The Basics of Whiplash

Whiplash car accident neck braceWhiplash is the slang term used to describe the neck pain that occurs after an injury to the neck. Often caused by strained ligaments, tendons, and/or muscles of the neck, whiplash involves an abnormal motion or force applied to the cervical spine and neck structures, which results in abnormal movement of the neck.

This flexion-extension motion pulls and stresses the neck muscles, tendons, and ligaments, resulting in injury. The medical terms for whiplash include cervical strain, cervical sprain, hyperextension injury, and acceleration flexion-extension neck injury.

Approximately 85% of all neck pain occurs from acute or repetitive neck injuries or from chronic strain. The prevalence rate of neck pain in the general population is around 17%, with more than 3 million whiplash injuries occurring each year. According to researchers, an estimated 6% (15.5 million people) of the U.S. population have late whiplash syndrome.

Causes of Whiplash

Whiplash is often caused by motor vehicle accidents, accidental falls, assault, and sporting activities. A car accident is the most common cause because the speed involved produces enough energy to force the neck out of normal position, even when the person is wearing a seat belt. In addition, bicycle accidents, falling on ice, roller coasters, and a blow to the head all can cause whiplash.

Symptoms of Whiplash

The symptoms of whiplash depend on the degree of neck strain and muscle stiffness. The signs and symptoms include:whiplash 2

  • Neck pain
  • Neck stiffness
  • Muscle spasms in the front of the neck (anterior cervical spine), back of the neck (posterior cervical spine), and back of the shoulders (trapezius muscles)
  • Pain with flexing and rotating the head
  • Difficulty concentrating
  • Headaches
  • Sleep disturbances

Diagnosing Whiplash

If you have suffered trauma or been in a car accident, the doctor will conduct a physical examination and take a medical history. In addition, certain tests are used to diagnose the condition and to rule out serious injury. These include:

  • X-rays – To assess for fractures and bony abnormalities.
  • Magnetic resonance imaging – To assess the spinal cord, discs, and spinal nerves.
  • Computed tomography – To assess for soft tissue injuries.
  • Bone scan – To detect small fractures and tumors.
  • Myelogram – Done when instability is a concern.
  • Discography – To assess for tears in intervertebral discs.

Treatment for Whiplash

  • Medications – Certain medicines will help with cervical strain, such as muscle relaxers, anti-inflammatory agents, and pain medicines.Cervical_Epidural
  • Physical therapy – The therapist will work with the patient to teach neck strengthening and flexibility exercises.
  • Cervical collar – Soft structure that supports and immobilizes the cervical spine.
  • Botox – Botulinum toxin (Botox) can be injected into the muscles around the cervical spine and shoulders to paralyze them. This prevents painful contractions that lead to pain.
  • Trigger point injections – The doctor will inject a local anesthetic with or without a long-acting steroid into the structures of the back and neck. This offers temporary relief of pain.
  • Epidural steroid injection – If the patient has symptoms of nerve irritation, the doctor can inject a long-acting steroid (cortisone) with or without an anesthetic into the epidural space near the spinal cord. This reduces inflammation and relieves nerve root pain.

 

Resources

Dreyer SJ, Boden SD. Nonoperative treatment of neck and arm pain. Spine. Dec 15 1998;23(24):2746-54.

Haldeman S, Dagenais S. Cervicogenic headaches: a critical review. Spine J. Jan-Feb 2001

Freeman MD, Croft AC, Rossignol AM, et al. A review and methodologic critique of the literature refuting whiplash syndrome. Spine. Jan 1 1999;24(1):86-96.