Discover whiplash injuries, their causes, symptoms, and effective recovery methods. Learn more at Meri Sehat.

Whiplash

Overview

Whiplash is a neck injury that results from the sudden, forceful back-and-forth movement of the neck.&nbsp;&nbsp; 
&nbsp;

As per the Quebec task force (QTF), whiplash is a bone or soft tissue injury as a result of rear-end or side impact<a href="#accordion">[2]</a>. These injuries are most commonly due to motor vehicle accidents, but can also be caused during diving or different accidents. It is associated with neck pain and stiffness, arm pain, memory issues, and psychological distress. This group of signs and symptoms is often collectively referred to as whiplash-associated disorders (WAD)<a href="#accordion">[2]</a>.

Whiplash impacts up to 83% of patients involved in motor vehicle accidents, and is a common cause of chronic disability<a href="#accordion">[2]</a>. In the United States, whiplash injury is associated with an overall economic burden of almost $3.9 billion annually<a href="#accordion">[2]</a>. When legal fees are taken into account, the expenses exceed $29 billion<a href="#accordion">[2]</a>.

Whiplash affects millions of individuals worldwide every year. The annual incidence varies between 16-200 per 100,000<a href="#accordion">[1]</a>. In the United States, it is approximately 4 per 1,000 persons<a href="#accordion">[2]</a>.

Although all ages are affected, whiplash is generally more serious in older adults and females. Adults over the age of 65 years are more at risk of lasting injuries due to age-related bone and muscle weakening.

Whiplash is generally not associated with any long-term complications. Most people fully recover within 3 months<a href="#accordion">[6]</a>. 
&nbsp;

Note: If you notice any neck pain or other whiplash symptoms after an injury or car accident, contact a doctor to rule out any broken bones and prevent the worsening of symptoms. 
&nbsp;

There are no specific subtypes of whiplash. 
&nbsp;

Signs and Symptoms

The signs and symptoms of whiplash usually become evident within hours or days of the injury. They typically vary depending on the severity of the injury and on the extent of compression and neck hyperextension.

<ul>
	<li>Neck pain and rigidity</li>
	<li>Neck pain worsens with movement</li>
	<li>Muscle spasms causing a loss of range of motion in the neck</li>
	<li>Headaches, commonly at the base of the skull</li>
	<li>Pain or tenderness in the back, shoulders, or arms</li>
	<li>Tingling or numbness in the arms</li>
	<li>Fatigue</li>
	<li>Dizziness or vertigo 
	&nbsp;</li>
</ul>

Some people also have:

<ul>
	<li>Blurring of vision</li>
	<li>Ringing in the ears (tinnitus)</li>
	<li>Pins and needles sensation (paresthesia) in the neck, upper back, shoulders, or upper arms</li>
	<li>Sleep disturbances</li>
	<li>Irritability</li>
	<li>Difficulty concentrating</li>
	<li>Dysphagia</li>
	<li>Hoarseness or loss of voice (dysphonia)</li>
	<li>Memory problems(<a href="https://merisehat.pk/disease/amnesia-17164">amnesia</a>)</li>
	<li>Cervical vertigo</li>
	<li><a href="https://merisehat.pk/disease/depression">Depression</a></li>
	<li>Chronic pain in the head, neck, or shoulders 
	&nbsp;</li>
</ul>

Note: If you suffer a neck injury and notice severe pain (despite taking painkillers), paresthesia, weak arms or legs, problems walking or sitting, or a sudden &lsquo;electric shock&rsquo; in the neck and back, contact a healthcare professional immediately. 
&nbsp;

The Quebec task force (WTF) classifies patients into the following grades based on the severity of signs and symptoms:<a href="#accordion">[1]</a> 
&nbsp;

