Whiplash Causes, Symptoms, Diagnosis, Treatment

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The Universal Guide to Whiplash: Everything you ever wanted to know, straight from the experts.

In This Article: What Is Whiplash?   |    Symptoms   |    Causes   |    Is Whiplash Serious?   |    Diagnosis   |    Treatments  |    Surgery   |    Alternative Treatments   |    Recovery   |    FAQs   |   Sources

 

Imagine you’re in your car and get rear-ended. Your head snaps back, then slams forward. Soon, not only does your neck ache, but it’s also so stiff you can barely turn your head.

If you go to the doctor – and you should – you may be diagnosed with whiplash. It’s sometimes called a neck strain or sprain, though not all neck strains and sprains are whiplash.

Two people involved in a car accident.Woman holding her neckSince whiplash can cause long-lasting effects on the spine, it is important to see your doctor if you have been injured. Photo Source: 123RF.com.

By some estimates, there are around 3 million whiplash injuries a year. More than just a neck-ache, whiplash is associated with disability, decreased quality of life, and distress. The distress doesn’t just stem from pain, but also from the false perception that whiplash isn’t a serious injury – since it doesn’t always show up on imaging scans.

We’re here to help set the record straight: Whiplash is a real physical condition that can have a major impact on your life and mental health.

What Is Whiplash?

Whiplash is the common term for a neck sprain or strain. It often results from being rear-ended in a car, making the head snap back and forth like the tip of a whip. A whiplash injury damages the soft tissues in the neck such as ligaments, tendons, and discs. Recovery can take days, months, or years.

Whiplash is essentially a two-part injury. First, there’s a jerking neck movement that creates hyperextension (excessive motion that opens a joint). Immediately after is a too-fast, too-far reversal of that motion known as hyperflexion. Either one on their own could injure any of the tissues in your neck, including the discs between your vertebrae, as well as ligaments, muscles, and nerves. Together, they’re doubly dangerous.


Illustration showing hyperextenion and hyperflexionDuring a whiplash incident, your neck moves forcefully and rapidly backward and forward. Photo Source:Spine Universe.com

“At its mildest, whiplash is associated with transient pain that may last a few hours to a few days and then resolve,” said Dwight S. Tyndall, MD, a spine surgeon at the Center for Minimally Invasive Surgery in Munster, Ind. In severe cases, recovery can take months or — in rare cases — even years.

Luckily, most people won’t take nearly that long to recover, as most cases of whiplash resolve on their own in a matter of days or weeks. To understand what’s going on with whiplash—however long you’re dealing with it—it helps to understand your neck’s structure.

Neck Anatomy

The upper part of your spine (your neck) is called your cervical spine. Despite it being  such a small part of your body, there’s a lot going on.

Your cervical spine features seven square bones called your cervical vertebrae. Starting from the top, they’re numbered C1 to C7. Together with ligaments and the long muscles over them, they form a protective structure (the spinal canal) surrounding the spinal cord.

Of course, your cervical spine does more than that. It supports the full weight of your head. It also enables you to nod, tilt, and rotate your head. When you look up at the stars, button your jeans, or reach for the salt at dinner, your cervical spine plays a central role.

The flexibility of your cervical spine enables you to move your head in all directions without a second thought. The downside of that flexibility, though, is that it can make your neck vulnerable to injury.

What Are Whiplash Symptoms?

Neck pain, stiffness, and limited range of motion are classic whiplash symptoms, but they’re not the only ones. Whiplash can also cause upper to mid-back pain (thoracic spine pain) in some people – particularly if you have high levels of pain right after the injury.

Other symptoms of whiplash may include:

  • Headache
  • Tenderness
  • Stiffness
  • Pain in the shoulder, upper back, or arms
  • Numbness or tingling in the arms
  • Fatigue
  • Diziness
  • Blurred vision
  • RInging in the ears (tinnitus)

There are some subtle symptoms, too – things you might not realize are connected to your injury. Cognitive symptoms of whiplash can include:

  • Difficulty sleeping
  • Problems with memory and concentration
  • Irritability
  • Depression

The signs of whiplash are sometimes immediately apparent. However, they may appear or get worse a day or two after the injury. “Patients can also sustain a mild traumatic brain injury in association with a whiplash injury, commonly called a concussion,” Dr. Tyndall said.

