OrthoNeuroSpine & Pain Institute
Whiplash is a term which describes pain in the cervical region after the specific mechanism of hyperflexion and hyperextension. This commonly occurs during motor vehicle accidents.
The neck (cervical spine) is composed of vertebrae which begin in the upper torso and end at the base of the skull. The bony vertebrae along with the ligaments (like thick rubber bands) provide stability to the spine. The muscles allow for support and motion. The neck has a significant amount of motion and supports the weight of the head. However, because it is less protected and more mobile than the rest of the spine, the neck can be vulnerable to motion related disorders producing pain and restricted motion. For most people, the neck pain is a temporary condition that disappears with time.
Signs and symptoms
People who experience whiplash may develop one or more of the following symptoms, usually within the first two days after the accident:
- Neck pain and stiffness
- Pain in the shoulder or between the shoulder blades
- Low back pain or thoracic back pain
- Pain or numbness in the arm and/or hand
- Difficulty concentrating or remembering
- Irritability, sleep disturbances, fatigue
Diagnosis and Treatment
During the physical exam, your doctor will ask you how the injury occurred, measure range of motion and check for any point tenderness. Your orthopaedist may request X-ray studies to look closely at the bones in your neck. This evaluation helps eliminate or identify other sources of neck pain, such as spinal fractures, dislocations, arthritis and other serious conditions.
All sprains or strains, no matter where they are located in the body, receive basically the same type of treatment. Usually, neck sprains, like other sprains, will gradually heal, given time and appropriate treatment. You may have to wear a soft cervical collar to help support the head and relieve pressure on the neck so the ligaments have time to heal.
Analgesics can help reduce the pain and any swelling. Muscle relaxants can help ease spasms. You can apply an ice pack for 15 to 30 minutes at a time, several times a day for the first two or three days after the injury. This will help reduce inflammation and discomfort. Although heat, particularly moist heat, can help loosen cramped muscles, it should not be applied too quickly.
Rarely does the treatment of whiplash require surgery. Because the term whiplash simply describes a mechanism of injury, all types of injury due to whiplash are included in a classification of "whiplash associated disorders" (WAD's). At their most severe, although rare, WAD's may involve broken bones or nerve damage and these may require some form of surgery.
Other treatment options include:
- Massaging the tender area
- Cervical traction
- Aerobic and isometric exercise
Generally, prognosis for individuals with whiplash is good. The neck and head pain clears within a few days or weeks. Most patients recover within 3 months after the injury, however, some may continue to have residual neck pain and headaches.
What is whiplash?
Whiplash and other medical conditions related to whiplash are types of neck injuries caused by sudden changes in the position of the neck. The most common way they happen is through car accidents where the car is hit from behind. The most common symptom reported by persons who have whiplash is pain due to mild muscle strain or minor injury to other non-bone tissue. Other injuries include injury to the nerves, discs and in the most severe cases injury to ligaments in the neck and even a broken bone in the neck. Minor whiplash injuries can result in pain and decreased movement in the head and neck. These symptoms may last for weeks or months, but sometimes they last longer and may include headaches, dizziness and tingling in the arms. Exactly what happens physically to produce whiplash symptoms is unknown. Some scientists believe that the cause of long-term whiplash symptoms is due to damage of nerves and that the cause of short-term pain may be minor injury to the muscles.
What else can cause neck pain besides whiplash?
Sitting for long periods of time combined with a lack of exercise can lead to symptoms similar to whiplash. Sports activities resulting in being hit from behind can cause similar injury as whiplash from car accidents. Other medical conditions such as arthritis can also cause neck and shoulder aches. Your doctor is trained to find them. Living with a lot of tension and stress can also cause neck pain. It’s important to keep your neck healthy, especially if you’ve already suffered whiplash injury. The most important thing to do is to prevent whiplash by properly positioning the head restraint of your seat in your car.
How long will it take to recover?
That depends. Every person is different and aches and pains are part of your body’s response to trauma and stress. Healing takes time. Research suggests that people with more symptoms from the initial injury may take longer to heal. Most people are back to their normal activities, including work, even though their symptoms may take weeks, months or longer to get much better. For those who need time away from work, most will return to their usual activities within weeks. Only 3-5% of people with whiplash injuries are still on disability after one year.
