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Whiplash injury facts
- Whiplash is a relatively common injury that is often ignored or mistreated due to lack of understanding of the condition.
- Whiplash is usually the result of a rear impact while in a stationary position.
- Early range of motion and exercises lead to a more rapid recovery than prolonged immobilization or use of a cervical collar.
- Failure to properly educate and treat patients with whiplash can lead to chronic psychosocial symptoms including depression and anxiety.
What is whiplash?
Whiplash is a relatively common injury that occurs to a person's neck following a sudden acceleration-deceleration force that causes unrestrained, rapid forward and backward movement of the head and neck, most commonly from motor vehicle accidents. The term "whiplash" was first used in 1928. The term "railway spine" was used to describe a similar condition that was common in persons involved in train accidents prior to 1928. The term "whiplash injury" describes damage to both the bone structures and soft tissues, while "whiplash associated disorders" describes a more severe and chronic condition.
Fortunately, whiplash is typically not a life threatening injury, but it can lead to a prolonged period of partial disability. There are significant economic expenses related to whiplash that can reach 30 billion dollars a year in the United States, including:
- medical care,
- sick leave,
- lost productivity, and
While most people involved in minor motor vehicle accidents recover quickly without any chronic symptoms, some continue to experience symptoms for years after the injury. This wide variation in symptoms after relatively minor injuries has led some to suggest that, in many cases, whiplash is not so much a real physiologic injury, but that symptoms are more created as a result of potential economic gain. Many clinical studies have investigated this issue. Unfortunately, while there will always be people willing to attempt to mislead the system for personal gain, whiplash is a real condition with real symptoms.
What causes whiplash?
Whiplash is most commonly caused by a motor vehicle accident in which the person is in a car that is not moving, and is struck by another vehicle from behind. It is commonly thought the rear impact causes the head and neck to be forced into hyperextended (backward) position as the seat pushes the person's torso forward - and the unrestrained head and neck fall backwards. After a short delay the head and neck then recover and are thrown into a hyperflexed (forward) position.
More recent studies investigating high-speed cameras and sophisticated crash dummies have determined that after the rear impact the lower cervical vertebrae (lower bones in the neck) are forced into a position of hyperextension while the upper cervical vertebrae (upper bones in the neck) are in a hyperflexed position. This leads to an abnormal S-shape in the cervical spine after the rear impact that is different from the normal motion. It is thought that this abnormal motion causes damage to the soft tissues that hold the cervical vertebrae together (ligaments, facet capsules, muscles).
What are the symptoms of whiplash?
Common symptoms related to whiplash may include:
- neck pain and stiffness,
- shoulder pain and stiffness,
- jaw pain (temporomandibular joint symptoms),
- arm pain,
- arm weakness,
- visual disturbances,
- ringing in the ears (tinnitus), and
- back pain.
In a more severe and chronic case of "whiplash associated disorder" symptoms may include:
- drug dependency,
- post-traumatic stress syndrome,
- sleep disturbance (insomnia),
Patients with whiplash injuries may enter into litigation and social isolation may occur as a result of their symptoms.
How is whiplash diagnosed?
After an accident the patient may be taken to the hospital or a doctor's office to be examined. The doctor will examine the patient to determine if they have any injuries that require treatment. Based on the symptoms and examination findings the doctor may place a collar on the neck for additional support. The doctor may also obtain x-rays of the neck to check for more serious injury. The most important first step is to make sure there is no major injury to the neck, head or the rest of the body requiring immediate treatment.
If the x-rays are normal but the patient continues to have neck pain, the doctor may keep the cervical collar in place and see the patient back in the office in about a week for an additional examination. At that time the doctor may obtain new x-rays to see if there have been any changes. If the doctor is still concerned about soft tissue injuries, he or she may obtain either x-rays with the head leaning forward and backwards (dynamic x-rays) or obtain an MRI (magnetic resonance imaging study). These dynamic x-rays or MRI scans are better able to detect injuries to the soft tissues of the neck, especially instability, that may not been seen with normal x-rays of the neck.
What is the treatment for whiplash?
Treatment of whiplash depends on the wide variety of symptoms present. Unfortunately, most treatments of whiplash have not been well tested to determine their effectiveness.
The most important issue in the management of whiplash is optimal education of the patient about their injury. This includes information on the cause, potential treatments, and likely outcomes. Patients should understand that this is a real injury, but that nearly all patients have the ability to fully recover. Patients that do not receive this information are much more likely to develop the more chronic "whiplash associated disorder."
In the past, the initial treatment for whiplash was often a soft cervical collar for several weeks. The goal of the collar was intended to reduce the range of motion of the neck and to prevent any additional injuries. More recent studies have shown that this prolonged immobilization actually slows the healing process. If there is no evidence of abnormal spinal alignment, early range of motion is advised.