In some cases, you may not notice any symptoms for several days after an injury. Delayed symptoms of whiplash may be masked initially by other, more acute pain.

What Causes Whiplash?

Auto accidents are the most common cause of whiplash. (There are several other physical traumas that cause whiplash as well. Take contact sports: football, karate, boxing, ice hockey, to name just a few. Any of these can cause a collision that can snap your neck forward and backward.

Besides auto accidents and contact sports, you can also get whiplash from:

  • Physical abuse, especially being punched or shaken
  • Cycling accidents
  • ATV or motorcycle accidents
  • Horseback riding accidents
  • Falls where the head snaps backward

“During a whiplash injury, tremendous force is applied to the soft tissues in the neck,” says Michael Fehlings, MD, professor of neurosurgery at the University of Toronto. “That includes the muscles, joints, the ligaments at the base of the skull and along the front and back of the spinal column, and the discs in the front of the neck.”

Whiplash Complications

If you’re diagnosed with whiplash, your physician may assess you for complications or associated conditions. Any impact or event forceful enough to produce a whiplash injury may also cause other injuries, including:

  • Concussion (very frequently associated with whiplash)
  • Pain in the arms
  • Lost range of motion
  • Memory loss
  • Headaches
  • Loss of coordination

Don’t discount the potential impact on mental health, either. There is a relatively high prevalence of psychiatric disorders – including post-traumatic stress disorder, major depression, and generalized anxiety disorder – in people with persistent whiplash pain. Experts believe whiplash can both trigger and worsen these conditions.

Be sure to tell your doctors if you experience new or worsening mental health symptoms post-whiplash injury, so that they can refer you to an appropriate specialist for treatment.

Is Whiplash Serious?

Whiplash can be mild or serious. It depends on the nature of the injury and the physical condition of the patient. Young patients with mild injuries may recover in a few days. In contrast, older patients and those in higher-impact accidents can suffer from whiplash symptoms for months or even years.

“There’s a wide range of pathologies that can occur, from a mild neck strain, bruising or stretch injury, right through at its worst to a fracture or dislocation of the cervical vertebrae,” says Dr. Tyndall.

To better evaluate patients with WAD (whiplash-associated disorders), a group of whiplash specialists called the Quebec Task Force created the following classification scale.

  • Grade 0: No complaints about the neck. No physical sign(s).
  • Grade I: Neck complaint of pain, stiffness or tenderness only. No physical sign(s).
  • Grade II: Neck complaint AND musculoskeletal sign(s). Musculoskeletal signs include decreased range of motion and point tenderness.
  • Grade III: Neck complaint AND neurological sign(s)such as numbness or tingling in an arm.
  • Grade IV: Neck complaint AND fracture or dislocation.

Where you fall on the whiplash classification scale can help determine the severity, treatment, duration, and prognosis for recovery.

How Can You Get a Whiplash Diagnosis?

The most important thing you can do, if you think there’s a chance you have whiplash, see a doctor for a proper whiplash diagnosis. If you’re in a lot of pain and your regular doctors’ offices aren’t open, go to an urgent care facility. Don’t wait; see a medical professional immediately.

“It’s important to have a physical examination and relevant imaging studies of the cervical spine to rule out a fracture or other associated conditions,” Dr. Tyndall says.

When getting checked out for a neck injury, you’ll start with a physical exam. Expect your doctor to touch and move your head, neck, and arms. You will be asked to move and perform simple tasks so that your doctor can explore:

  • Range of motion in your neck and shoulders
  • Degree of motion that causes pain or an increase in pain
  • Tenderness in your neck, shoulders or back
  • Reflexes, strength and sensation in your limbs

Chances are you’ll also get imaging studies, which enable doctors to look inside your neck. You may get one or more of the following:

  • X-rays. Electromagnetic energy beams produce pictures of your internal structures. X-rays can depict fractures and other problems with bone, but they don’t show soft damage to soft tissue such as tendons, ligaments or intervertebral discs.
  • Computerized tomography (CT). More detailed than traditional X-rays, a CT scan shows detailed images of any part of your body: bones, muscles, fat, and organs.
  • Magnetic resonance imaging (MRI). Large magnets and a computer create detailed, 3D images of soft tissue structures and organs.

