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Whiplash
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Whiplash

(Cervical Strain and Neck Muscle Sprain)

En Español (Spanish Version)

Definition

Whiplash is a neck injury that includes:

  • Spraining the neck ligaments
  • Straining the neck muscles
  • Bone and nerve injury may be involved

Whiplash is defined as an injury that happens after acceleration-deceleration involving the neck.

Process Leading to Whiplash

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Causes

Whiplash can occur with any sudden, violent, backward jerk of the head or neck. Common causes include:

  • Motor vehicle accidents
  • Athletic injuries
  • Falls
  • Assaults

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors for whiplash include:

Risk factors for poor outcome or longer recovery include being:

  • An older woman
  • In a truck
  • A passenger
  • Hit by a moving object
  • Hit head-on or perpendicular
  • Involved in litigation
  • Affected with severe pain or radicular symptoms

Symptoms

The symptoms of whiplash, or whiplash associated disorders, usually develop over the several hours following the injury. Within 24 hours of the injuring event, symptoms tend to reach their peak.

Symptoms include:

  • Stiff neck
  • Neck pain
  • Numbness or tingling
  • Shoulder pain and stiffness
  • Decreased range of neck motion
  • Muscle spasms
  • Headache
  • Pain, numbness, or tingling extending down an arm

Diagnosis

The doctor will ask about your symptoms and how the injury occurred, and perform a physical exam. Although most whiplash injuries do not show up on imaging tests, your healthcare provider may choose to order some tests to make sure that no other injuries are responsible for your symptoms.

Tests may include:

  • Neck x-rays—a test that uses radiation to take a picture of structures in the neck, especially bones.
  • CT scan—a type of x-ray that uses a computer to make pictures of the bony structures inside the neck
  • MRI scan—a test that uses magnetic waves to make pictures of bony and soft tissue structures inside the neck
  • CT myelogram—a test that uses dye to better see structures in the neck
  • Electrodiagnostic testing—also known as EMG

Treatment

Treatment includes:

  • Physical therapy—Physical therapy and exercises and modalities may help strengthen neck muscles and improve neck motion. While exercise used to be recommended later in the recovery period, current recommendations suggest that maximum benefit is obtained from beginning prescribed exercises within two days of injury.
  • Heat or ice packs—Talk with your doctor about using heat or ice to relieve muscle tension and pain. Wrap the heat or ice pack in a towel. Never place it directly on the skin.
  • Medications—These may include:
    • Pain relievers
    • Anti-inflammatories
    • Muscle relaxants
  • Restricted activity—While activity restriction used to be a common recommendation, current understanding of whiplash suggests that performing prescribed exercises is preferable.
  • Mobilization—Consistent evidence shows this to be helpful.
  • Chiropractic—There is some evidence of effect.
  • Neck (cervical) collar—This may be prescribed for short-term or occasional use, depending upon the extent of injury.
  • Cervical facet injections—There is some evidence of effect.
  • Radiofrequency neurotomy—There is some evidence of effect.
  • Pulsed magnetic field treatment—There is some evidence of effect.
  • Trigger point and botulinum toxin injection— There is conflicting evidence, but it may be helpful in select cases.

Prevention

There are no guidelines for preventing whiplash because it often occurs due to an unexpected event.

RESOURCES:

American Academy of Family Physicians
http://www.aafp.org

American Academy of Orthopaedic Surgeons
http://www.aaos.org

CANADIAN RESOURCES:

Healthy Canadians
http://www.healthycanadians.gc.ca

Physical Therapy Canada
http://www.physicaltherapy.ca/

References:

Conlin A. Bhogal S. Sequeira K. Teasell R. Treatment of whiplash-associated disorders--part II: Medical and surgical interventions. Pain Research & Management. 10(1):33-40, 2005.

Conlin A. Bhogal S. Sequeira K. Teasell R. Treatment of whiplash-associated disorders--part I: Non-invasive interventions. Pain Research & Management. 10(1):21-32, 2005.

Curatolo M. Arendt-Nielsen L. Petersen-Felix S. Evidence, mechanisms, and clinical implications of central hypersensitivity in chronic pain after whiplash injury. Clinical Journal of Pain. 20(6):469-76, 2004 Nov-Dec.

Dambro MR. Griffith's 5-Minute Clinical Consult . 2001 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001.

Primary Care Medicine . 4th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2000.

Rosen's Emergency Medicine: Concepts and Clinical Practice . 4th ed. Philadelphia, PA: Mosby-Year Book; 1998.

Verhagen AP. Scholten-Peeters GG. van Wijngaarden S. de Bie RA. Bierma-Zeinstra SM. Conservative treatments for whiplash. Cochrane Database of Systematic Reviews. (2):CD003338, 2007.



Last reviewed January 2008 by John C. Keel, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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