<ul>
	<li>Grade 0: The patient has no physical signs or neck complaints.</li>
	<li>Grade I: There is neck pain, tenderness, or stiffness. However, no physical signs are present.</li>
	<li>Grade II: Patient has neck complaints and musculoskeletal signs, such as point tenderness and decreased range of motion. Physical signs, like bruising and swelling, are also present. Moreover, muscle spasms may make it difficult to move or turn the neck and head.</li>
	<li>Grade III: The neck complaints are associated with neurological signs, such as numbness, paresthesia, headaches, vision problems, and vertigo.</li>
	<li>Grade IV: The patient will have neck complaints and a fracture or dislocation of a neck vertebra. Moreover, severe neurological symptoms are present. 
	&nbsp;</li>
</ul>

Causes

Whiplash typically occurs when the head is suddenly and forcefully thrown backward and then forward. This back-and-forth motion can injure bones in the spine, discs between the bones, ligaments, muscles, nerves, and other tissues of the neck.

A whiplash injury typically results from a collision including sudden acceleration or deceleration. Some common causes of whiplash are: 
&nbsp;

<ul>
	<li>Motor Vehicle Accidents - These are a major cause of whiplash.&nbsp;</li>
	<li>Physical Abuse Or Assault - Whiplash can occur if one is punched or shaken. Moreover, it is one of the injuries linked to shaken baby syndrome.</li>
	<li>Contact Sports - Whiplash can occasionally result from football collisions and other sports-related incidents. Examples of contact sports include boxing, football, and some martial arts.</li>
	<li>Roller Coasters</li>
	<li>Horseback riding</li>
	<li>Cycling falls 
	&nbsp;</li>
</ul>

There are essentially no screening tests available for Whiplash injuries. 
&nbsp;

Diagnosis

To diagnose whiplash, the doctor will first need to rule out other possible causes. Therefore, they will begin by asking the following questions about the injury:

<ul>
	<li>How did the injury happen?</li>
	<li>Where is the pain?</li>
	<li>Is the pain dull, severe, or sharp? 
	&nbsp;</li>
</ul>

In order to assess the range of motion and look for painful spots, they might also perform a physical examination. During the physical examination, the doctor will check for the range of motion in the patient&rsquo;s neck and shoulder, and check their reflexes and sensations.&nbsp;

Moreover,&nbsp; imaging tests will allow them to evaluate any damage or inflammation of the soft tissues, spinal cord, or nerves. They can also evaluate for brain injury. These imaging tests may include<a href="#accordion">[3]</a>: 
&nbsp;

<ul>
	<li>X-ray - This can help rule out other types of injuries or any degenerative disease, such as arthritis. Moreover, fractures and dislocations can also be identified with the help of X-rays.</li>
	<li>CT Scan - This helps identify any bone damage.</li>
	<li>MRI Scan - Along with bone injuries, MRI scans allow doctors to look for spinal cord injuries or any damage to the discs and ligaments. 
	&nbsp;</li>
</ul>

In rare cases, doctors may order diffuse tensor imaging (DTI) or positron emission tomography (PET scan). These can help detect and measure the extent of injury to the brain or other areas. 
&nbsp;

Treatment

The aim of whiplash treatment is to control pain, restore the range of motion in the neck, and help the patient get back to their normal everyday activities. A patient&rsquo;s treatment plan typically depends on the severity of their injury. Some treatments for whiplash are helpful right after an injury, while others are best used to treat long-term and chronic problems from a whiplash injury. And some can do both. 
&nbsp;

The following treatments are most commonly used to treat whiplash:

<ul>
	<li>Immobilization</li>
	<li>Medications</li>
	<li>Cold and heat application</li>
	<li>Exercise/physical therapy</li>
	<li>Transcutaneous electrical nerve stimulation (TENS) therapy</li>
	<li>Radiofrequency nerve ablation</li>
	<li>Spine surgery 
	&nbsp;</li>
</ul>

<h5>Rest </h5>

Doctors will typically advise a rest of 1-2 days after the injury. However, too much bed rest should be avoided as it can delay recovery. 
&nbsp;

