Whiplash

Whiplash is a term sometimes used to describe to injuries to muscles tendons, ligaments, and other soft tissue in the neck caused by a sudden jerking movement of the head. It is a common injury from motor vehicle accidents. Treatment mainly involves pain medication and exercises or physiotherapy.

Symptoms include neck pain and/or stiffness, pain or tingling in the arm, headaches, problems with memory and concentration, and psychological distress.

Whiplash injury may also be referred to as a neck sprain or strain, although these terms are also used to describe other types of neck stiffness or pain such as that caused by poor posture or sleeping awkwardly.

Causes

Whiplash-associated disorders often occur in motor vehicle accidents but can also result from an unexpected blow to the head such as that received during contact sports (e.g. rugby, boxing) or physical abuse or assault (e.g. shaken baby syndrome). Slips or falls that result in the head being jolted backwards can also cause whiplash.

Whiplash injuries can range from minor to severe, depending on the force of the jerking movement of the head. Whiplash is typically more serious in older adults (those aged more than 65 years) due to weakening of muscles and bone deterioration that is associated with ageing.

A blow or accident causing whiplash might also cause concussion, some symptoms of which are similar to those of whiplash. Concussion is a potentially serious condition.

Signs and symptoms

The initial signs and symptoms of disorders associated with whiplash usually appear within 24 hours. Common symptoms include:

• Neck pain
• Neck stiffness
• Headaches at the base of the head
• Dizziness
• Blurred vision
• Fatigue.

Visit your doctor if you have neck pain or any other whiplash symptoms after a car accident, sports injury, or other traumatic injury. It is important to get a prompt diagnosis to rule out broken bones or other more serious conditions. You should also see your doctor immediately if you have:

• Pain, tingling, or numbness in your arms
• Pain when you move your head
• Pain, tingling, or numbness in your buttocks or legs
• Issues with your bowels or bladder.

Whiplash injury usually gets better on its own within three months but some people experience symptoms that persist beyond six months. You should see your doctor if symptoms persist.

Longer-term symptoms of whiplash include neck pain and stiffness that does not get better with time, persistent headache, abnormal sensations such as numbness or pins and needles in the arms and hands, problems with memory or concentration, and psychological issues such as anxiety and depression.

Diagnosis

Whiplash can usually be diagnosed by your doctor after discussing your symptoms and how the injury occurred, combined with a physical examination.

A physical examination will determine the degree of tenderness or pain in your neck, shoulders, and back. It will also assess the range of motion in your neck and shoulders as well as reflexes and strength in your limbs.

Imaging tests such as x-rays and computerised tomography (CT) scans will not reveal soft tissue damage caused by whiplash but may be used to rule out other conditions like broken bones. However, magnetic resonance imaging (MRI) can show injury to certain soft tissues (i.e. spinal cord, discs, and ligaments).

Treatment

The aim of treatment for whiplash injury is to manage pain and encourage you to get moving again, restoring a normal range of movement in your neck as soon as possible and enable you to carry out your normal daily activities.

Depending on the severity of the whiplash injury, some people will only require over-the-counter pain relief medication and self-care. Others may require prescription medications. Some people find ice or heat and relaxation techniques help with recovery.

Previously, soft foam collars (also known as cervical collars) were commonly used for whiplash injuries to immobilise the neck. However, evidence shows that keeping the neck still for a long period of time reduces muscle strength and delays recovery.

It is important to keep your neck mobile because early active movement has been shown to speed up recovery. You may be given stretching and movement exercises by your doctor or a physiotherapist, which will help to restore the range of motion in your neck. Examples of such exercises are slowly and gently bending your neck toward your chest tucking your chin in, slowly tilting your head side to side, and rolling your shoulders.

References

Anderson, C., et al. A narrative review on cervical interventions in adults with chronic whiplash-associated disorder. BMJ Open Sport Exerc med. 2018 Apr 25; 4(1): e000299. Cleveland Clinic (2022). Whiplash (Web Page). Cleveland, OH: Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/11982-whiplash [Accessed: 01/02/23] Mayo Clinic (2022). Whiplash (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/whiplash/symptoms-causes/syc-20378921 [Accessed: 01/02/23]

NHS inform (2022). Whiplash (Web Page). Glasgow: National Health Information Service, National Health Service (NHS) Scotland. https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/whiplash/ [Accessed: 01/02/23]

O’Toole, M.T. (Ed.) (2017). Whiplash injury. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.

Ricciardi, L., et al. The role of non-rigid cervical collar in pain relief and functional restoration after whiplash injury: a systematic review and a pooled analysis of randomized controlled trials. Eur Spine J. 2019 Aug;28(8):1821-1828

Rosenfeld et al. Active intervention in patients with whiplash-associated disorders improves long-term prognosis: a randomized controlled clinical trial. Spine (Phila Pa 1976). 2003 Nov 15; 28(22): 2491-8.

Scholten-Peeters, G.G.M., et al. Education by general practitioners or education and exercises by physiotherapists for patients with whiplash-associated disorders? A randomized controlled trial. Spine (Phila Pa 1976). 2006 Apr 1; 31(7): 723-31.

Reviewed: February 2023