Whiplash: What you need to know
Whiplash, or whiplash-associated disorder (WAD), is often the result of being struck from behind, for example, by a fast moving vehicle in an automobile accident.
When a blow is struck, the individual's body is immediately pushed forward while the head remains behind for an instant. This forces the head to rock up and back, stretching and sometimes tearing some muscles, tendons, and ligaments.
The muscles automatically contract and bring the head forward, sometimes too far, and the head may rock forward violently, further stretching or tearing muscles, tendons, and ligaments.
- Whiplash can be caused by a collision from any direction, not just behind.
- It can also be caused in other ways, including abuse, horse riding, and contact sports.
- Sometimes, the full effect of whiplash is not felt for 24 hours or more after the incident.
- Symptoms can include lower back pain, dizziness, and muscle spasms.
- Even a slow speed collision can cause whiplash.
How does it happen?
Whiplash symptoms can include headaches, dizziness, and vision problems.
Most people associate whiplash with a vehicle being hit from behind by another vehicle - the driver in front gets whiplash. However, the impact can come from any direction, and the head may move backward or sideways, not only forward.
Whiplash injury may also be sustained in other ways, including:
- falling off a bicycle
- horse riding accident
- physical abuse - including shaking a baby
- amusement park rides
- contact sports
- blows to the head with a heavy object
Put simply, the ligaments and tendons in the neck are sprained during a whiplash injury because they have been overstretched. Even though the neck has not been broken, it may sometimes take several months for everything to heal.
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.
How does it feel?
A whiplash injury typically takes 12-24 hours 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 whiplash may experience:
- a loss (or reduction) of movement in the neck
- neck pain
- neck stiffness
- the back of the neck feels tender
These whiplash 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
- swallowing difficulties
- vision problems (vision may be blurred)
- a feeling that you are moving or spinning (vertigo)
- ringing in the ears (tinnitus)
- sleep disturbances
These less common signs and symptoms are also possible:
- memory loss
- poor concentration
Headaches, dizziness, problems swallowing, and vision problems should not last long. If they do, tell your doctor.
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 made worse 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, or from the side. Even a slow-speed collision can cause whiplash.
A range of imaging techniques might be used to diagnose whiplash.
The doctor 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:
CT (computerized tomography) scan - many X-ray images are taken from different angles and a more detailed picture of the bone and soft tissues can be seen on a monitor.
MRI (magnetic resonance imaging) scan - radio waves and a strong magnetic field gradually produce a detailed picture of the affected area. The doctor will be able to detect soft tissue injuries.
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), United Kingdom, in approximately 60 percent of cases, symptoms clear up completely within 1-4 weeks. However, some people still have symptoms several months after the injury occurred; on rare occasions, problems may persist for even longer.
The following treatments may help alleviate symptoms of whiplash:
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 10-30 minutes.
Patients should try to move their necks normally; it is important to do this under the directions of a qualified healthcare 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.
Medications for pain
Painkillers, such as Tylenol (paracetamol), may 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, can help with the swelling (inflammation). Patients with asthma, hypertension (high blood pressure), kidney failure, or heart failure should check with their doctors before taking NSAIDs. Make sure to consult with your doctor before taking any medication for pain.
A qualified healthcare professional can teach the patient how to maintain a good upright posture, for example, keeping the back straight when walking, standing, or sitting; this can prevent neck pain and stiffness from getting worse. A firm pillow can help maintain good posture while sleeping. See a physical therapist for posture training and tips to reduce pain.
Corticosteroid or lidocaine injections might help relieve muscle spasms.
These may help ease muscle spasms. As muscle relaxants can cause drowsiness, most doctors advise their patients to take them at bedtime.
A physical therapist might use massage and manipulation, as well as recommending neck exercises. The physical therapist may also use ice, heat, electrical stimulation, or ultrasound to reduce pain.
In Western Europe, osteopathy is commonly used to treat whiplash. Osteopathy uses manipulation to treat back, neck, and sports injuries.
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 no more than 3 hours at a time.
A small percentage of patients have chronic (long-term) pain, which can persist for 6 months or longer. Long-term pain can 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 without pain.
Make sure the headrest in your car is adjusted correctly so that your head is prevented from moving backwards. However, 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.