Patients involved in early range of motion exercises have been shown to have a more reliable and rapid improvement in their symptoms. This treatment typically involves rotational exercises performed 10 times per hour as soon as symptoms allow within the first four days of the accident.
It seems that excessive rest and immobilization have been shown to have greater chances of chronic symptoms. This is explained by loss of range of motion leading to increased pain and stiffness. Immobilization also causes muscle atrophy (muscle wasting), decreased blood flow to the injured soft tissues, and healing of damaged muscles in shortened position that renders them less flexible.
Physical therapy can be useful in helping to wean a patient from a cervical collar as well as to help strengthen muscles and reduce painful motions. Occupational therapy can be used to help return the patient to the work environment.
If the patient begins to develop psychological symptoms including anger, anxiety or depression following an injury, prompt treatment of the emotional condition is recommended. This can help the patient better understand the good chances for successful recovery and reduce the chances of chronic symptoms.
What can be done to prevent whiplash?
While it is not always possible to prevent accidents, advances in automobile safety have attempted to reduce the associated risks. Many advances in seat belts and head restraints have been able to reduce the risk of whiplash injury. The proper use of these devices is crucial to their success in preventing injury. Head restraints are designed to prevent the head from moving into hyperextension when struck from behind. In order for this to work properly, the head restraint should be optimally positioned directly behind the head. If the head restraint is lowered below the level of the head it could actually force the head into further hyperextension after an impact. Many automobiles have additional safety equipment including air bags and air curtains to further protect drivers and passengers from injury.
Pain Management Resources
Crowe H. Injuries to the cervical spine. Western Orthop Assoc., San Francisco, CA, 1928.
Spitzer WO, Skovron ML, Salmi LR, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining whiplash and its management. Spine 1995;20:2S-73S.
Freeman MD. A review and methodologic critique of the literature refuting whiplash syndrome. Spine 1999;24:86-98.
Bogduk N. The anatomy and pathophysiology of whiplash. Clin Biomech 1986;1:92-101.
Kaneoka K, Ono K, Inami S, Hayashi K. Motion analysis of cervical vertebrae during whiplash loading. Spine 1999;24:763-770.
Panjabi MM, Cholewicki J, Nibu K, et al. Simulation of whiplash trauma using whole cervical spine specimens. Spine 1998;23:17-24.
McKinney LA, Dornan JO, Ryan M. The role of physiotherapy in the management of acute neck sprains following road-traffic accidents. Arch Emerg Med 1989;6:27-33.
Mealy K, Brennan H, Fenelon GC. Early mobilization of acute whiplash injuries. BMJ 1986;292:656-657.
Rosenfeld M, Gunnarsson R, Borenstein P. Early intervention in whiplash-associated disorders. A comparison of two treatment protocols. Spine 2000;25:1782-1787.
Top Whiplash Related Articles
Acetaminophen is a drug that reduces fever and relieves pain. It is available alone, or in combination with hundreds of other drugs available both over-the-counter (without a prescription) or that that may require a prescription from your doctor, for example, acetaminophen and hydrocodone (Vicodin, Norco) or acetaminophen and oxycodone (Percocet).
Acetaminophen treats a variety of diseases or other medical problems that cause pain or fever. Examples of conditions acetaminophen treats include, headache, minor arthritis pain, back pain, tooth pain, menstrual cramps, PMS, osteoarthritis, common cold, tension headache, chronic pain, hip pain, shoulder and neck pain, sore throat, sinus infection, teething, TMJ, bites and stings, and sprains and strains.
Acetaminophen generally has no side effects when taken as prescribed. When side effects are experienced, the most common are headache, rash, and nausea.
In 2014, the FDA recommended that doctors and other health care professionals only prescribe acetaminophen in doses of 325 mg or less. This warning highlights the potential for allergic reactions, for example, face, mouth, and throat swelling, difficulty breathing, itching, or rash. This action also will help reduce the risk of severe liver injury and serious allergic reactions associated with this drug. Other possible serious side effects adverse effects include anemia, kidney damage, thrombocytopenia (a reduced number of platelets in the blood), and liver problems.
Other patient information. Do not take more than one product that contains acetaminophen at the same time. Do not take more than one acetaminophen-containing drug than directed. Do not drink alcohol while taking medicine that contains acetaminophen due to severe liver damage.
REFERENCE: FDA Prescribing Information.
acetylsalicylic acidAspirin (Aspirin, Arthritis Foundation Safety Coated Aspirin, Bayer Aspirin, Bayer Children's Aspirin, Ecotrin, and many others) is a NSAID used to treat fever, pain, and inflammation in the body that results from forms of arthritis, and soft tissue injuries. Aspirin is also used for decreasing the risk of heart attacks and strokes. Side effects, drug interactions, pregnancy information, and pregnancy safety information should be reviewed prior to taking any medication.
