Whiplash

Definition

Whiplash is a neck injury that can occur during rear-end automobile collisions, when your head suddenly moves backward and then forward — similar to the motion of someone cracking a whip. These extreme motions push your neck muscles and ligaments beyond their normal range of motion.

Whiplash injuries can be mild or severe. Treatment typically begins with over-the-counter pain relievers and ice applied to the painful neck muscles. If pain persists, prescription medications and physical therapy may be helpful.

Most people recover from whiplash in just a few weeks, but some people with whiplash injuries develop chronic conditions that can be extremely painful and disabling.

Symptoms

Most whiplash symptoms develop within 24 hours of the injury and may include:

• Neck pain and stiffness
• Headaches, most commonly at the base of the skull
• Dizziness
• Blurred vision
• Fatigue

Some people also experience:

• Difficulty concentrating
• Memory problems
• Ringing in the ears
• Sleep disturbances
• Irritability

When to see a doctor
Contact your doctor promptly if:

• The pain spreads to your shoulders or arms
• It becomes painful to move your head
• You experience numbness, tingling or weakness in your arms

Causes

Whiplash typically occurs during situations in which a person's head is thrown backward and then forward, straining the neck's muscles and ligaments. This type of injury may result from:

• Auto accidents. Rear-end collisions are the most common cause of whiplash.
• Physical abuse. Whiplash may also result from incidents of being punched or shaken. Whiplash is one of the injuries sustained in shaken baby syndrome.
• Contact sports. Football tackles and other sports-related collisions can sometimes cause whiplash injuries.

Risk factors

Women are more likely to experience whiplash than are men, perhaps because their necks aren't usually as strong as those of men.

Complications

Up to half the people who experience whiplash will continue to have pain months after the injury occurred. In some people, this chronic pain can be traced to damage in the joints, disks and ligaments of the neck. But in many cases, no abnormality can be found to explain this persistent neck pain.

Preparing for your appointment

Because whiplash often occurs during car accidents, it's common to seek immediate treatment at a hospital's emergency department or an urgent care clinic.

What you can do
You may want to write a list that includes:

• Detailed descriptions of the symptoms and the precipitating event
• Information about past medical problems
• All the medications and dietary supplements you take
• Questions you want to ask the doctor

What to expect from your doctor
Your doctor will ask how the injury occurred and will measure how far your neck can move in a variety of directions. He or she will also check to see if any parts of your neck are especially tender to pressure.

The doctor may also perform a neurological exam to check for:

• Diminished muscle strength
• Abnormal reflexes
• Numbness

Tests and diagnosis

A variety of imaging tests may help rule out other causes of neck pain.

• X-rays. Neck X-rays can help rule out problems such as spinal fractures, dislocations or arthritis.
• Computerized tomography (CT). This type of test combines X-ray images taken from many different directions to produce more-detailed images of bone and soft tissues.
• Magnetic resonance imaging (MRI). Using radio waves and a strong magnetic field, MRI scans are particularly good at detecting soft tissue injuries, such as to the spinal cord or nerve roots.

Treatments and drugs

Medications
If over-the-counter pain medications and self-care treatments at home aren't enough, your doctor may suggest:

• Prescription painkillers. People with more severe pain may benefit from short-term treatment with prescription pain relievers.
• Injections. An injection of corticosteroid medicine or lidocaine — a numbing medicine — into painful muscle areas may relieve the muscle spasms that can be associated with whiplash injuries.
• Muscle relaxants. These drugs can help ease muscle spasms but often cause drowsiness, so your doctor may want you to take them only at bedtime.

Therapy
Physical therapy interventions are the mainstay of treatment for whiplash. Therapy treatments may include:

• Ice
• Heat
• Ultrasound

As pain permits, exercises to stretch and strengthen neck muscles can help to minimize symptoms and help protect your neck in the future.

Foam collars
Although soft foam cervical collars were once commonly used for whiplash injuries, they no longer are recommended routinely. Immobilizing the neck for long periods of time can lead to decreased muscle bulk and strength and impair recovery.

During the day, cervical collars should be worn for no longer than three hours at a time and for only the first few days after the injury. If you're continually being awakened at night by whiplash pain, especially early on after the injury, wearing a cervical collar may help you sleep.

Lifestyle and home remedies

Over-the-counter pain relievers, such as acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin, others), often can control mild to moderate whiplash pain.

Many people with whiplash pain find it helpful to use ice or heat on their necks and upper backs. In general, ice should be used early in the recovery period, to reduce inflammation, while heat is especially helpful to relax muscles before range-of-motion exercises.

Once your pain is under control, your doctor will likely want you to regularly perform gentle stretching exercises to help restore your neck's range of motion. These usually involve rotating your head from side to side, and bending your neck forward, backward and to the sides.

Alternative medicine

Many nontraditional therapies have been employed to treat whiplash pain, including:

• Acupuncture. By inserting ultrafine needles through specific locations on your skin, acupuncturists can relieve many different types of pain. But research studies have been unable to definitely show whether acupuncture can help relieve persistent neck pain caused by strains.
• Chiropractic care. Many people seek chiropractic care for neck pain, and it has been shown in certain types of neck pain to work just as well as, but no better than, physical therapy. Pairing spinal manipulation with exercise provides more benefit. However, chiropractic manipulation of the neck has been associated, in very rare instances, with potentially life-threatening injuries.
• Massage. Kneading the tight muscles in your neck may be helpful if you continue to have muscle spasms for more than a week or two. Relax the muscles in your neck first by taking a hot shower or bath, or by using a moist towel warmed in the microwave.
• Transcutaneous electrical nerve stimulation (TENS). TENS is a device that applies a mild electric current to the skin. This nonharmful current can help to decrease some types of pain, possibly by interfering with the transmission of pain signals or by releasing endorphins, the body's natural painkillers. TENS can help relieve chronic neck pain, but only when combined with exercise.