Whiplash Injuries

woman suffering from a whiplash injury following a car accident

What is Whiplash?

Whiplash injuries are short, rapid accelerations of the neck that result in injury to the cervical (neck) tissues and will result in pain and discomfort. When our body is accelerated, and because our head has significant weight compared to our neck, this creates the momentum to come forward and “whip” the head forward or to the side, thereby injuring the neck. The quick motion of accelerating and deceleration and subsequent stopping causes micro-tears inside the muscular tissue and tendons. This can result in swelling, inflammation, muscle tightness, tenderness, decreased range of motion, and headaches. There are a wide variety of causes of whiplash injuries they can include: car accidents, contact sports, work accidents, slip and falls, or other physical trauma.

What Causes Whiplash Injuries?

In a car accident, depending on where you are hit, there is rapid acceleration and deceleration that is caused by the impact of the two cars or the car and some obstacle. Since most people thankfully wear their seatbelts, there has been an increased number of whiplash injuries reported after a car accident. Seatbelts will impede the body from accelerating around the car, which is a good thing since this was the primary cause of injury for people during car accidents. However, since seatbelt technology means that your body is strapped down to the seat, your head is free to roam. Having your head be free will mean that it can accelerate at a high rate of speed (almost equal to the speed of the car). However, since the ligaments and musculature of the neck are quite strong, there is a rapid deceleration that will happen in tandem with this acceleration. This is what causes whiplash injuries and the strain and sprains of the soft tissues. The muscles, tendons, ligaments, and other tissue will be stretched, stressed and sometimes torn during this motion, causing the injury.

Other actions that can cause whiplash injuries include physical assault. If a person experiences a physical trauma such as a tackle or punch, the same mechanism as a car accident will cause the head to experience whiplash. Although the force of a tackle or physical assault is less than a car accident, it can still generate enough force to cause an injury. The sports that are most common with whiplash injuries are those sports called collision sports. This can include, football, rugby, hockey, lacrosse, and wrestling. Along with the initial force of a tackle or punch, there is the rebound effect that a person will have when his or her head hits the ground.

In addition to physical assault, fall can cause whiplash injuries as well. Slipping and falling on ice or a wet surface, common workplace injuries can cause a jolting or sudden change in motion of the neck. In older adults, whiplash injuries can be further compounded due to compromised musculature or joints.

Visit a Doctor Right Away

If you have been experienced a whiplash injury, the first thing that you should do is visit a healthcare professional. You can visit your primary physician, or a specialist, either way you need to get to a doctor or as soon as you can following your injury. This is extremely important because most don’t realize the extent of their injuries following whiplash. On numerous occasions, the symptoms of a whiplash injury don’t present themselves until hours, days or even weeks after the initial impact. However, the sooner you can get professional care following your injury, the better your recovery will be, and the sooner you will be able to get back to life as normal.

Diagnosing a Whiplash Injury

After you have been hurt and visit the doctor, your health care provider will do an examination to determine what type of injuries you may have sustained and whether or not you are dealing with a whiplash injury. Your doctor will take down your medical history, including asking you a number of questions about your symptoms and the event that caused the injury, and then take your vitals.

Most doctors will do an exam that will test your reflexes, strength, and range of motion in your head, neck, and arms. If you are suffering from neck pain, your doctor may take diagnostic tests to rule out other issues or to see what may be making your neck pain worse. These imaging tests include X-rays, CT scans or MRIs to look for other injuries. Together with all of this information, your doctor will be able to diagnose whether or not you are suffering from a whiplash injury.

Treatment for Whiplash

Often after an accident or other physical trauma, our adrenaline and endorphins can decrease the immediate pain and discomfort of an injury. Generally, after about 4-12 hours, those effects will wear off, and we will start to feel the pain associated with the injury. There are a variety of treatment options that are available to patients who experience whiplash injuries and need relief. They can include

  • Medication
  • Physical Therapy  
  • Chiropractic Care
  • Massage Therapy
  • Epidural injection

Medication

As stated before, inflammation caused by whiplash injuries can result in a stiff and sore neck. Some medications that would be most effective would be brand names like Tylenol® (generic: acetaminophen), Motrin® (generic: ibuprofen), and Aleve® (generic: naproxen). All of these medications are over the counter (OTC) and generally can be taken 2-3 per day.  However, some higher doses of these medications may need to be taken. This will mean that you have to see a healthcare provider (Medical Doctor, Nurse Practitioner or Physician Assistant) write a prescription. In addition to anti-inflammatory medication, muscle relaxers can be an effective medication to take to calm down muscle spasms. All muscle relaxers must be prescribed by a medical professional. In addition to oral medication, lidocaine patches can be beneficial to patients who have whiplash injuries. Lidocaine patches work by the transmission of medicine that is applied to a patch through the skin; this is known as transdermal administration of medication. For stronger doses of lidocaine patches, you will have to get a prescription from a healthcare provider.

Physical Therapy

Physical therapy is a specialty healthcare profession that involves treating the soft tissues, osseous (bony) and neurological structures, ligaments/tendons, and postural/ergonomic deficits.  If you want your care to be covered by your insurance, you will need a prescription for physical therapy assessment and follow-up. However, many physical therapy clinics will also offer private pay options so that you do not have to go through insurance. Physical therapy is done in an outpatient clinic where you will see a therapist for 6-8 weeks. After an initial assessment, therapy can include modalities, postural re-training, ergonomic adjustment and modifications, stretching, and manual therapy for soft tissue and joint issues that a patient is experiencing.

