What is Whiplash?
A whiplash injury is one to the muscles, soft tissue and tendons of the neck that is sustained by sudden movement in any direction and then back with speed. It commonly occurs with impact from the rear direction, while in a stationary position. The movement of the head extends beyond the normal range of motion of the neck, overstretches the tissues and supporting structures and is often described as happening with sudden acceleration-deceleration forces. Damage can be incurred to the muscles, discs, nerves, joints or bones or a combination of these. Whiplash is most commonly sustained during motor vehicle accidents, a slip or fall where the head is jolted, head contact during sports such as rugby or trauma to the head inflicted by a heavy object.
During an episode of rear impact, the lower cervical vertebrae are forced into hyperextension while the upper cervical vertebra are flexed beyond normal range, resulting in an abnormal S-shape of the cervical spine and damage to the surrounding tissue.
Whiplash can be characterised by neck pain, tenderness over neck joints as well as pain in the shoulders and back, possibly radiating down the arms. It can also involve stiffness and restricted neck movement as well as headaches that originate at base of skull and radiate towards the forehead. Pain usually begins 6-12 hours after the injury is sustained as the inflammatory process takes place. Pain and symptoms usually improve within days to weeks although some residual stiffness and pain can still be present weeks to months after the initial injury. The term Whiplash Associated Disorders is used to describe more severe and chronic cases
Less common symptoms that can still be present include:
- Dizziness
- Visual disturbances
- Difficulty swallowing
- Difficulty concentrating
- Altered sensation
- Tinnitus
- Fatigue
- Jaw pain
A diagnosis of whiplash is usually made by a doctor or a physiotherapist who will take a full history of the injury sustained, may also request x-rays and CT (computed tomography) scan.
Red flags:
- Bilateral pins and needles or numbness
- Progressive weakness
- Difficulty walking
- Facial pins and needles or numbness
- Bladder and bowel changes
- Fainting
If any of the above are noticed as symptoms, then advice from a medical professional should be sought immediately as they can be a sign of something more sinister.
Who Suffers from Whiplash?
Whiplash is a common injury sustained in motor vehicle accidents but can also occur on the sporting field. Those involved in contact sports such as rugby and martial arts but also race car drivers, cyclists, mountain bike riders and gymnasts are at risk. If whiplash is sustained due to a head knock during sports or a motor vehicle accident, medical staff should also screen for possible concussion as the two often occur concurrently.
However, it’s not only athletes at risk as whiplash can occur due to such leisure activities as roller-coasters, bungy jumping, jet skiing and water skiing. This is due to the high speed at which the body travels and the sudden change of directions.
How is Whiplash Treated?
Whiplash should heal on its own with time and patience although physiotherapy may be needed to help with joint stiffness and muscle retraining once initial inflammation has resolved. Throughout recovery it is best to try and maintain normal activities of daily living as much as possible. It is important to try and avoid any abnormal head or neck movements as these can lead to poor posture and compensatory habits which can be difficult to break.
Ice can initially be applied to reduce inflammation and then heat packs can be used once the acute phase has passed. Never apply either directly to the skin and only ever use for a maximum of 20 minutes at a time to help protect the skin.
Over the counter analgesia and anti-inflammatories can be beneficial to help with pain and swelling. These should not be taken long term as they have potential side effects. If pain and symptoms persist or if you feel that over the counter options aren’t adequate, then it is important to consult a medical professional.
Neck braces and collars have traditionally been a popular treatment option for whiplash. While they can provide initial support, comfort and pain relief they shouldn’t be used long term as the muscles in the neck can become weak and the neck joints can become stiff from decreased movement. Early mobilisation exercises have been shown to lead to a better outcome for patients than the use of neck collars. If using a brace or a collar, try and wean off it as soon as possible and potentially only wear it at certain times during the day when active or when requiring support e.g. when sleeping or as a passenger in a car.
Once initial symptoms have resolved then it’s advisable to visit a physiotherapist who will advise on rehabilitation for the muscles and the joints in the neck. Gentle neck stretches and range of movement exercises as well as deep neck flexor muscle strengthening are usually the focus of treatment. Ultrasound, massage and dry needling may be used as adjunct treatment options as well.
Any return to physical activity and sport should only be once cleared by a physio or doctor and is usually only once full range of movement in the neck has returned.
Due to the potential long-term nature of the pain and other assorted symptoms there can be a prolonged period of partial disability and resulting psychosocial elements, especially with Whiplash Associated Disorder. Adequate education should be given to patients to assist them with managing the condition.