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Whiplash and Whiplash-Associated Disorder

What is Whiplash?

Whiplash is a soft tissue injury to the neck caused from a sudden extension and flexion of the cervical spine.  It occurs when the soft tissues of the neck, such as the muscles and ligaments, extend beyond their typical range of motion. 

Whiplash is caused by impact such as an automobile accident.  Whiplash-associated disorder is the most common injury following a motor vehicle collision.  Whiplash injury may also be caused by contact sports or physical assault.

Whiplash-associated disorder is the most common injury following a motor vehicle collision (Teasell et al., 2010).

Neck pain from a whiplash injury occurs in 65% of patients within 6 hours, 93% within 24 hours, and nearly 100% within 72 hours.  Many factors can influence the extent and location of pain, such as the condition of the patient’s neck, the speed, and direction of impact. 

20% to 50% of people with a whiplash injury report persistent interference in daily life up to 1 year later.  Neck pain from whiplash is associated with disability, decreased quality of life, and psychological distress (Walton & Elliott, 2017). 

Inflammation, decreased range of neck motion, disturbed neuromuscular control, and impaired neck muscle function is associated with whiplash injury.  Impaired muscle function of the neck is important for stability, coordination, and postural control (Peolsson et al., 2017).

Whiplash consists of multiple symptoms after the impact such as a neck sprain or strain, neck pain, decreased cervical range of motion, headaches, and dizziness.  Headaches present as chronic symptoms in 70% of patients (Atesok et al., 2019).

In some severe cases people suffering from whiplash may experience memory loss, paresthesia, sleep disturbances, fatigue, nervousness, blurred vision, or depression (National Institute of Neurological Disorders and Stroke, 2019).

Symptoms of Whiplash

  • Neck pain: it is common to experience neck pain, decreased neck range of motion, stiffness, and tenderness
  • Shoulder stiffness and tenderness: stiffness and tenderness may also be experienced in your shoulders
  • Headaches: headaches are a common side effect of whiplash.  The pain commonly starts in the neck and projects up to the head
  • Dizziness: be aware if you experience dizziness and/or instability after the whiplash injury.  Consult a specialist if you experience dizziness
  • Tingling of the upper extremity: you may experience pain or abnormal sensation down your arm

How Whiplash Can Impact Your Health

  • Abnormal sensation of the upper extremity: persistent pain or abnormal sensation down the arm
  • Chronic neck pain: neck pain that persists beyond 6 months after your whiplash injury
  • Psychological distress: stress, anxiety, depression, or PTSD associated with the whiplash injury
  • Jaw pain: “popping” of the jaw or jaw pain, especially while opening your mouth to chew

Risk Factors for Whiplash

  • Motor vehicle accidents
  • Sports collisions and trauma

Potential Complications of Whiplash

If you have experienced a whiplash injury, diagnostic imaging after the injury will be performed to rule out red flags such as a spinal fracture.  If you have experienced dizziness, nausea, severe pain, memory loss, or blurred vision be sure to communicate this to your doctor to rule out severe complications of head trauma.  

What to Do if you have Experienced Whiplash

If you have experienced a whiplash injury consult a physician to rule out any emergencies.  

Once you have ruled out severity of injury consider the following treatment options for conservative care.  The purpose of conservative care for whiplash is to manage pain such as neck pain and headaches and to improve function such as an improvement of range of motion of the neck. 

Treatment Options for Whiplash

Recovery time from whiplash will vary from patient to patient.  It may be a few days to several weeks.  Most people will recover fully within 3-months, although some people will experience persistent chronic neck pain (National Institute of Neurological Disorders and Stroke, 2019). 

Continue to monitor how your body is feeling in response to treatment and communicate with your healthcare provider.  If you are experiencing psychological distress consider the importance of seeking advice from a trained psychologist.   

Physical Therapy:
Exercise based interventions targeted at the cervical spine appear most beneficial for adults with chronic whiplash-associated disorder.  Exercise programs targeting the cervical spine for strength, endurance, flexibility, and postural control appear to be effective in reducing pain and disability (Anderson et al., 2018).

Heat and Ice Therapy:
While working and resting use heat and ice therapy in intervals of 15 minutes.  Ice will help with inflammation and heat will help with muscle tension.  Do not apply heat or ice directly to the skin.  Place a small towel between the heat or cold pack and your skin.

Check Your Posture:
Keep your neck in a neutral posture.  Relax your shoulders and retract your neck back so your ears are aligned over your shoulders.  Keep your eyes up, looking forward.  Avoid looking down for prolonged periods of time, and avoid clenching your jaw or tightening your shoulder muscles.

Chiropractic or Osteopathic Spinal Mobilization:

Mobilization treatments to the cervical spine had a beneficial effect on the physical as well as the mental aspects of late whiplash syndrome.  The outcome measures showed significant relief of neck-related pain and disability and quality of life (Schwerla et al., 2013). 

Acupuncture:

Acupuncture treatment has been associated with a significant alleviation of pain and has been shown to be a safe and effective treatment for whiplash-associated disorder (Kwak et al., 2012).

How Can We Help?

We can help you if you are considering conservative treatment options.  To determine if you are a good candidate for conservative care, we recommend a consultation and a complete posture analysis for specialized patient centered care options. 

After ruling out complications with your physician we can discuss best options based on objective measures.  All new patients are valued, will felt heard, and will have an objective analysis performed prior to discussing treatment options. 

References:

Anderson, C., Yeung, E., Tong, T., & Reed, N. (2018). A narrative review on cervical interventions in adults with chronic whiplash-associated disorder. BMJ open sport & exercise medicine4(1).

Atesok, K., Tanaka, N., Robinson, Y., Pittman, J., & Theiss, S. (2019). Current Best Practices and Emerging Approaches in the Management of Acute Spinal Trauma.

Burns, K. (2021) Whiplash, American Posture Institute Blog

Kwak, H. Y., Kim, J. I., Park, J. M., Lee, S. H., Yu, H. S., Lee, J. D., … & Choi, D. Y. (2012). Acupuncture for Whiplash-associated disorder: a randomized, waiting-list controlled, pilot trial. European Journal of Integrative Medicine4(2), e151-e158.

National Institute of Neurological Disorders and Stroke (2019) Whiplash Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Whiplash-Information-Page

Peolsson, A., Karlsson, A., Ghafouri, B., Ebbers, T., Engström, M., Jönsson, M., … & Peterson, G. (2019). Pathophysiology behind prolonged whiplash associated disorders: study protocol for an experimental study. BMC musculoskeletal disorders20(1), 1-9.

Schwerla, F., Kaiser, A. K., Gietz, R., & Kastner, R. (2013). Osteopathic treatment of patients with long-term sequelae of whiplash injury: effect on neck pain disability and quality of life. The Journal of Alternative and Complementary Medicine19(6), 543-549.

Teasell, R. W., McClure, J. A., Walton, D., Pretty, J., Salter, K., Meyer, M., … & Death, B. (2010). A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): part 4–noninvasive interventions for chronic WAD. Pain Research and Management15(5), 313-322.

Walton, D. M., & Elliott, J. M. (2017). An integrated model of chronic whiplash-associated disorder. journal of orthopaedic & sports physical therapy47(7), 462-471.