What Is Whiplash? What Causes Whiplash?

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Main Category: Bones / Orthopedics
Also Included In: Sports Medicine / Fitness;  Primary Care / General Practice;  Pain / Anesthetics
Article Date: 21 Dec 2009 - 0:00 PDT

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Whiplash, or WAD (whiplash-associated disorders) refers to a series of neck injuries caused by or related to a sudden distortion of the neck - hyperextension (over-extension) injury to the neck. In many cases whiplash is the result of being struck from behind, for example, by a fast moving vehicle in an automobile accident.

In a typical case the victim's body is initially pushed or accelerated forward while the head remains behind for an instant, making the head rock up and back, stretching and/or tearing some muscles, tendons and ligaments. The muscles react automatically (reflex motion) to bring the heard forward - sometimes this is overdone and the head may rock forward violently, further stretching and/or tearing muscles, tendons and ligaments.

Tendons are tissues by which muscles attach to bone. Tendons are flexible, fibrous and tough. Like ligaments, tendons are tough flexible cords. Ligaments go from bone-to-bone while tendons go from muscle-to-bone. Although tendons and ligaments are tough, they are known as soft tissue (because they are usually compared to bone or cartilage).

Most people associate whiplash with one vehicle being hit in the rear by another vehicle - the driver in front sustains the whiplash. However, the impact can come from any direction and the head may move backwards or sideways, not only forwards initially. Whiplash injury may also be sustained in various ways, such as from falling off a bicycle or a horse.

Put simply, the ligaments and tendons in the neck are sprained during a whiplash injury because, for example, the ligament has been overstretched. Even though the neck has not been broken, it may sometimes take several months for everything to heal.

An individual with a whiplash injury will experience stiffness, pain, headaches, muscle spasms, shoulder pain, and temporary loss of movement in the neck. Whiplash may also be caused by a powerful blow to the head, for example during rugby, American football, karate, or boxing.

Women are more susceptible to whiplash injuries than men; experts believe it is because women's neck muscles are usually not as strong as men's.

According to Medilexicon's medical dictionary:

Whiplash injury is a "popular term for flexion-extension injury."

What are the symptoms of a whiplash injury?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

A whiplash injury typically takes from 12 to 24 hours after the accident or blow to develop. At the time of the incident any swelling or bruising to the neck muscles will not be apparent straight away. In most cases the discomfort, pain and stiffness is much worse on the following day, and may continue to worsen as each day goes by. A person with a whiplash injury may experience:

• A loss (or reduction) of movement in the neck
• Headaches
• Neck pain
• Neck stiffness
• The back of the neck feels tender

The following signs and symptoms are also possible:


• Lower back pain
• Pain in the arms and hands
• Numbness or pins and needles in the arms and hands
• Muscle spasms
• Dizziness
• Fatigue
• Swallowing difficulties
• Vision problems (vision may be blurred)
• A feeling that you are moving or spinning (vertigo)
• Ringing in the ears (tinnitus)
• Sleep disturbances

The following less common signs and symptoms are also possible:


• Irritability
• Memory loss
• Poor concentration

Headaches, dizziness, problems swallowing and vision problems should not last long. If they do, tell your doctor.

What are the causes of whiplash injuries?

A whiplash injury may occur if the head is moved violently away from the body because of a sudden and powerful jerk or jolt. The neck moves beyond its normal range of movement, resulting in overstretched ligaments, muscles and tendons. The injury is often exacerbated because the muscles, in order to compensate for the sudden movement, pull the head back into position too hard, causing another overstretching in the opposite direction.

The jolt (or blow to the head) can come from behind, in front, and from the side. A slow-speed collision may also cause a whiplash injury.

The following are possible causes of whiplash:

• Automobile accidents
• A sudden blow to the head from a contact sport, such as rugby, boxing, karate, or American football.
• A horse riding or cycling accident
• Any fall which causes the head to violently jolt backwards
• Being hit on the head with a heavy object
• Shaking a child/baby violently (possible child abuse)
• Punching a child/baby (possible child abuse)

How is a whiplash injury diagnosed?

