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Whiplash Injury

What is Whiplash

Whiplash is an injury to the neck caused by a sudden whipping movement of the head and neck. Whiplash commonly occurs in rear end vehicle collisions (the most common type of car accident). It may also occur in side impact and head-on collisions. Whiplash injury also may occur when diving or during a fall or blow to the head.

When the head is abruptly jolted forward or backward, the muscles in the neck do not have time to react and the neck is extended beyond its normal range of motion. The force may also be too great for the muscles in the neck to be able to hold the neck within a safe range of motion.

This hyperextension of the neck causes muscles and/or ligaments that support the neck to become overstretched or torn. In some cases, the discs and facet joints (spinal joints) and nerve roots may also be damaged. Inflammation of soft tissues may also result in compression of nerve roots. In severe cases, there may be fractures or dislocation.

Whiplash injury is usually not serious (life-threatening). The severity of the injuries, the symptoms, and recovery time from whiplash varies greatly. Mild whiplash injuries often heal completely within two to three weeks, moderate whiplash injuries within two to three months. Severe whiplash may take several months to heal. Most people recover fully but some develop long-term problems.

Whiplash is sometimes referred to as neck strain (a strain is a muscle or tendon injury) or neck sprain (a sprain is a ligament injury). Whiplash may also be referred to as hyperextension-hyperflexion injury.

Factors affecting Severity of Whiplash

Whiplash is not well understood. Severity of injury varies considerably between people in the same types of car accidents, even when circumstances are similar. Speed is a major factor, as is the weight of the vehicles. There are several other factors involved. When the person sees the accident coming, the injury is often less severe. This may be because the nervous system has time to prepare. The position of the neck at the time of impact also plays a role. Risk of injury appears to be greater when the head is turned to the side than when it is facing straight ahead - except in very low speed crashes. The position of the headrest is important - it needs to be at the proper height and distance from the head to reduce severity of injury. The strength of a persons neck also plays a role. Females, having less strength in their necks, generally suffer more severe whiplash injuries than males.

*Seatbelts with shoulder harnesses should always be used and head rests at the proper height for the person. The height of the headrest should be just above the ear. The distance between the headrest and back of the head should be two to four inches.

Whiplash Symptoms

Symptoms may occur immediately after the injury or set in gradually over the next couple of days. It is common for a person with no immediate symptoms to wake up stiff and sore the next morning. Whiplash can vary greatly in severity and cause a wide range of symptoms. Not all people experience the same symptoms. Symptoms that develop rapidly often indicate a serious injury.

The most common symptoms of whiplash are neck pain and stiffness. The neck becomes stiff as muscles tighten up to protect the injured area from further injury by reducing motion.

Headaches are also common. Pain originating in the neck (from muscle spasms in the neck and/or irritated nerves in the back of the neck) is often referred to the head. The pain may felt be over the entire head or any area of the head - often over the forehead and behind the eyes.

There may be back pain or shoulder pain, or numbness or tingling in the arm. Other symptoms of whiplash include problems with memory and concentration, feelings of disorientation, dizziness, ringing in the ears, impaired hearing, blurred vision, sensitivity to sound and light, irritability, depression, and difficulty sleeping.

Neurological symptoms may be the result of injury to soft tissue injury to the neck or a mild brain injury or concussion. A sudden jolt to the head can jar the brain. Neurological symptoms often resolve within a week

Seeking Medical Attention

*If symptoms occur immediately or shortly after the accident an ambulance should be called so that the neck can be immobilized during transport to a hospital emergency ward.

There may be serious injuries that may require immediate medical treatment (such as hemorrhage, fracture, dislocation, or spinal cord injury). In addition, auto accidents that result in whiplash may also result in other injuries such as chest injuries, back injuries, internal injuries, etc.

Always seek a proper diagnosis from a physician, even if the symptoms are mild. The diagnosis may be based upon symptoms alone, or an MRI or CT may be taken to see the extent of soft tissue injury. X-rays may be taken to rule out fractures or dislocation.

Whiplash Treatment

Treatment depends on severity of symptoms. If the injury is mild, applying ice packs at home for the first couple of days along with the short-term use of NSAIDs may be sufficient. If symptoms are moderate (especially if there is limited range of motion), physical therapy is often recommended. Massage therapy and/or spinal manipulation may also be beneficial.

Applying Ice

Applying ice every four hours for the first couple of days helps reduce inflammation (the main cause of the pain). Inflammation is greatest for the first two days. Wrap ice in a cloth and apply to area of neck pain for 20 minutes every three to four hours.

Medications

Anti-inflammatory medication to relieve both pain and inflammation such as Ibuprofen or Aspirin are often helpful. Your physician may prescribe muscle relaxants or pain medication that contains codeine for temporary use.

Physical Therapy

Depending upon the severity of the whiplash injury, physical therapy may be recommended by your physician. A physical therapist can prescribe range-of-motion exercises, teach proper posture to avoid excess strain on neck, treat pain with cold and heat, etc.

Massage therapy is useful for increasing blood flow, speeding healing, and relaxing tight muscles, and relieving pain.

Chiropractic treatment may help. Spinal manipulation appears to be the most effective during the first six weeks after the injury.

Soft Collars

Soft collars may be helpful for the first two or three days, when pain and inflammation is at its greatest. Inflammation may trigger muscle spasms - a protective mechanism to restrict movement to prevent further injury. Wearing a soft collar helps relax the muscles to relieve pain. However, prolonged use of soft collars has been shown to delay recovery from whiplash. Intermittent use may be recommended in some cases.

*If a fracture or dislocation is involved, a wearing molded collar may be necessary to stabilize the neck.

Prognosis

How quickly one recovers from whiplash depends largely upon the severity of the injury. The seriousness of the injury often correlates with how quickly the symptoms develop.

Mild whiplash injuries often heal completely within two to three weeks, moderate whiplash injuries within two to three months. Severe whiplash injury may take several months to heal. For some people, symptoms (such as mild neck pain and/or headaches) may linger for longer periods of time. If symptoms are still present after six months, the pain is considered to be chronic. Chronic symptoms may last for years. Whiplash injury may increase risk of degenerative changes in the discs and spinal joints.

Some people report that new symptoms appear years after the initial whiplash injury, though it is difficult to determine whether or not symptoms that appear years later are related to the whiplash injury.