<h5>Heat Or Cold</h5>

For the first 7-10 days, cold packs should be applied to the affected area. This helps decrease swelling and inflammation. Heat application can then follow to help improve blood flow and heal damaged tissues. 
&nbsp;

<h5>Medications</h5>

Medications play a major role in treating whiplash, helping address many of the symptoms. The most typical types of drugs that doctors use to treat whiplash are:

<ul>
	<li>Painkillers - These include acetaminophen and other over-the-counter medications, as well as nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. For moderate to severe pain, more potent analgesics like opioids are also an option. However, such strong drugs are prescribed very cautiously as they can result in long-term addiction and dependence.</li>
	<li>Anti-inflammatory Drugs - They help reduce the swelling from inflamed tissue. Swelling from whiplash leads to other complications if it presses on nerves and disrupts the transfer of signals to and from the brain.</li>
	<li>Muscle Relaxers - Sprained muscles can often become stiff uncontrollably, resulting in severe pain which prevents healing from an injury. Muscle relaxers cause muscles to relax, preventing spasms and helping the muscles to heal.</li>
	<li>Nerve Blocks - Blocking nerve signals can offer relief to people dealing with excruciating and chronic pain from whiplash. 
	&nbsp;</li>
</ul>

<h5>Immobilization</h5>

Cervical collars may help stabilize the neck and head. However, it is theorized that keeping the neck immobilized for too long can delay recovery and decrease muscle strength. Therefore, they should only be worn for 3 hours at a time, and for a few days after the injury. 
&nbsp;

<h5>Exercise And Physical Therapy</h5>

A combination of at-home stretches and movements can help restore the range of motion in the neck and reduce pain. However, these exercises should only be done on a doctor&rsquo;s advice. Physical therapists can guide patients through these different exercises.

Transcutaneous electrical nerve stimulation (TENS) uses mild electric currents to reduce pain in affected regions and improve muscle strength.&nbsp;

Moreover, people also benefit from practicing good posture, exercises to build strength, and relaxation techniques. 
&nbsp;

<h5>Surgery</h5>

In some cases, especially when whiplash is associated with fractured vertebrae, spine surgery may be performed. 
&nbsp;

<h5>Alternative Techniques</h5>

The following alternative remedies have been shown to help reduce pain associated with whiplash.

<ul>
	<li>Acupuncture - This involves the insertion of ultrafine needles in specific areas of the skin.</li>
	<li>Chiropractic Care - Joint and spinal manipulation techniques may be beneficial when combined with physical therapy or exercise.</li>
	<li>Massage - This can help provide short-term relief of neck pain.</li>
	<li>Breathing and mindfulness practices, such as yoga, tai chi, and qi gong. 
	&nbsp;</li>
</ul>

Most people recover within a few weeks, without any long-term effects. However, some may experience chronic pain or headaches months or even years after the incident.

It is difficult to anticipate how each person with a whiplash injury may recover. People with the following signs and symptoms are more likely to experience chronic pain.

<ul>
	<li>Severe neck pain</li>
	<li>More-limited range of motion</li>
	<li>Pain radiating to the arms 
	&nbsp;</li>
</ul>

&nbsp;The following risk factors have been associated with a worse outcome:

<ul>
	<li>History of whiplashOlder age</li>
	<li>Neck or back pain</li>
	<li>A high-speed injury 
	&nbsp;</li>
</ul>

Older adults (&gt;65 years of age) and women are generally at a higher risk of whiplash. Age-related muscle and bone weakness make older adults more prone to muscle and bone injuries of any kind.

