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Treatment Of Whiplash

Whiplash Associated Disorder is a common consequence of sudden acceleration and deceleration movements of the neck.

Car accidents, especially the celebrated rear shunt, are the commonest cause. Usually minor, they can be a source of significant pain and suffering.

Permanent damage is uncommon and your long-term outlook is good.

Whiplash injuries are not usually serious and do not involve damage to the bones, discs or nerves in the neck.

The acute, more severe pain usually improves within days or a few weeks, at least enough to get on with normal activities.

Pain may in some cases may last a long time after whiplash, but usually settles at some unspecified time. These cases may be no more serious than the ones that settle early, except for the effects they have on the person.

What can you do about it?

The overall principle for both whiplash and back pain is not to rest too much or avoid activities, as this can lead to long term pain and disability.

  • Modify your activities for a short while (ie a day or two) and take some pain killers.
  • Wear a collar if prescribed only for a short period of time
  • Try heat and cold, manipulation, or other physical treatments if you want to – they may give some benefit
  • Get on with ordinary life as soon as possible. The people who cope best with whiplash are those who stay active, exercise their necks and get on with life despite the pain.

Neck Pain Causes

Pathology and physiology

The neck is strong and supported by powerful muscles which stabilise and move it. Long-term effects are rare from most small rear shunt accidents.

The cause of pain in the acute (recent) stage after whiplash may be acute muscle injury, but there can be other significant injuries depending on the force of the injury. These can include spinal fracture, haematomas (bleeding into the tissues) and nerve damage.

Arm symptoms may be the result of muscle spasm in the neck muscles irritating nerves in the spinal area.

If the force of the impact is great, there can also be a primary brain injury at the time, which may relate to the psychological difficulties some people have in the long-term. Uncommon however.

Many people believe the primary pathology is an arthritic process occurring in the small neck joints (facets), and this may refer pain to various areas depending on which joints are damaged.

Whiplash Signs and symptoms

Most people report pain in the back of the neck, worse on movement. Pain may radiate up to the head, across to the shoulders, arms or between the shoulder blades. Headaches are typically at the back of the head and spread forwards over the head.

Other, less common symptoms can be:

  • Disturbances of eyesight
  • Problems with balance and dizziness
  • Weakness and heaviness in the arms
  • Pins and needles on the inner sides of the hands
  • Hoarseness and difficulty swallowing and eating
  • Disturbances of hearing

Serious symptoms are rare, and include unconsciousness, visual disturbance, walking or balance disturbance, numbness or pins and needles in your arms and legs, and severe pain with postural abnormality. Consult your doctor for these and he or she will likely give you the OK anyhow.

Whiplash Investigations

Investigations are of little use in confirming or excluding whiplash injury. Xrays of the neck from the side may be taken to exclude the possibility of spinal fracture or instability, which can occur without direct impact. However the force involved would have to be considerable to make it worthwhile doing these.

MRI scans will show up changes in the neck unless you are very young, but most of these changes will have no relevance to your pain. Best to think of them as age-related joint changes.

Nerve blocks of the nerves coming from the cervical facet joints have shown they are involved in the pain in over 50% of cases.

Whiplash Treatment

Self treatment is the key to managing whiplash successfully and gives you the best chance of recovering fully and going back to normal life. You may want to try treatments from various professionals and they may be useful in the short term, but should have an effect you can notice pretty quickly. Long term treatment is not indicated.

Self management includes daily range of motion and strengthening exercises for the neck and upper back, general exercise for the whole body, relaxation, realistic thinking and planning for the future rather than sitting passively and waiting for the pain to go away.

Normal activities may hurt, but provided the pain is not severe or increasing you are not doing yourself harm, and indeed this is the route to recovery.

See Fear avoidance for advice on how to approach a pain problem in the best manner for a good outcome.

For detailed guidance see this booklet, published on 15th February 2003.

Cited Reference:
Moore A, Jackson A, Hammersley S, Hill J, Mercer C, Smith C, Thompson J, Woby S, Hudson A (2005). Clinical guidelines for the physiotherapy management of Whiplash Associated Disorder. Chartered Society of Physiotherapy. London.

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