Whiplash

Whiplash is a common neck injury caused by rapid forward and backward movement of the head and neck following a sudden acceleration-deceleration force, often from car accidents. It was first described in 1928 and was previously known as "railway spine" in train accident victims. Whiplash can damage both bone structures and soft tissues, leading to a range of symptoms and sometimes prolonged disability.

While whiplash is generally not life-threatening, it poses significant economic burden in the United States, with costs reaching up to 30 billion dollars annually. These expenses include medical care, disability, sick leave, lost productivity, and litigation.

Although most people recover quickly from minor accidents, some experience symptoms for years. The variability of symptoms has led to debates about the authenticity of whiplash and whether it stems from genuine physiological injury or economic motives. However, numerous clinical studies have established that whiplash is a real condition with real symptoms.

Causes of Whiplash

Whiplash is most commonly caused by rear-end collisions, where the head and neck are forced into a hyperextended (backward) position before moving into a hyperflexed (forward) position. Advanced studies using high-speed cameras and crash dummies have revealed that the lower cervical vertebrae are hyperextended while the upper cervical vertebrae are hyperflexed after a rear impact. This abnormal motion can damage the ligaments, facet capsules, and muscles that hold the cervical vertebrae together.

Symptoms of Whiplash

Common symptoms of whiplash include neck pain and stiffness, headache, shoulder pain and stiffness, dizziness, fatigue, jaw pain, arm pain, arm weakness, visual disturbances, ringing in the ears, and back pain. Severe cases of whiplash associated disorder may also involve depression, anger, frustration, anxiety, stress, drug dependency, post-traumatic stress syndrome, and sleep disturbance.

Whiplash patients may face litigation and social isolation due to their symptoms.

Diagnosis of Whiplash

After an accident, patients are usually examined at a hospital or doctor’s office. The doctor will determine if any immediate treatment is required and may place a collar on the neck for added support. X-rays may be ordered to check for any serious injury. If neck pain persists despite normal X-rays, the doctor may keep the cervical collar and request further examination in about a week. Dynamic X-rays or MRI scans might be used to identify injuries to the neck’s soft tissues that are not visible with regular X-rays.

Treatment of Whiplash

The treatment of whiplash depends on the specific symptoms. Education plays a pivotal role in managing whiplash, as patients need to understand the cause, potential treatments, and expected outcomes. Early immobilization with a soft cervical collar used to be a common approach but has been found to hinder the healing process. Instead, early range of motion exercises, including rotational exercises, have shown better and faster symptom improvement. Rest and immobilization can lead to chronic symptoms, as they cause stiffness, muscle atrophy, decreased blood flow, and healing in a shortened position.

Physical therapy may help patients transition out of the cervical collar, strengthen muscles, and reduce pain. Occupational therapy can assist in returning patients to work. Prompt treatment for emotional conditions such as anger, anxiety, or depression can also improve recovery outcomes and minimize the risk of chronic symptoms.

Prevention of Whiplash

While accidents cannot always be prevented, advancements in automobile safety have aimed to reduce the risks associated with whiplash. Proper use of seat belts and head restraints, positioned directly behind the head to prevent hyperextension, can significantly minimize injury. Additional safety features like air bags and air curtains offer further protection.

Medically reviewed by Joseph Palermo, DO; Board Certificate: Internal Medicine/Geriatric Medicine

Sources: Crowe H. Injuries to the cervical spine (1928), Spitzer WO, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders (1995), Freeman MD. A review and methodologic critique of the literature refuting whiplash syndrome (1999), Bogduk N. The anatomy and pathophysiology of whiplash (1986), Kaneoka K, et al. Motion analysis of cervical vertebrae during whiplash loading (1999), Panjabi MM, et al. Simulation of whiplash trauma using whole cervical spine specimens (1998), McKinney LA, et al. The role of physiotherapy in the management of acute neck sprains following road-traffic accidents (1989), Mealy K, et al. Early mobilization of acute whiplash injuries (1986), Rosenfeld M, et al. Early intervention in whiplash-associated disorders (2000).