Whiplash is caused by a sudden impact that causes the head to whip back and forth very abruptly, such as during an automobile accident or from a sports injury.
What is whiplash?
Whiplash, or neck strain, occurs when the ligaments tough, fibrous bands that connect bones in the neck have are overstretched or torn. Whiplash is caused by a sudden impact that causes the head to whip back and forth very suddenly, such as during an automobile accident, a fast amusement park ride, or a sports injury.
Symptoms may include:
- Pain and stiffness in the neck, shoulders, and upper back areas
- Ringing in the ears
- Numbness in the arms or hands
Cognitive and psychological symptoms such as anxiety, depression, and difficulty with memory can also occur in some people.
Medical evaluation after whiplash is recommended to rule out damage to the spinal cord. Paralysis, difficulty walking, or loss of control over your bladder and bowels suggests an emergency requiring immediate medical attention.
Treatment predominantly consists of rest and over-the-counter nonsteroidal anti-inflammatory drugs to reduce inflammation and relieve pain. In some cases, muscle relaxants may also be prescribed.
You do not need treatment. Your whiplash should improve within a week. In the meantime, you can take an over-the-counter painkiller to manage your pain. If your symptoms do not improve, you should see your primary care physician.
Two-thirds of people in MVCs report neck pain immediately, with an additional one-third reporting pain within 48 hours. After 12 months, most people with whiplash have completely improved, while 20 to 25 percent of patients remain symptomatic. Symptoms can be divided into physical and psychosocial categories, and other resulting injuries may also occur which should be addressed individually.
Physical symptoms of whiplash include:
- Neck pain and stiffness: This is the most common and immediate symptom following a whiplash injury.
- Shoulder pain and stiffness
- Arm pain
- Back pain
- Vertigo: A sensation that the room is spinning.
- Dizziness: A sensation of being off balance.
- Abnormal sensation (paresthesias): Numbness and "pins and needles" sensations may be felt in the skin over the arm or hand.
- Weakness: This may be felt in your arm or hand.
- Blurry vision
- Fatigue: This is characterized by persistent tiredness.
- Temporomandibular joint (TMJ) symptoms: These include jaw pain, difficulty opening the mouth, difficulty chewing, and ear pain.
- Ringing in the ear (tinnitus)
- Difficulty swallowing (dysphagia)
In addition to physical symptoms, a number of psychosocial symptoms have been associated with whiplash injury and typically occur weeks or months after the initial injury. These include:
- Depressed mood
- Anger and frustration
- Stress: This may occur within your family and/or at your workplace.
- Hypochondriasis: An excessive concern about one's health.
- Difficulty with memory and concentration
- Drug dependency
- Post traumatic stress syndrome: Nightmares, flashbacks, and avoidance behaviors related to the injury may occur.
- Insomnia: This involves difficulty falling asleep or staying asleep.
- Social isolation: This involves withdrawing oneself from activities with family or friends.
Other resulting injuries
When the cervical spine is compressed from below, it leads to compression, shearing, and tension forces on the neck, resulting in injury to bones, ligaments, muscles, tendons, discs, and the zygapophyseal joint (z-joint).
Whiplash injury is not completely understood.It typically results when the body accelerates with respect to the head from read-end or side impact. Acceleration and deceleration result in hyperflexion and hyperextension of the neck. Some causes are more frequent than others.
- Frequent causes: Whiplash frequently results from rear-end or side-impact motor vehicle collisions (MVCs). Injury can result from collisions at speeds as low as 10 mph.
- Less frequent causes: Whiplash can also resultfrom falls, contact sports (such as football and soccer), physical assault, and diving.
Who is affected by whiplash
Statistics for who is affected by whiplash include:
- Four in 1000 persons suffer from whiplash each year
- One percent of people suffer from chronic symptoms of whiplash
- Almost half of people with chronic neck pain attribute it to MVCs
Treatment options and prevention for whiplash
Although suffering a whiplash injury is not always avoidable, treatment methods can accelerate recovery and alleviate symptoms. Treatments involve pain control, careful mobility, therapy, and interventional methods.
Methods to reduce pain are among some of the most important for treating symptoms of whiplash.
- Apply ice: You can apply ice to the affected area for 20 minutes three to five times throughout the day to reduce inflammation.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Ibuprofen (Motrin, Advil) and naproxen (Aleve) can effectively reduce inflammation and pain associated with this injury.
