Whiplash Injuries - Serious Spinal Trauma

by American Chiropractic Association

What is Whiplash?

Whiplash is a generic term applied to certain injuries of the neck. Injuries that occur when the neck is suddenly and/or violently jolted in one direction and then another, creating a whip-like movement. Whiplash is most commonly seen in people involved in motor vehicle accidents, but it can also occur from falls, sports injuries, work injuries, and other incidents. Most whiplash injuries are associated with forward and backward movement of the head and neck on the shoulders. Side-impact crashes, or crashes when that happen while a person’s head is turned, may result in side-to-side or even oblique whiplash-style injuries to the neck. Although severe whiplash injuries can result in paralysis and even death, most such injuries range from relatively mild to moderate. Keep in mind that even mild injuries may have a significant effect on the spine and your health.

What structures are injured in a whiplash?

Whiplash most often results in sprain and strain injuries of the neck. A sprain of the spine occurs when the ligaments that help support, protect, and restrict excessive movement of the vertebrae are torn. The joints in the back of the spine are called the facet joints; ligaments called facet capsules cover these joints. The facet capsules seem to be particularly susceptible to whiplash injury. Additionally, muscles and tendons are strained during a whiplash injury. They are stretched beyond their normal limits, causing tears within the muscles and tendons. The discs between the vertebrae, which are essentially ligaments, can be torn, potentially causing a disc herniation. The nerve roots between the vertebrae may also be stretched and become inflamed. Even though it is rare, vertebrae can be fractured and/or dislocated in a whiplash injury.

What are the common signs and symptoms of whiplash?

Approximately two thirds of people involved in motor vehicle accidents develop symptoms of whiplash. Interestingly, the violence of the crash is not a definitive indicator of pain or even the amount of pain. Generally speaking, however, those involved in more severe accidents have more signs and symptoms.

Another important and interesting aspect of whiplash is that the signs and symptoms often do not develop until 2 to 48 hours after the injury. This scenario is relatively common but not completely understood. Some speculate that it may be due to delayed muscle soreness, a condition seen in other circumstances.

The most common symptoms of whiplash are pain and stiffness in the neck. These symptoms are generally found in the areas that are “whiplashed.” To illustrate what can happen during a whiplash, imagine a car being struck from behind. First, the head is lifted up from the upper-cervical spine as it moves backward towards the impact. Next, the head recoils forward and down away from the impact over-stretching muscles, tendons, and ligaments along the back of the spine and neck. This back and forward motion is the recreates a whip-like action, therefore the term “whiplash.” It’s important to note that the weight of the head is significant in comparison to the size of the cervical spine. As the head moves back and forth, the action creates a sprain/strain in the region just below the skull, further down in the mid cervical spine, and in the muscles and tendons of the neck. Turning the head often makes the pain and discomfort worse. Headache, especially at the base of the skull, is also a common symptom, seen in more than two thirds of patients. These headaches may be one-sided (unilateral) or experienced on both sides (bilateral). In addition, the pain and stiffness may extend down into the shoulders and arms, upper back, and even the upper chest.

Going beyond musculoskeletal symptoms, some patients also experience dizziness, difficulty swallowing, nausea, and even blurred vision after a whiplash injury. While these symptoms are disconcerting, in most cases, they can resolve within a relatively short time. If they persist, it is very important to inform your doctor that they are not resolving. Some whiplash victims can experience vertigo (the sensation of the room spinning), ringing in the ears, and/or pain in the jaw (TMJ). Others will have complaints of irritability, fatigue, and difficulty concentrating. These symptoms also resolve in most cases. In rare cases, symptoms can persist for weeks, months, or even years.

How is whiplash diagnosed?

To make a diagnosis, a thorough history of the injury and the patient’s previous medical history are taken. Preexisting conditions, such as arthritis and/or previous injury, may increase the severity of the signs and symptoms of whiplash. After obtaining the patient’s history, an in-depth physical examination is performed, with special concentration on the neuromusculoskeletal system. When appropriate, X-rays may be taken. If the doctor suspects that the soft tissues (for example, discs or ligaments) in the neck are injured, more advanced imaging studies, such as magnetic resonance imaging (MRI), may be ordered.

How is whiplash treated?

Staying active – One of the most important aspects of whiplash management is for the patient to stay active, unless there is some serious injury that requires immobilization. Patients should not be afraid to move and be active, within reason. In addition, your doctor will often prescribe an exercise or stretching program. It is particularly important to follow this program as prescribed, so that you can achieve the best long-term benefits.

Soft-cervical collar – The use of a soft-cervical collar remains controversial. Some suggest that such devices are inappropriate, as they act as a “crutch” and encourage a patient to avoid activity. Others suggest that, with proper counseling, a collar can help a patient slowly return to normal activities. There is no controversy, however, when discussing the length of time that a soft collar should be worn—no more than one week.

Chiropractic manipulation and physical therapy – Ice and/or heat are often used to help control pain and reduce the muscle spasm that results from whiplash injuries. Other physical therapy modalities, such as electrical stimulation and/or ultrasound, may provide some short-term relief. They should not, however, replace an active-care program of exercise and stretching. Spinal manipulation and/or mobilization provided by a chiropractor can also give relief in many cases of neck pain.

Surgery and injections – Surgery, injections, and other invasive options are rarely necessary but are available, when appropriate. They are generally reserved for patients with more severe injuries to the discs, vertebrae, and nerves in the neck region.

Can whiplash be prevented?

Generally speaking, whiplash cannot be “prevented,” but there are some things that you can do while in a motor vehicle that may reduce the chances of a more severe injury. Always wear restraints (lap or shoulder belt), and ensure that the headrest in your vehicle is adjusted to the appropriate height.

This patient information page is a public service of the Massachusetts Chiropractic Society and American Chiropractic Association. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for a diagnosis by a specialist. For specific information concerning your health condition, consult your doctor of chiropractic.