Carisoprodol (Soma) is a medication prescribed for the treatment of relief of short-term acute painful muscle and skeletal conditions in adults. Side effects may include:
Dosing, drug interactions, and pregnancy and breastfeeding safety should be reviewed prior to taking this medication.
Chronic PainChronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Cyclobenzaprine (Fexmid, Amrix, Flexeril) is a drug prescribed for the short-term relief of muscle spasms associated with acute painful muscle and skeletal conditions. Common side effects include dry mouth, fatigue, and headaches. Possible serious side effects include stroke, heart attacks, and heat stroke.
Drug interactions, warnings and precautions, and pregnancy and breastfeeding safety information should be reviewed prior to taking any medication. The brand name Flexeril has been discontinued and is no longer available in the US.
DepressionDepression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
HeadacheHeadaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
hydrocodone/acetaminophenHydrocodone/acetaminophen (Vicodin, Vicodin ES, Vicodin HP, Anexsia, Lortab, Lorcet, Lorcet Plus, Norco, Zydone) is a narcotic pain reliever and cough suppressant. Hydrocodone/acetaminophen is prescribed for moderate to moderately severe pain. Side effects, drug interactions, warnings and precautions should be reviewed prior to taking any medication.
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce mild to moderate pain, inflammation, and fever. Ibuprofen works by blocking an enzyme that makes prostaglandin (a hormone-like substance that participates in a variety of body functions), which results in lower levels of prostaglandins in the body. Lower levels of prostaglandins reduce pain, inflammation, and fever.
Ibuprofen is prescribed to treat diseases and conditions that cause mild to moderate pain, fever, and inflammation. For example, Pain from strains and sprains; pain from cuts, scrapes, and puncture wounds; muscle aches and pains; tooth pain; common cold; mild headache; some arthritis conditions; joint pain; and to reduce fever.
Common side effects of ibuprofen include, diarrhea, constipation, nausea, heartburn, belly pain, drowsiness, headaches, tinnitus (ringing in the ears), and mild rash.
More serious side effects and adverse effects include, increased bleeding after injury, stomach ulcers, impaired kidney function, severe allergic reaction (anaphylaxis), blood clots, heart attack, heart failure, and high blood pressure.
The maximum dose prescribed under a doctor's care is 3.2 g daily. Otherwise, the over-the-counter (OTC) maximum daily dose is 1.2 g daily. Dosage depends upon the age, weight, and any current medical conditions of the patient. Several drugs interact with ibuprofen so check with your doctor, pharmacist, or other health care professional with questions in regard to this drug. Doctors don't know if it is safe to take ibuprofen if your are pregnant, therefore it is not recommended if you are pregnant. According to the American Academy of Pediatrics, ibuprofen is safe to take while breastfeeding.
REFERENCE: FDA Prescribing Information.
naproxenNaproxen (Aleve, Anaprox, Naprelan, Naprosyn) is in the class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Naproxen is prescribed for the treatment of mild to moderate pain, inflammation, and fever. Side effects, drug interactions, and pregnancy information should be reviewed prior to taking this medication.
Neck PainNeck pain (cervical pain) may be caused by any number of disorders and diseases. Tenderness is another symptom of neck pain. Though treatment for neck pain really depends upon the cause, treatment typically may involve heat/ice application, traction, physical therapy, cortisone injection, topical anesthetic creams, and muscle relaxants.
Occipital neuralgia is a type of headache that involves inflammation or irritation of occipital nerves. Signs and symptoms include a stabbing and throbbing head pain, and an aching pain in the upper back of the head and neck.
Potential causes include infection, irritation, or trauma of the occipital nerves. This type of headache is diagnosed by physical examination findings and imaging tests. Treatment involves a multidisciplinary approach that includes massage, rest, physical therapy, heat, muscle relaxants, and anti-inflammatory drugs. Invasive procedures and even surgery may be considered if first-line treatments fail to bring relief from the chronic pain of this type of headache.
Pain ManagementPain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain include:
- complex regional pain syndrome,
- interstitial cystitis,
- and irritable bowel syndrome.
Shoulder and Neck Pain HealthShoulder and neck pain may be caused by bursitis, a pinched nerve, whiplash, tendinitis, a herniated disc, or a rotator cuff injury. Symptoms also include weakness, numbness, coolness, color changes, swelling, and deformity. Treatment at home may incorporate resting, icing, and elevating the injury. A doctor may prescribe pain medications and immobilize the injury.
Sprained AnkleAn injury to a ligament is called a sprain, and an injury to muscle or tendon is called a strain. Sprains and strains may be caused by repetitive movements or a single stressful incident. Symptoms and signs include pain and swelling. Though treatment depends upon the extent and location of the injury, rest, ice, compression, and elevation are key elements of treatment.
Trauma/First Aid QuizWhat should be in your first-aid kit? Take this quiz to understand trauma and learn the truth about how to administer first aid.