Whiplash

Overview

Whiplash is a neck injury due to forceful, rapid back-and-forth movement of the neck, like the cracking of a whip.

Whiplash is commonly caused by rear-end car crashes. But whiplash also can result from sports accidents, physical abuse and other types of traumas, such as a fall. Whiplash may be called a neck sprain or strain, but these terms also include other types of neck injuries.

Most people with whiplash get better within a few weeks by following a treatment plan that includes pain medicine and exercise. However, some people have long-lasting neck pain and other complications.

Symptoms

Symptoms of whiplash most often start within days of the injury. They may include:

• Neck pain and stiffness.
• Pain that gets worse with neck movement.
• Loss of range of motion in the neck.
• Headaches, most often starting at the base of the skull.
• Tenderness or pain in the shoulder, upper back or arms.
• Tingling or numbness in the arms.
• Tiredness.
• Dizziness.

Some people also have:

• Blurred vision.
• Ringing in the ears, called tinnitus.
• Trouble sleeping.
• Crankiness.
• Trouble focusing.
• Memory problems.
• Depression.

When to see a doctor

See your healthcare professional if you have neck pain or other whiplash symptoms after a car accident, sports injury or other injury. It's important to get a quick diagnosis. This is to rule out broken bones or other damage that can cause or worsen symptoms.

Causes

Whiplash most often occurs when the head is quickly thrown backward and then forward with force. This often happens as a result of a rear-end car crash. This motion can cause damage to the muscles and tissues of the neck.

Risk factors

Risk factors for whiplash include:

• Rear-end car crash. This is the most common risk factor for getting whiplash.
• Physical abuse or assault. Whiplash can occur if you are punched or shaken. It's one of the injuries seen in shaken baby syndrome.
• Contact sports. Football tackles and other sports-related contact hits sometimes can cause whiplash.

Complications

Most people who have whiplash feel better within a few weeks. They don't seem to have lasting effects from the injury. But some people have pain for months or years after the injury.

It's hard to predict how recovery from whiplash might go. As a rule, you may be more likely to have ongoing pain if your first symptoms were intense, started quickly and included:

• Severe neck pain.
• More-limited range of motion.
• Pain that spread to the arms.

The following risk factors have been linked to a worse outcome:

• Having had whiplash before.
• Older age.
• Already having low back or neck pain.
• A high-speed injury.

Diagnosis

Your healthcare professional will ask about the event and your symptoms. You also may be asked questions that help your healthcare professional understand how bad your symptoms are and how often they occur. Your healthcare professional also will want to know how well you can do everyday tasks.

Examination

During the exam your healthcare professional will need to touch and move your head, neck and arms. You will be asked to move and do simple tasks to check the:

• Range of motion in your neck and shoulders.
• Degree of motion that causes pain or an increase in pain.
• Tenderness in your neck, shoulders or back.
• Reflexes, strength and feeling in your limbs.

Imaging tests

A whiplash injury doesn't show on imaging tests. But imaging tests can rule out other conditions that could be making your neck pain worse. Imaging tests include:

• X-rays. X-rays of the neck taken from many angles can show broken bones, arthritis and other issues.
• CT scan. This special type of X-ray can make detailed images of bone and show damage.
• MRI. This imaging test uses radio waves and a magnetic field to make detailed 3D images. Besides bone injuries, MRI scans can show some soft tissue injuries, such as damage to the spinal cord, disks or ligaments.

Treatment

The goals of whiplash treatment are to:

• Control pain.
• Restore range of motion in your neck.
• Get you back to your regular activities.

Your treatment plan will depend on the extent of your whiplash injury. Some people need only medicines available without a prescription and at-home care. Others may need prescription medicines, pain treatment or physical therapy.

Pain management

Your healthcare professional may suggest one or more of the following treatments to lessen pain:

• Rest. Rest may be helpful for a day or two after your injury. But too much bed rest may slow healing.
• Heat or cold. Either heat or cold put on the neck for 15 minutes every three hours or so can help you feel better.
• Pain medicines available without a prescription. Pain relievers, such as acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others), often can control mild to moderate whiplash pain.
• Prescription medicines. People with more-severe pain may be given certain antidepressant drugs that have been shown to relieve nerve pain.
• Muscle relaxants. Short-term use of these drugs might help loosen tight muscles and soothe pain. The medicine also can make you feel sleepy. It may be used to help restore your usual sleep if pain keeps you from getting a good night's rest.
• Numbing shots. A shot of lidocaine (Xylocaine) into painful muscle areas might decrease pain so that you can do physical therapy.

Exercise

Your healthcare professional might prescribe stretching and movement exercises for you to do at home. These exercises can help restore range of motion in your neck and get you back to your regular activities. You might be told to put moist heat on the painful area or take a warm shower before exercise.

Exercises may include:

• Rotating your neck to each side.
• Tilting your head side to side.
• Bending your neck toward your chest.
• Rolling your shoulders.

Physical therapy

If you have ongoing whiplash pain or need help with range-of-motion exercises, physical therapy might help you feel better and prevent further injury. Your physical therapist will guide you through exercises to strengthen your muscles, improve posture and restore movement.

In some cases, a procedure called transcutaneous electrical nerve stimulation (TENS) may be used. TENS sends a mild electric current to the skin. Limited research suggests this treatment might ease neck pain and improve muscle strength for a short time.

The number of physical therapy sessions depends on the person's needs. Your physical therapist also can create an exercise program for you to do at home.

Foam collars

Soft foam collars were once used for whiplash injuries to hold the neck and head still. But studies have shown that keeping the neck still for long periods can decrease muscle strength and slow recovery.

But use of a collar to limit movement may help reduce pain soon after your injury. And it may help you sleep at night. Experts don't agree on how to use a collar, though. Some experts suggest using it no more than 72 hours. Others say it may be worn up to three hours a day for a few weeks. Your healthcare professional can tell you how to use the collar, and for how long.

Alternative medicine

Nontraditional therapies have been tried to treat whiplash pain, but research about how well they work is limited. Some include:

• Acupuncture. Acupuncture involves putting fine needles into certain areas on the skin. It may offer some relief from neck pain.
• Chiropractic care. A chiropractor puts pressure on joints, called manipulation. Some studies show that chiropractic care may ease pain when paired with exercise or physical therapy. Putting pressure on the spine may cause minor problems. They include numbness or dizziness, and rarely damage to spinal tissues.
• Massage. Neck massage may provide short-term relief of neck pain from whiplash injury.
• Mind-body therapies. Exercises that incorporate gentle movements and a focus on breathing and the movement, such as tai chi, qigong and yoga, may help ease pain and stiffness.

Preparing for an appointment

If you've been in a car accident, you might get care on the scene or in an emergency room. However, a whiplash injury may not cause symptoms right away. If you have neck pain and other symptoms after an injury, see a healthcare professional as soon as possible.

Be ready to describe in detail the event that may have caused your symptoms and to answer questions, such as:

• How would you rate your neck pain on a scale of 1 to 10, with 10 being the worst.
• Does movement make the pain worse?
• What other symptoms do you have?
• How long after the event did the symptoms start?
• Have you had neck pain in the past, or do you have it often?
• Have you tried medicines or other treatments to relieve the pain? If so, what happened?
• What medicines do you take daily or often? Include dietary supplements and herbal medicines?