What Whiplash Treatment Is Available?

The primary goals of whiplash treatment are to control pain and restore your range of motion, so you can get back to the normal activities of your daily life.

Medication. To reduce the pain of whiplash, your doctor may recommend one or more medications, such as:

  • Over-the-counter pain relievers for mild to moderate pain
  • Antidepressant drugs, which can help relieve nerve pain people with moderate to severe whiplash pain 
  • Muscle relaxants

Neck stretches. Gentle moves can ease stiffness and help you recover faster. These are a few your doctor or physical therapist may encourage you to do on your own.

  • Rotate your neck in both directions
  • Tilt your head side to side
  • Bend your neck toward your chest
  • Roll your shoulders

Physical therapy. Guided exercise and sometimes other treatments (including transcutaneous electrical nerve stimulation, or TENS) may help ease neck pain and strengthen muscles.

Soft foam collars. Doctors used to recommend soft foam collars (cervical collars) to keep the neck still after whiplash injury. Now we know that prolonged rest can hinder recovery. The cervical collar may still be a good idea, but only for short periods of time.

Whiplash treatmentWhiplash is usually treated without surgery, but you may need a similar neck collar.

Note that most of these strategies are primarily for people who have whiplash in the middle ranges of severity. If your case is very mild, you might not need treatment.

Do You Need Surgery for Whiplash?

If you’re on the severe side of the scale – especially if your pain persists even after you’ve undergone non-surgical treatment – your health care provider may recommend whiplash surgery. The need for surgery depends on the severity of the injury and the parts of your spine involved. The hyperextension and hyperflexion that characterize whiplash can cause damage to important structures in the neck, and it’s those that need to be treated with surgery.

Trauma from whiplash can cause a herniated disc, when one or more intervertebral discs that sit between the vertebrae and act as shock absorbers are damaged. A part of the soft inner layer of the disc can punch through the hard outer layer (herniate) and compress a nearby nerve root, which can cause pain, tingling, numbness or weakness.  Standard treatment for a herniated disc is a microdiscectomy, a minimally invasive procedure in which the surgeon removes the portion of the disc that’s compressing the nerve.

Sometimes it’s beneficial to reduce the movement of damaged vertebrae after whiplash, and a cervical fusion is one way to do so. Fusion surgery uses a tissue graft to encourage vertebrae to grow together, eliminating potentially painful movement. In one study, some patients who experienced stabbing neck pain with movement found relief from cervical fusion

Can Alternative Medicine Help Whiplash?

Some people use alternative medicine, or nontraditional therapies, to treat their whiplash pain. Research is limited on how well such strategies work. In one recent, large analysis, researchers found there is little or no neck-pain benefit with:

  • Electroacupuncture
  • Relaxation massage
  • Hot or cold therapies
  • Ultrasound
  • Hydrotherapy

However, the analysis found that clinical massage, and sometimes cervical manipulation, may improve neck pain. To explore these modalities, start by asking your healthcare provider to recommend a practitioner with expertise in neck disorders.

How Long Does Whiplash Recovery Usually Take?

If you’re like most people who get whiplash, you’ll recover within about one to three weeks after your initial injury. “Because whiplash is a soft-tissue injury,” says Dr. Fehlings, “you should get full resolution.”

The question from patients who don’t recover quickly: “When will I get better?” Unfortunately, there’s no way to know for sure.

“With milder types of injury,” says Dr. Tyndall, “such as a grade 0 to grade I injury, the prognosis is quite favorable and tends to resolve itself over days to weeks.” In fact, about 9% of whiplash patients will make an excellent and swift recovery, Dr. Tyndall says.

With more severe injuries such as grade II to IV injuries, symptoms may persist much longer. A small sampling of patients may never fully recover. “It's felt that probably around 10% to 20% will be left with significant chronic pain down the road,” says Dr. Tyndall.

