Whiplash

Whiplash is a neck injury due to forceful, rapid back-and-forth movement of the neck, like the cracking of a whip.

Whiplash is commonly caused by rear-end car accidents. But whiplash can also result from sports accidents, physical abuse and other types of traumas, such as a fall. Whiplash may be called a neck sprain or strain, but these terms also include other types of neck injuries.

Most people with whiplash get better within a few weeks by following a treatment plan that includes pain medication and exercise. However, some people have chronic neck pain and other long-lasting complications.

Symptoms

Signs and symptoms of whiplash usually develop within days of the injury, and may include:

• Neck pain and stiffness
• Worsening of pain with neck movement
• Loss of range of motion in the neck
• Headaches, most often starting at the base of the skull
• Tenderness or pain in the shoulder, upper back or arms
• Tingling or numbness in the arms
• Fatigue
• Dizziness

Some people also have:

• Blurred vision
• Ringing in the ears (tinnitus)
• Sleep disturbances
• Irritability
• Difficulty concentrating
• Memory problems
• Depression

When to see a doctor

See your doctor if you have any neck pain or other whiplash symptoms after a car accident, sports injury or other traumatic injury. It's important to get a prompt and accurate diagnosis and to rule out broken bones or other damage that can cause or worsen symptoms.

Causes

Whiplash typically occurs when your head is forcefully and quickly thrown backward and then forward. This motion can injure bones in the spine, disks between the bones, ligaments, muscles, nerves and other tissues of the neck.

A whiplash injury may result from:

• Auto accidents. Rear-end collisions are a major cause of whiplash.
• Physical abuse or assault. Whiplash can occur if you are punched or shaken. It's one of the injuries seen in shaken baby syndrome.
• Contact sports. Football tackles and other sports-related collisions can sometimes cause whiplash.

Complications

Most people who have whiplash feel better within a few weeks and don't seem to have any lasting effects from the injury. However, some people continue to have pain for several months or years after the injury occurred.

It is difficult to predict how each person with whiplash may recover. In general, you may be more likely to have chronic pain if your first symptoms were intense, started rapidly and included:

• Severe neck pain
• More-limited range of motion
• Pain that spread to the arms

The following risk factors have been linked to a worse outcome:

• Having had whiplash before
• Older age
• Existing low back or neck pain
• A high-speed injury

Diagnosis

Your doctor will ask questions about the event and your symptoms. You also may be asked questions that help your doctor understand how severe your symptoms are and how often they occur. Your doctor will also want to know how well you can perform normal everyday tasks.

Examination

During the exam your doctor will need to touch and move your head, neck and arms. You will be asked to move and perform simple tasks so that your doctor can check the:

• 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

Imaging tests

A whiplash injury isn't apparent on imaging tests. But your doctor will likely order one or more imaging tests to rule out other conditions that could be making your neck pain worse. Imaging tests include:

• X-rays. Fractures, dislocations or arthritis can be identified by X-rays of the neck taken from many angles.
• Computerized tomography (CT). This special type of X-ray can produce cross-sectional images of bone and show possible bone damage.
• Magnetic resonance imaging (MRI). This imaging test uses radio waves and a magnetic field to produce detailed 3D images. In addition to bone injuries, MRI scans can detect some soft tissue injuries, such as damage to the spinal cord, disks or ligaments.

Treatment

The goals of whiplash treatment are to:

• Control pain
• Restore normal range of motion in your neck
• Get you back to your normal activities

Your treatment plan will depend on the extent of your whiplash injury. Some people only need over-the-counter medication and at-home care. Others may need prescription medication, specialized pain treatment or physical therapy.

Pain management

Your doctor may recommend one or more of the following treatments to lessen pain:

• Rest. Rest may be helpful for a day or two after your injury, but too much bed rest may delay recovery.
• Heat or cold. Either heat or cold applied to the neck for 15 minutes every three hours or so can help you feel better.
• Over-the-counter pain medications. Over-the-counter pain relievers, such as acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others), often can control mild to moderate whiplash pain.
• Prescription medications. People with more-severe pain may be given certain antidepressant drugs that have been shown to relieve nerve pain.
• Muscle relaxants. Short-term use of these drugs may be recommended to loosen tight muscles and soothe pain. The medicine also can make you feel sleepy. It may be used to help restore normal sleep if pain prevents you from getting a good night's rest.
• Injections. An injection of lidocaine (Xylocaine) — a numbing medicine — into painful muscle areas may be used to decrease pain so that you can do physical therapy.

Exercise

Your doctor will likely prescribe a series of stretching and movement exercises for you to do at home. These exercises can help restore range of motion in your neck and get you back to your normal activities. Applying moist heat to the painful area or taking a warm shower may be recommended before exercise.

Exercises may include:

• Rotating your neck in both directions
• Tilting your head side to side
• Bending your neck toward your chest
• Rolling your shoulders

Physical therapy

If you have ongoing whiplash pain or need assistance with range-of-motion exercises, your doctor may recommend that you see a physical therapist. Physical therapy can help you feel better and may prevent further injury. Your physical therapist will guide you through exercises to strengthen your muscles, improve posture and restore normal movement.

In some cases, transcutaneous electrical nerve stimulation (TENS) may be used. TENS applies a mild electric current to the skin. Limited research suggests this treatment may temporarily ease neck pain and improve muscle strength.

The number of physical therapy sessions needed will vary from person to person. Your physical therapist can also create a personalized exercise routine that you can do at home.

Foam collars

Soft foam cervical collars were once commonly used for whiplash injuries to hold the neck and head still. However, studies have shown that keeping the neck still for long periods of time can decrease muscle strength and interfere with recovery.

Still, use of a collar to limit movement may help reduce pain soon after your injury, and may help you sleep at night. Recommendations for using a collar vary though. Some experts suggest limiting use to no more than 72 hours, while others say it may be worn up to three hours a day for a few weeks. Your doctor can instruct you on how to properly use the collar, and for how long.

Alternative medicine

Nontraditional therapies have been tried to treat whiplash pain, but research about how well they work is limited. Some include:

• Acupuncture. Acupuncture involves inserting ultrafine needles through specific areas on your skin. It may offer some relief from neck pain.
• Chiropractic care. A chiropractor performs joint manipulation techniques. There is some evidence that chiropractic care may provide pain relief when paired with exercise or physical therapy. Manipulation of the spine may cause minor problems, such as numbness or dizziness, and rarely damage to spinal tissues.
• Massage. Neck massage may provide short-term relief of neck pain from whiplash injury.
• Mind-body therapies. Exercises that incorporate gentle movements and a focus on breathing and mindfulness, such as tai chi, qi gong and yoga, may help ease pain and stiffness.

Preparing for an appointment

If you've been in a car accident, you might receive care on the scene or in an emergency room. However, a whiplash injury may not cause symptoms immediately. If you have neck pain and other symptoms after an injury, see your doctor or an urgent care center as soon as possible.

Be prepared to describe in detail the event that may have caused your symptoms and to answer the following questions.

• How would you rate your neck pain on a scale of 1 to 10?
• Does movement make the pain worse?
• What other symptoms do you have?
• How long after the event did the symptoms appear?
• Have you had neck pain in the past, or do you experience it regularly?
• Have you tried any medications or other treatments to relieve the pain? If so, what was the effect?
• What medications do you take regularly, including dietary supplements and herbal medicines?

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