FAQs on Whiplash

Whiplash is a serious neck injury that causes considerable pain and disability. Also called cervical (neck) strain, whiplash occurs when the head is forced violently forward then backward, like cracking a whip. With this condition, many structures of the neck are affected.

What causes whiplash?

With whiplash, the structures affected are the vertebrae, the intervertebral joints, the intervertebral discs, ligaments, muscles, and nerves. The most common cause of whiplash is a car accident, where the head is jerked backward and/or forward. However, whiplash can occur secondary to a fall, sports accident, and other injuries.

What symptoms are associated with whiplash?

Many people do not experience any symptoms until 24 hours after the accident or initial trauma. With whiplash, symptoms include:

  • Severe neck pain
  • Neck stiffness
  • Headaches
  • Shoulder pain
  • Numbness or tingling of one or both arms
  • Irritability, fatigue, and sleep disturbances
  • Trouble concentrating

How is whiplash diagnosed?

The soft tissues of the cervical spine are not visible on a plain x-ray. However, if you have neck pain, the doctor will order x-rays. In addition, a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan may be ordered. After taking a medical history and inquiring about symptoms, the doctor will also perform a physical examination.

How is whiplash treated?

There is no single treatment for whiplash. Depending on the severity of the condition, options for treatment include:

  • Medications – Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to take down swelling and relieve pain. For muscle spasms, the doctor may prescribe Baclofen or Flexiril. Severe pain is treated with narcotic analgesics short-term.
  • Cervical collar – To stabilize the neck, the doctor may order a cervical collar. This soft device worn around the neck that prevents movement.
  • Cervical epidural steroid injection (ESI) – To decrease pain and inflammation, the doctor can inject the space around the spinal cord with a corticosteroid. A long-acting anesthetic may be also injected into the epidural space for added benefit.
  • Trigger point injections – For severe upper neck and shoulder pain, the doctor can inject the regions with an anesthetic agent. Botox and corticosteroids may also be injected into painful trigger points to deactivate them.
  • Medial branch nerve block – For chronic neck pain, a block may be recommended. This involves using x-ray guidance to position a needle near the affected nerve. An anesthetic or neurolytic agent is injected onto the nerve to block pain signal transmission. A large review of studies found that the medial branch nerve block offers significant pain relief with a 92% success rate.
  • Physical therapy – To ease the pain associated with whiplash, a short course of physical therapy may be required. The therapist uses a variety of techniques, such as ultrasound, electrical stimulation, cold packs, and heat therapy. In addition, the patient can learn stretching, flexibility, and strengthening exercises for the cervical spine.
  • Chiropractic care – A chiropractor is a trained professional who specializes in the bones and muscles. If you visit this professional, he will perform adjustments and maneuvers for pain relief.
  • Acupuncture – This ancient Chinese therapy involves insertion of tiny needles along special meridians (body regions). The aim of this therapy is to promote the body’s natural healing response and restore energy.

Resources

Manchikanti L, Manchikanti K, Damron K, et al. Effectiveness of cervical medial branch blocks in chronic neck pain: a prospective outcome study. Pain Physician. 2004; 7: 195-201.

Schofferman J, Bogduk N, Slosar P. Chronic whiplash and whiplash associated disorders: an evidence-based approach.