as a neck sprain or strain, but these terms can include other types of neck injuries.

“Whiplash” can be considered a non-medical term with a range of neck and head injuries that are a result of speeding up or slowing down mechanisms of energy transfer to the neck. There are over a million cases of whiplash injuries reported every year, and these are mostly due to motor accidents. Hence, it is one of the most common types of non-fatal motor accident injuries. Any victim of either slow- or high-speed collisions is at risk of developing this condition. Whiplash can be caused by an impact from any direction, however, the most common is a hit from behind.

When the force is sudden and impactful, it tends to damage the soft tissues of the body. This happens because the head is thrown all of a sudden in a backwards direction and then forwards the cervical spine. The severity of whiplash differs from person to person, so the symptoms can also vary.

Typically, in the case of whiplash, symptoms show up within twenty-four hours after the neck injury and include:

• Neck pain and stiffness
• Worsening of pain with any movement of the neck
• Loss of range of motion
• Headache
• Tenderness
• Tingling sensation
• Fatigue
• Dizziness

Some people may experience more severe signs and symptoms, such as:

• Blurred vision
• Ringing in the ears
• Disturbed sleep
• Irritability
• Difficulty concentrating
• Memory problems
• Depression

Immediately after the forceful impact, patients would not be aware of any swelling or bruising on the neck. They would come to know about the symptoms typically twelve to twenty-four hours after the accident. Following the day of the accident, there would be stiffness and pain, which tends to worsen with each passing day. Many patients have reported that the level of discomfort is usually highest when they wake up first thing in the morning or during the night. When the severity is low, the person recovers rather quickly from the stiffness and pain in a matter of few weeks, but if the severity is high, it takes much longer to heal, and proper treatment is required from a physiotherapist. Very few patients experience chronic pain and stiffness months or years after the accident. Similar to the symptoms, the healing time also varies from person to person and depends on the damage done to the tissues.

When the pain spreads to the arms or shoulders, it becomes difficult for an individual to even move the head, and there can be numbness or a tingling sensation as well. Some people may notice weakness or pain that worsens, causing an interference in day-to-day activities. In such instances, one should seek medical attention right away. With guidance from a doctor and prompt treatment from a physiotherapist, the whiplash symptoms can dramatically improve.

The main cause of whiplash is mechanical trauma to the neck. Such an injury can occur due to rear-end auto accidents, punching or shaking someone, and contact sports (e.g., football tackles or wrestling).  Whiplash can also occur due to horseback riding, any kind of blow to the head with a heavy object, amusement park rides or roller coasters, shaking a child violently, hitting a baby, or any falls in which the head is violently jerked backwards.

The initial step in the diagnosis of whiplash is an inquiry about events that took place prior to the neck pain. The doctor may also ask about the frequency and severity of the illness. This is followed by a physical examination.

The doctor will touch the area of the  neck that is injured and will ask to move the neck, head, and arms to determine the following:

• Range and degree of motion
• Tenderness
• Strength
• Reflexes
• Sensation in the neck or arm

In order to rule out other conditions, some imaging tests may be required, like:

• X-rays of the neck
• Computerized tomography (CT) to see a cross-sectional view
• MRI (magnetic resonance imaging) to get a more detailed picture of the neck   

The goal of treatment for whiplash is to reduce pain, restore the normal range of motion, and reduce the risk of complications. Treatment depends on the severity of symptoms and the degree of injury.

Treatment includes:

• Pain management with the help of pain medications, prescribed painkillers for severe pain, muscle relaxants, and injections of lidocaine (local anesthetic) to decrease the pain for physical therapy.
• Immediately after the individual sustains the injury, apply an ice pack on the affected region to reduce inflammation and swelling. This should be carried out for the initial few days following the injury. You can wrap the ice in a cloth or towel and hold it against the neck for five to ten minutes. Doing this for a couple of times each day can provide quick relief and prevent the pain from worsening.
• After a few days of the ice pack remedy, one can use moist heat to provide relief from pain and aches. Examples include a warm towel or hot bath.
• Exercises to stretch the neck muscle will help restore normal activity. Some exercises may include rotating the neck in both directions, tilting the neck from side to side, bending the neck towards the chest, and rolling the shoulders.
• A physical therapist will help decrease pain and provide additional exercises, thus improving posture and restoring one’s range of motion.
• Doctors may also recommend the use of foam collars, which help keep the head and neck still.
• Be sure to maintain proper posture at all times to prevent the pain and stiffness from worsening. Maintaining good posture can assist the correct and quick healing of the soft tissues. You can talk with a physiotherapist, who will provide guidance and advice on how to maintain good posture while sitting, standing, and lying down.

Some alternative remedies for whiplash have been suggested, but their effectiveness is not yet proven. These include:         

• Acupuncture, which is a procedure that provides pain relief by applying needles at special pressure points.
• Chiropractic care, which involves the manipulation of joints to relieve pain.
• Massage, which is a very old method of pain relief that is done by kneading the neck muscles.
• Transcutaneous electrical nerve stimulation, which involves a device that applies a mild electrical current to the skin to decrease pain.  

In the past, for whiplash conditions, treatment would include wearing a foam neck collar for a couple of weeks after the injury and complete bed rest, when needed. The use of a neck collar was done to prevent any kind of neck movement or further neck damage. However, researchers confirmed that this treatment option did little good, since it slowed down the healing process of the affected site and actually led to further damage. To heal from whiplash, the neck needs to strengthen and the soft tissues need to be repaired. This can best be done through certain neck exercises under the guidance of a physiotherapist. Once the acute symptoms caused by whiplash heal, the physiotherapy will allow the neck muscles to strengthen and become more limber. This becomes a quick path to recovery and, in the future, the neck will be more resistant to any kind of strain. Individuals who were involved in carrying out certain motion exercises after an injury were shown to have a reliable as well as speedy recovery from whiplash. In such cases, treatment would mostly involve performing certain rotation exercises that should be repeated ten times per hour. It is always better to start physiotherapy treatment as soon as possible after the accident or injury. Early treatments can prevent lasting damage or chronic pain caused by whiplash.

Most people recover within a few months, but others may continue to have pain and develop complications such as:

• Chronic pain
• Rapid onset of pain
• Interference in daily activities that require neck movements
• Headache

One of the common complications of whiplash is hyperlordosis. Many patients tend to overarch their neck and adapt a bad posture so as to avoid pain. However, this will prevent quick healing from whiplash and will also lead to chronic pain and other long-term problems in the neck. Hence, it is important to get whiplash treated under the proper supervision of a physiotherapist.

Other complex problems related to whiplash are joint dysfunction, faulty patterns of movement, concussion, and disc herniation.