- Acetaminophen (Tylenol): This can also help reduce pain associated with whiplash.
- Muscle relaxants: Baclofen may also be recommended to relieve muscle stiffness. They can make you sleepy and may be helpful in restoring sleep lost to whiplash pain.
- Topical analgesics: Pain-relieving patches that may be helpful for some people when other treatments were not effective.
- Antidepressants: SSRIs, SNRIs, and tricyclics may also be recommended to help reduce pain as well as anxiety or mood symptoms that sometimes accompany prolonged whiplash symptoms.
- Practice good sleep hygiene: Poor sleep can exacerbate chronic pain.
Some symptoms of whiplash can be alleviated through careful movements and assistive devices.
- Refrain from strenuous neck movements: These movements should be avoidedin the first day after the injury.
- Resumption of gentle movement: Resuming gentle movement 24 hours after the injury may speed up recovery. A quick return to normal activity is typically the goal in mild and moderate whiplash injuries. Your physician may also prescribe stretching exercises.
- Soft neck collars: Use of these devices may be recommended after the injury to restrict neck motion and prevent further injury. However, studies have shown their use may result in a slower recovery. Discuss the need for a neck collar carefully with your physician, including how many hours per day, and for how many days it is recommended.
A few methods of therapy can be used to help alleviate symptoms of whiplash.
- Physical therapy: This can help reduce pain-related behaviors and strengthen muscles.
- Occupational therapy: This is used to restore function and help you resume activities in your workplace and home.
- Neuropsychological therapy: You can discuss views of symptoms and goals for recovery.
- Osteopathic manipulative medicine (OMM): Specially trained physicians can use their hands to adjust the neck in order to relieve pain.
Other methods that can be used to reduce pain include:
- Trigger point injections: Injections of a pain-relieving medication (lidocaine) into the muscles of the neck and upper back may facilitate pain relief for some people.
- Cervical radiofrequency neurotomy: In people with chronic whiplash, a procedure that temporarily quiets the nerves involved in the pain has been associated with prolonged symptom improvement.
Most people will experience substantial improvement in neck and head pain within days and fully recover within six months. Treatment may accelerate the recovery process and reduce pain. Some people with whiplash may have neck pain and headaches that persist beyond the six months. Factors associated with delayed recovery include:
- Female gender
- Older age
- Intense initial pain
- Neurologic deficits (such as weakness or numbness)
- Pre-existing neck pain
- Use of cervical collars
- Rest, or lack thereof
- Negative attitudes
When to seek further consultation for whiplash
You should seek medical attention if your symptoms are persistent or are interfering with your quality of life.
If you have symptoms of whiplash that persist for more than a month
Most people with whiplash experience rapid improvement in symptoms. If your symptoms are not improving, despite initial treatments, discuss your condition further with your physician. Further evaluation or treatment may be recommended.
If you are requiring NSAIDs for more than a few weeks
NSAIDs are a fantastic way to control pain in the short-term. However, long-term use of these medications can result in rebound headaches, gastrointestinal discomfort and ulcers, and kidney damage. If you are relying on NSAIDS to control your pain for more than a few weeks, talk to your physician about alternative methods of pain control.
If your whiplash symptoms significantly impair your ability to work
Talk with your physician about how whiplash is affecting your life. Physical, occupational, or neuropsychological therapy may be recommended to help facilitate your recovery.
Questions your doctor may ask to determine whiplash
- How long has your current headache been going on?
- Are you sick enough to consider going to the emergency room right now?
- How severe is your headache?
- Any fever today or during the last week?
- Have you experienced any nausea?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Becker is a psychiatry resident at the Mount Sinai Hospital. He received his undergraduate degree in Urban & Regional Studies from Cornell University (2012) and completed his medical degree at the Perelman School of Medicine at the University of Pennsylvania (2018). Prior to medical school, he worked as a pre-medical teaching assistant at Weill Cornell Medicine-Qatar, where he received an Excellence in Teaching Award. His research has focused on global health (including explanatory models of mental illness in Botswana, epidemiology of head trauma, and psychosocial aspects of HIV), adolescent and young adult mental health, and quality improvement. He enjoys communicating health-related science through writing and teaching and joined Buoy Health as a writer in 2018. In his free time he enjoys running, hiking, and exploring new places.
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