Whiplash is a sprain or strain of the muscles and ligaments in the neck (cervical spine) caused by sudden and forceful movement of one’s head in a backward-then-forward motion. This occurs most commonly from a deceleration injury, as seen in automobile accidents. Whiplash can occur whether the force is directed from the front or from behind. Symptoms accompanying whiplash include neck pain and swelling, decreased motion, tenderness along the upper portion of the back and neck, muscle spasms and possibly headache. In severe cases, “neurologic-like” symptoms may develop even without injury to neural structures. Symptoms can include dizziness or other balance complaints, vision changes, nausea and referred symptoms into the extremities.
Common symptoms include neck and upper back pain; neck stiffness with reduced range of motion; muscle spasm, swelling, and tenderness in the neck and upper back. Also, “referred pain” may occur with symptoms such as headache, jaw pain, shoulder and arm pain with with or without numbness and tingling into those areas. In more severe cases, “neurologic-like” symptoms with can develop in the absence of a specific nerve injury. Such complaints include ringing in the ears, blurry vision, poor concentration or memory, nausea, vision changes, difficulty sleeping and fatigue. Additionally, since whiplash often involves a motor vehicle collision it is important to note whether or not a patient might have suffered a concussion or loss of consciousness which could act as a primary cause of the “neurologic-like” complaints.
Whiplash is a general term used to describe sprain or strain injury to the cervical spine structures including the muscles, ligaments, joints, and discs resulting from a sudden and forceful backward and then forward head and neck motion. The injury is usually related to a motor vehicle collision from the front or back. Often times, symptoms are not immediately present at the time of injury but may develop after a few days or even a few weeks.
Most patients with whiplash will improve within a few weeks, however, it is not uncommon for the condition to take several weeks to months to heal and symptoms to significantly improve. Maintaining a positive attitude and compliance with the treatment program is highly recommended in order to improve your outcome.
Studies indicate that young women with flexible necks can be more to suffer whiplash. Additional, older adults with underlying cervical spine arthritis or disk degeneration will commonly experience whiplash.
After whiplash we have a tendency to guard our necks against motion. However, this tendency to guard ourselves will lead to worsening of symptoms due to muscle disuse. The neck muscles will weaken and range of motion will be further lost. Exercise is meant to restore normal function to our muscles and spinal segments, improve range of motion, and improve pain symptoms.
It is highly recommended that you return to work as soon as your symptoms allow. Medical research recognizes a strong therapeutic value to maintaining your normal work and life routine as your symptoms allow. Do not wait to be 100% improved before returning to work.
Dealing with a car wreck and the resulting aftermath can be stressful and time consuming. Both the patient and automobile are injured. Dealing with health and auto insurance companies can be difficult. In more severe cases, patients may lose work time and resulting income may be affected. It is important that the patient be mindful of the stress that can mount and make time for activities and relationships that can be beneficial for stress relief and maintenance of a positive, healing attitude.
Diagnostic testing begins with a history and physical examination by your doctor. Specific diagnostics tests include include x-ray, CT scan, and MRI which, in the case of whiplash, are used to rule out more severe structural spinal injury such as disc herniation, pinched nerve, spinal fracture, or spinal instability. Additionally, nerve testing with an EMG/nerve conduction study can evaluate for possible nerve damage. Finally, a neurology consultation can be considered if neurologic symptoms such as headache, vision changes, difficulty sleeping and fatigue persist.
Most patients with whiplash will improve within a few weeks with conservative care measures. However, in more severe cases symptoms can linger and supervised medical treatment is required. Treatment options can include acute pain management options such as physical therapy, medication, and injections. Physical therapy consists of both active and passive treatments. These treatments are utilized to stretch sore muscles, reduce muscle spasm, increase muscle blood flow, strengthen muscle, improve cervical range of motion and thereby reduce pain symptoms. Physical therapy, an active treatment, consists of stretching and strengthening exercise activities. Exercise is utilized improve strength of the supporting spinal muscles and restore normal spinal posture and range of motion. Passive treatment can include such things as ice, muscles rubs, electrical stimulation, ultrasound, traction, massage, and chiropractic manipulation which are used to relieve muscle tension and pain. Injections could include trigger point injections, facet joint block, and epidural steroid injection. Injections are used to decrease muscle, joint, or nerve inflammation and pain. Surgery is rarely needed unless other injuries are identified on diagnostic imaging or nerve testing such as spinal disc injury, nerve impingement or damage, or spinal instability.