What treatments help?
Most whiplash injuries respond to a simple approach:
- Keep generally active and do some neck exercises
- Download Neck Exercise Sheet and discuss with your health professional
- Stay at work or return as soon as you can
- Research shows that people who keep active and are involved with other parts of their life recover faster than those who stop working and focus on their pain.
- Practice activities that help reduce stress
- Keep a positive attitude - A sense of humour is essential
- Prevent future injuries - Get a vehicle with GOOD rated head restraints and adjust them correctly!
- Over a third of chronic neck injuries from rear-end collisions are preventable.
- What else can I do to relieve the pain?
- Here are some recommendations about other therapies:
- Stay active and exercise. Prolonged rest or use of a collar weakens tissues and slows recovery. Most people do not need a collar.
- Neck manipulation, mobilization or massage by a trained professional may help in the beginning, but is not recommended as a long-term treatment.
- Treatments where you are not active (for example, treatments that you recieve when you are lying down) not recommended for long periods of time. These passive treatments should be combined with an active exercise program.
- Using painkillers or muscle relaxants is generally not a good idea because they may be harmful.
- As a general rule, if a treatment is going to help, you should feel some improvement in days to weeks. If not, check back with your doctor.
Is it all in my head?
Most physical pain and suffering have a psychological component, especially when pain continues and leads to fear, anxiety and depression. That is normal. However, focusing too much on your suffering, fears and anxieties can make you feel worse. If you find yourself dwelling on pain, reassure yourself and seek help from your doctor.
Who’s most likely to get whiplash?
Studies show that young women who are not very muscular are more prone to whiplash.
Can I reduce my chance of getting whiplash from a car accident?
Yes. The proper use of well-engineered head restraints dramatically reduces serious neck injuries from automobile accidents. Studies show that vehicles with well designed head restraints can reduce injuries in rear-impact crashes by 24% to 44%. Drivers can protect themselves from whiplash by buying safer vehicles. However, having a car with well-engineered head restraints isn’t enough.To reduce your chance of whiplash, those restraints have to be positioned correctly.
How do I know if my head restraint is positioned correctly?
Ask yourself the following two questions:
- Is it high enough? The top of the restraint should be even with the top of your head or at least to the top of your ears.
- Is it close enough? The restraint should be around 5 cm (2 inches) from the back of your head. Closer head restraints are twice as good at preventing injuries as those set too far back.
Many motorists refer to a head restraint as a headrest. But head restraints are not comfort features. They are essential safety features like lap/shoulder belts. In a rear-end crash, effective, well-designed head restraints help move your head forward along with your body, thereby decreasing your chances of getting a whiplash injury.
What happens if the vehicle I’m driving is hit from the rear?
At impact, the vehicle moves forward causing the seat to push against your back (1). Your body is cushioned by the seat while your head and neck continue to move back (2). If your head is unsupported due to an improperly positioned head restraint (top sequence), it continues to move backwards over the head restraint (3). Properly adjusted head restraints (bottom sequence) keep your head and body positioned in line with each other throughout the collision, thereby protecting your neck (4).
- Reactive Head Restraint: A head restraint that automatically moves up and forward during the crash, activated by the weight of the person in the seat.
- Pro-Active Head Restraint: A head restraint that automatically moves up and forward at the start of the crash, activated by crash sensors on the bumper or within the car.
- Reactive Seat: An entire seat and head restraint that absorbs the energy of a rear end crash.
- Passive Seat: A seat that uses passive foam technology to absorb the energy of the crash and allows the person to use the head restraint without the neck changing position.
- Traditional Seat: A traditional fixed or adjustable head restraint that has no specific anti-whiplash technology.
Do newer vehicles have better head restraints than older ones?
Yes. Head restraints have improved so that a newer vehicles are likely to have better head restraints than older ones. In 1995 only 3% of measured head restraints received good geometric ratings from the Institute, compared with 51% in 2005. The number of poor restraints decreased from 82% in 1995 to only 6% in 2005.