Women are more likely to experience whiplash-like injuries because of the following causes: 
&nbsp;

<ul>
	<li>Height - According to experts, females have relatively shorter heights than men. Thus, increasing their risk. &nbsp;</li>
	<li>Spine Structure Differences - There is a difference in spinal column structure in men and women. This affected the intervertebral distance, increasing the risk of injury.</li>
	<li>Muscle Difference - Women have less muscle tissue available for the absorption of shock during sudden impact forces.</li>
	<li>Vehicle Construction - Women and others with disabilities may be at increased risk of injury because of contemporary vehicle design. Head restraints, also referred to as headrests, are designed to prevent excessive head retraction during collisions. Seat back and headrest height may have a different impact on women because of their shorter average height. 
	&nbsp;</li>
</ul>

Unfortunately, it is quite unpredictable, so there&rsquo;s no way to prevent it entirely. The following factors can lower the risk of whiplash: 
&nbsp;

<ul>
	<li>Adjust The Vehicle Seat - Putting the seat into the right position and using the headrests can reduce the risk of developing whiplash from vehicle-related situations. There are also orthopedic seat cushions that can help adjust the height or posture so the seat&rsquo;s safety features, like headrests, have the most benefit.</li>
	<li>Wear The Seat Belt Properly - If the seat belt is worn incorrectly, it will not stop the person&rsquo;s forward movement during acceleration injuries.</li>
	<li>Drive Safely - Driving carefully can help avoid car accidents. Keeping a safe distance from the vehicle in front can help prevent any collisions in case the person suddenly slams the brakes.</li>
	<li>Position Matters - If the vehicle is about to be rear-ended, it is advised to place the head against the headrest and hold the face straight ahead. This avoids the neck and head from moving at different speeds during impact. &nbsp;</li>
	<li>Play Contact Sports Safely -&nbsp;In these sports, avoiding risky contact can help prevent whiplash injuries to other players.</li>
	<li>Talk To A&nbsp;Healthcare Provider - A primary care provider can advise whether riding roller coasters or participating in other high-movement activities is safe or not. 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>As per the Quebec task force (QTF), whiplash is a bone or soft tissue injury as a result of rear-end or side impact. These injuries are most commonly due to motor vehicle accidents, but can also be caused during diving or different accidents.</li>
	<li>&nbsp;Signs and symptoms of whiplash usually become evident within hours or days of the injury, which include neck pain and rigidity, aggravation of pain with neck movement, and loss of range of motion in the neck.</li>
	<li>A whiplash injury may result from motor vehicle accidents, &nbsp;physical assault, or contact sports.</li>
	<li>&nbsp;A doctor might do a physical exam to check the patient&rsquo;s range of motion and look for areas of tenderness.</li>
	<li>Imaging tests done to diagnose whiplash include X Ray, CT scan, and MRI.</li>
	<li>The aim of whiplash treatment is to control pain, restore the range of motion in the neck, and help the patient get back to their normal everyday activities.</li>
	<li>The most common treatments for whiplash include immobilization, medications, and cold application for the first seven to 10 days. Heat application is recommended after that.</li>
	<li>Although all ages are affected, whiplash is generally more serious in older adults and females. Adults over the age of 65 years are more at risk of lasting injuries due to age-related bone and muscle weakening. 
	&nbsp;</li>
</ul>

[1] Pastakia, K., & Kumar, S. (2011). Acute whiplash associated disorders (WAD). Open access emergency medicine : OAEM, 3, 29–32.

[2] Yadla, S., Ratliff, J. K., & Harrop, J. S. (2008). Whiplash: diagnosis, treatment, and associated injuries. Current reviews in musculoskeletal medicine, 1(1), 65–68.

[3] Whiplash (neck strain): What it is, symptoms & treatment. Cleveland Clinic.

[4] Dickson C, de Zoete RM, Stanton TR. From where we've come to where we need to go: Physiotherapy management of chronic whiplash-associated disorder. Frontiers in Pain Research. 2022;2. doi:10.3389/fpain.2021.795369.

[5] Sethi, R. K., Kozin, E. D., Fagenholz, P. J., Lee, D. J., Shrime, M. G., & Gray, S. T. (2014). Epidemiological survey of head and neck injuries and trauma in the United States. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 151(5), 776–784.