Whiplash

Whiplash is a soft tissue injury to the neck. It is also called neck sprain or neck strain. It is characterized by a collection of symptoms that occur following damage to the neck, usually because of sudden extension and flexion. The disorder commonly occurs as the result of an automobile accident, or other fast injuries to the neck and head.

Symptoms

Symptoms such as neck pain may be present directly after the injury or may be delayed for several days. Below are some other common symptoms of whiplash:

• Neck stiffness
• Injuries to the muscles and ligaments (myofascial injuries)
• Headache
• Dizziness
• Abnormal sensations such as burning or prickling (paresthesias)
• Shoulder or back pain
• Memory loss
• Concentration impairment
• Nervousness/irritability
• Sleep disturbances
• Fatigue
• Depression

Causes

Whiplash is most commonly caused by automobile accidents, especially rear-end collisions.^[1] However it can also be caused by any high-speed, high-force injury to the neck. Some other common causes are sports collisions, bicycle accidents, or blunt force trauma.

The actual cause of pain in the neck and surrounding tissues are injuries such as sprains, strains, pinched nerves, head injury, and joint irritation. This pain arises in many ways. Damage to bone can occur in the intervertebral joints and discs. Cervical muscles and ligaments can also be injured, as well as nerves.

Video of whiplash

Diagnosis

Most people share common symptoms of whiplash. After an accident, when the pain begins to manifest, healthcare providers assess the cause of the pain. This assessment involves evaluation of the accident and the signs and symptoms of injury. X-rays are often taken of the neck from the side and front as well as through the mouth to check for a dens fracture. A dens fracture occurs in the dens of the cervical spine (see image).

side view x-ray

view through mouth of dens process

If the x-rays show that there are no fractures or other major injury, other tests are performed:

Range of motion of the neck and usually the shoulders

• Reflexes of both arms
• Ability to feel light touch
• Strength of various muscle groups

The likelihood of whiplash increases with the number of symptoms displayed. Whiplash is often categorized into mild, moderate or severe. The classification depends on the amount of pain.

Common Exams and Tests

• X-Rays are used to see inside the neck and the bony structure
• Computerized tomography (CT) Scans are sometimes used to see muscle and soft tissue damage in severe whiplash.
• Magnetic resonance imaging (MRI) may be used to check for damage of intervertebral discs, nerves, and soft tissue.
• Sharp-Purser Test to look for instability of the second vertebrae of the neck.

Treatment

Treatment for whiplash includes pain medications, non-steroidal anti-inflammatory drugs, antidepressants, muscle relaxants, and a cervical collar (usually worn for two to three weeks). Range of motion exercises, physical therapy, and cervical traction may also be prescribed. Supplemental heat application may relieve muscle tension.

Initial pain, that present before seeking medical attention, may be alleviated by the following:

• R - Rest the area that is hurt, including sleep
• I – Icing the area for 15 minute increments during the first 72 hours after the injury
• C - Compression to any limbs that were injured
• E - Elevation of any limbs that were injured, above the level of the heart is best

For anyone in a significant injury involving the head and neck, it is usually recommended to go to a local emergency clinic for x-rays and other evaluation.

Therapies

Physical therapists and chiropractors have different approaches to whiplash treatment. They often suggest stretches and self-care techniques.

The neck has several small and large muscles that can be injured in a whiplash injury:

Muscles of Neck

These muscles are evaluated before therapy in order to direct treatment. Personalized treatments are used because any or all of these muscles can be injured.

Outcome

Generally, prognosis for individuals with whiplash is good. The neck and head pain clears within a few days or weeks. Many patients recover within three months after the injury.^[2] A 2008 review summarized 70 studies on the course and prognosis of whiplash.^[3] The review found that approximately 50% of whiplash victims experience neck pain one year after the injury. Outcome was poorer in patients with more symptoms and for those with greater initial pain or disability. A one-year study of patients with whiplash found that nearly 8% of study participants with whiplash did not return to work or usual activity within a year of suffering the injury.^[4] A cervical range-of-motion test was able to predict long-term disability in 91% of the paitnets with whiplash. The test is a simple measure of how much the head can move. The ability to predict outcome improved further when symptoms and severity of pain were considered in addition to the test.

Research

Research focuses on understanding the mechanisms underlying whiplash as well as prevention and treatment.

References

1. ↑ Ivancic P. Grants for Traumatic Injury Biomechanics Research
2. ↑ Kamper SJ,Rebbeck TJ,Maher CG et al. Course and prognostic factors of whiplash: A systematic review and meta-analysis. Pain. Apr 2008. Abstract
3. ↑ Carroll LJ, Holm LW, Hogg-Johnson S, et al. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008 Feb 15;33(4 Suppl):S83-92. Abstract
4. ↑ Kasch H, Bach FW, Jensen TS. Handicap after acute whiplash injury: a 1-year prospective study of risk factors. Neurology. 2001 Jun 26;56(12):1637-43. Abstract

External Links

Successful Grant Applications for research on traumatic biomechanic injuries

Dens Fractures