Whiplash

Written by Staff | 30 October 2011

Whiplash is a common flexion/hyperextension injury of the neck¹. Hyperextension occurs when the head is tilted upward and backward while flexion occurs as the head “whips” back forward; both motions can cause injury to ligaments, muscles, cartilage and bone in the neck^{1, 2}. Whiplash generally occurs with sudden forward acceleration of the body; a situation prototypically experienced with motor vehicle accidents in which an affected driver is struck from behind, or with shaken baby syndrome. Other possible causes of whiplash include trauma from falls, sporting activities, and physical abuse/fighting. Whiplash affects over one million people each year².

After receiving a whiplash injury, the primary symptom that most experience is pain that sets on several hours, or even days, after the inciting event². Other possible symptoms include^{1, 2}:

• Neck stiffness and/or tightness
• Muscle spasm
• Headache, often localized to the back of the head (occipital region)
• Pain and/or numbness in the jaw, shoulders, back and/or upper extremities
• Tinnitus, or ringing in the ears
• Difficulty swallowing and/or hoarseness
• Decreased range of motion with neck movement
• Depression

Most cases of whiplash resolve on their own within a few weeks; however some cases can persist for months or years.

Diagnosis and Treatment

Diagnosis of whiplash is made by a doctor after taking a thorough history and performing a comprehensive physical exam. A physician will often order supplemental imaging studies, such as x-ray, CT and/or MRI scans to rule out possible complications of whiplash including spinal fractures and herniated discs, as well as other potential causes of Neck Pain².

The goals for treatment of whiplash injuries are to effectively manage pain and allow for injuries to properly heal. Conservative treatments are often very effective and include^{2, 3, 4}:

• Rest and avoidance of aggravating activities to give injured tissues a chance to heal
• Over-the-counter or prescription analgesics (pain relievers), such as Tylenol ™, Advil ™ or Alleve ™ for the short- or long-term management of mild to moderate pain
• Muscle relaxants for the short term relief of pain and muscle spasms
• The application of heat several times a day may help with increasing blood flow to injured tissues, healing and relieving tension. The application of cold compresses may help reduce swelling and relieve pain
• Home exercises prescribed by a physician can help maintain range of motion once pain is under control
• Physical therapy may be beneficial for the treatment of more persistent pain

Cervical collars are generally discouraged as they can delay treatment, and there is no significant role for surgery in the majority of whiplash cases⁴.

Again, most patients will recover from whiplash within a few weeks. In some cases of severe whiplash, however, symptoms such as headache and neck pain can persist longer in a condition known as chronic whiplash syndrome². Severe cases of whiplash have been associated with higher-speed impacts, more rapid onset of intense pain following injury, greater restriction of neck range of motion and vertebral fractures.

References

1. Isaac, Z.; Anderson, B. (2011). Evaluation of the patient with neck pain and cervical spine disorders. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
2. Ferri, F. (2011). Whiplash. Ferri’s Clinical Advisor, 1st Ed. MD Consult Web site, Core Collection.
3. Patel, M.; Shah, K. (2011). Whiplash. Rakel: Textbook of Family Medicine, 8th Ed. MD Consult Web site, Core Collection.
4. Anderson, B.; Isaac, Z.; Devine, J. (2011). Treatment of neck pain. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.