The GP (general practitioner, primary care physician) will examine the patient and ask them about any recent accidents, sporting events, falls or blows to the head.

The following imaging scans may be ordered, especially if a spinal injury is suspected:

• X-ray - this test may rule out broken bones or other conditions, such as a spinal fracture, arthritis or dislocations.


• A CT (computerized tomography) scan - many X-ray images are taken from different angles and a more detailed picture of the bone and soft tissues may be seen on a monitor.


• An MRI (magnetic resonance imaging) scan - radio waves and a strong magnetic field gradually produce a detailed picture of the affected area on a monitor. The health care professional will be able to detect soft tissue injuries.

What are the treatment options for a whiplash injury?

Treatment focuses on alleviating pain and stiffness in the neck, as well as healing the damage to muscles, ligaments and tendons.

Most patients will experience a significant improvement in symptoms after a few days. According to the NHS (National Health Service), UK, in approximately 60% of cases symptoms clear up completely within one to four weeks. Some people still have symptoms several months after the injury occurred; on rare occasions problems may persist for even longer.

The following treatment may help alleviate symptoms:

• Ice-pack - applying an ice-pack immediately after the injury occurs, or as soon as possible, helps reduce swelling (inflammation). Wrap the ice in a towel or some protective barrier - do not apply ice directly to the skin. An ice-pack session should last from 10 to 30 minutes.


• Exercise - patients should try to move their necks normally; it is important to do this under the directions of a doctor, physical therapist (UK: physiotherapist) or qualified health care professional. In cases where symptoms are severe, the individual may have to completely rest the neck until the pain allows for movement.

When pain levels allow, the patient should exercise the neck gently so that it does not stiffen up. The neck should be moved slowly in each direction, gradually widening the range.

• Pain - painkillers, such as Tylenol (paracetamol) should help reduce whiplash injury pain. Some doctors may advise patients to take painkillers regularly, and not just when the pain is severe. It is important not to exceed the dose.
  
  NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen may help with the swelling (inflammation). Patients with asthma, hypertension (high blood pressure), kidney failure or heart failure should check with their doctors, because in most cases they should not take NSAIDs.
  
  If pain is more severe the doctor may prescribe codeine, or some other stronger painkiller. Sometimes codeine with Tylenol (parecetamol) are prescribed together.


• Posture - a qualified health care professional should teach the patient how to maintain an upright good posture, for example, keeping the back straight when walking, standing or sitting, as this can prevent neck pain and stiffness from getting worse. A firm pillow may help maintain good posture while sleeping.


• Injections - corticosteroid or lidocaine injections may help relieve muscle spasms.


• Muscle relaxants - these may help ease muscle spasms. As muscle relaxants may cause drowsiness, most doctors advise their patients to take them at bedtime.


• Physical therapy (UK: physiotherapy) - a physical therapist may use massage and manipulation, as well as recommending neck exercises. The physical therapist may also use ice, heat and/or ultrasound.


• Osteopathy - in Western Europe osteopathy is commonly used to treat whiplash. Osteopathy uses manipulation to treat back, neck, and sports injuries.


• Collars - soft foam collars used to be popular for whiplash injury treatment. However, immobilizing the neck for long periods may undermine recovery, because muscle bulk and strength is reduced. If a cervical collar is needed, it should usually be worn for more than three hours at a time. For some patients who keep waking up with whiplash pain, a collar may help get a good night's sleep.

What are the possible complications of a whiplash injury?

A small percentage of patients may have chronic (long-term) pain, which can persist for six months, and sometimes longer. Long-term pain may make it more difficult for the patient to enjoy some activities, as well as carrying out many everyday chores. In some cases the chronic pain can be traced back to joint, disk or ligament damage. For some patients the cause of the long-term pain is never found.

Driving - patients with severe stiffness and pain should refrain from driving until they are able to turn their heads quickly.

Preventing whiplash injuries

Make sure the headrest in your car is adjusted correctly so that your head is prevented from moving backwards. There is nothing you can do to prevent your head from moving forward or sideways if the collision comes from in front or from the sides.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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