Mental health and pain perception may also play a role in recovery. The most consistent risk factors for poor recovery are people who report from the start:

  • Higher levels of pain
  • Higher levels of disability
  • Post-traumatic stress symptoms
  • Pain catastrophizing
  • Symptoms of depression
  • Low expectations of recovery

Age is a factor to consider as well. Younger patients tend to recover faster from whiplash than older ones. “All things being equal,” says Dr. Fehlings, “A young person involved in a car accident where the airbag goes off will recover faster than someone in their 60s or 70s under the same circumstances.” Patients with a history of back pain, bone spurs, or a previous whiplash event may also take longer to heal.

Getting whiplash can be a terrifying experience. Not only is there the neck injury aspect, but you’ve probably gotten whiplash from a traumatic event like a car crash. Luckily, there are excellent treatments for the physical, mental and emotional symptoms of whiplash. Talk to your doctor about what whiplash treatments are right for you.

FAQs

What is whiplash?

Whiplash is a neck injury caused by a violent impact — like a car crash. The impact makes the head snap forward and back, injuring soft tissues like ligaments, tendons, and muscles. In many cases it can resolve in a few days or weeks, but in some cases the symptoms last longer.

How long does whiplash last?

The duration of whiplash depends on two factors: impact severity and patient age. Though the condition often clears up in a few days or a couple weeks, older patients or victims of high-force accidents may take months to recover. In rare cases, whiplash can last years.

How can you treat whiplash?

A mild case of whiplash can be treated at home, with rest and ice. In cases of severe or persistent pain or loss of mobility, a doctor may treat whiplash with over-the-counter pain relievers, muscle relaxers, a stretching regimen, and physical therapy. Scans like MRIs or X-rays can rule out deeper injury.

What does whiplash feel like?

Whiplash causes symptoms of severe neck pain and stiffness, along with loss of range of motion. You may feel upper back pain too, or have frequent headaches at the base of the skull. In severe cases, numbness or tingling may point to complications.

Sources:

Intro: Mayo Clinic. (N.d.) “Whiplash.” https://www.mayoclinic.org/diseases-conditions/whiplash/symptoms-causes/syc-20378921

Prevalence: Spine Research Institute of San Diego. (N.d.) “Facts about the incidence, risk and prevalence of whiplash.” http://www.srisd.com/consumer_site/epidemiology.htm

Mental health: Journal of Physiotherapy. (2014) “Physiotherapy management of whiplash-associated disorders (WAD).” https://www.sciencedirect.com/science/article/pii/S1836955314000058?via%3Dihub

Harvard Medical school. (2009) “Whiplash.” https://www.health.harvard.edu/newsletter_article/Whiplash

How the Neck Works: UpToDate. (2020) “Patient education: Neck pain (Beyond the Basics). https://www.uptodate.com/contents/neck-pain-beyond-the-basics

Symptoms: PLOS ONE. (2018) “Thoracic dysfunction in whiplash associated disorders: A systematic review.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865734/

Causes: Mayo Clinic. (N.d.) “Whiplash.” https://www.mayoclinic.org/diseases-conditions/whiplash/symptoms-causes/syc-20378921

Diagnosis: Johns Hopkins Medicine. (N.d.) “Whiplash Injury.”

Is Whiplash Serious: Open Access Emergency Medicine. (2011)“Acute whiplash Associated Disorders.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753964/

Treatment: Mayo Clinic. (N.d.) “Whiplash.” https://www.mayoclinic.org/diseases-conditions/whiplash/symptoms-causes/syc-20378921

Scandinavian Journal of Pain. (2016) “A small group Whiplash-Associated-Disorders (WAD) patients with central neck pain and movement induced stabbing pain, the painful segment determined by mechanical provocation: Fusion surgery was superior to multimodal rehabilitation in a randomized trial.” https://www.sciencedirect.com/science/article/pii/S1877886016000203

Alternative therapies: The Spine Journal. (2016) “Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration.” https://pubmed.ncbi.nlm.nih.gov/26707074/

Recovery, Complications: Journal of Physiotherapy. (2014) “Physiotherapy management of whiplash-associated disorders (WAD).” https://www.sciencedirect.com/science/article/pii/S1836955314000058?via%3Dihub

 

Updated on: 10/26/20
Michael G. Fehlings, MD, PhD, FRCSC, FACS
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Whiplash: 5 Things You Should Know

Whiplash, also called neck sprain or neck strain, is an injury to the soft tissues of the neck. Here are five important things you should know about this injury.
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