  • Modalities involve hot packs, electrical stimulation, and cold packs.
    • Hot packs allow increased tissue extensibility and metabolic activity allowing for the pliability of tissue when performing soft tissue techniques. This is typically done with a moist hot pack or heating pad.
    • Electrical stimulation involves taking pads attached to an electrical stimulation machine. A patient will feel some tapping and tingling that will overload the superficial nerves of the skin and decrease pain transmission.
    • Cold packs are prescribed in order to slow the nerve conduction in the area that the cold pack is applied. It is also done after a physical therapy session.
  • Postural re-training is an important aspect of managing and decreasing the symptoms of whiplash injuries. This involves improving the upper back strength and retraction exercises. Resistance bands or weights will be utilized to improve the strength of the upper back. Additionally, the therapist will stretch the forward part of the body, this includes chest, shoulder, and neck stretches for the upper trapezius. All of this exercise will help to keep the head in a better biomechanical alignment, thereby reducing stress on the tissues that are injured by whiplash and allowing for recovery.
  • Ergonomic adjustment involves maintaining all equipment at an appropriate height, chairs with good lumbar support, and ergonomic keyboards/mouses. Having a better ergonomic design while a patient is at work or in the home, can also reduce the whiplash injury and allow for recovery. Often, if you are in therapy, a therapist can come out to your place of work and give you ergonomic evaluations and adjustments/modifications.
  • Stretching the specific neck exercises can help to reduce neck pain and reduce the symptoms of whiplash. This involves stretching the trapezius muscles, sternocleidomastoid, and scalene muscles. All of these muscles can get tight after a whiplash injury. Regular stretching of these muscles can reduce the symptoms of neck pain. Also, performing stretching with chin tucks to improve deep neck flexor strength and improve the flexibility of the anterior part of the neck.
  • Manual therapy for physical therapy involves treatment of the soft tissue and osseous/ligamentous structures. There are many effective treatments for soft tissue that includes: active release techniques, transverse friction massage, and trigger point release. Active release technique involves applied and continuous pressure on an area of tension or knots. After this pressure is applied, the patient is told to move through a certain range of motion. Using this technique, the muscle will be stretched out and reduce the knot or trigger point. Transverse friction massage is a technique that involves rubbing an arm of scar tissue perpendicular to the orientation to the fibers. This motion is usually done by a skilled physical therapist for 5-8 minutes for 2-3 sessions per week. This improves the elasticity, pliability, and flexibility to the scar tissue increasing the range of motion. Trigger points are when a muscle forms a knot as a protective mechanism after an injury. Tigger point release is when a therapist applies sustained pressure to a knot of tissue thereby, reducing the swelling inside of the muscle tissue.

Chiropractic Care

Chiropractic physicians are licensed healthcare professionals that are trained to use the body’s own natural mechanisms to treat the diseases of the spine including trauma sustained to the neck and back. Chiropractic therapy usually involves spinal manipulation techniques (adjustments) to correct spinal alignment and alleviate pain to the neck following a whiplash injury instead of using medications or surgical intervention. When it comes to injuries sustained during workplace accidents, some states may require additional requirements for healthcare professionals in order to treat injured workers. In New York State, for example, chiropractors and other medical providers have to be authorized by the NYS Workers’ Compensation Board (NYS WCB) to treat work-related injuries.

Massage Therapy

An additional adjunct to physical therapy is massage therapy. Generally, massage therapy is performed by a certified massage therapist. This moderate friction rubbing and soothing can help to reduce pain and reduce the swelling in the neck.

Acupuncture

Acupuncture is a type of alternative medicine, based on traditional Oriental medicine, where thin needles are inserted in specific points in person to facilitate the flow of energy in relieving pain. Research shows that acupuncture can be effective for the treatment of whiplash injuries for some patients. Acupuncturists are healthcare professionals that are licensed by the NYS Education Department and have to be authorized by the NYS WCB in order to treat injuries sustained in work-related accidents.

Epidural Injections

Sometimes the pain from a whiplash injury can be intense and prolonged that it requires a more direct medical intervention. An epidural injection is a more direct anti-inflammatory method rather than taking a pill or with oral medicine. You will have to go to a doctor or healthcare provider’s office. Epidural steroid injections, or “epidurals” are usually performed by an anesthesiologist (pain management specialist) but can also be administered by a trained physiatrist, neurologist or a spine surgeon. The doctor will apply a cold spray to de-sensitize the skin for an injection. Next, the clinical will inject an anti-inflammatory medication, such as a corticosteroid, that will help to alleviate the inflammation or swelling around the nerve that is injured. For most injuries, it will only take one injection to lessen the pain. In addition to an epidural, the clinical can inject an anti-inflammatory medication into musculature that is sore or injured. This also takes usually takes one injection.

Long Term Effects

While treatment can be effective for whiplash injuries, and most symptoms can resolve themselves, there can be some long term effects of whiplash injuries. These problems can show up many years later.

  • Arthritis in the neck is the most common long term issue that people with whiplash face. Arthritis will develop in the facet joints of the neck, in the central vertebral column, and transverse processes of the spine. Arthritis will develop when cartilage wears down, and bony spurs will develop causing pain and reduced range of motion. The bone spur can impede the nerve and cause pain. There is generally no cure for arthritis; however it can be managed with the techniques described above, and the pain can be mitigated with medication and modalities as described above. However, this can be a chronic condition that affects patients.
  • Other long term effects can include nerve pain or weakness down the upper extremities. Our nerves exit our spinal column through openings called foramen. These windows for our nerves can sometimes become encumbered with scar tissue, bony formation, or inflammation around the nerve. Nerve pain can, at first, be a nuisance and irritating. However, if left untreated over a long enough time period, it can be debilitating and cause significant weakness. Notify the clinician of all the symptoms that you are experiencing. Typically, massage and physical therapy can help in the treatment of this condition. However, if there is scar tissue or bony formation from an older whiplash injury, surgical intervention may be needed.

Other Conditions That Can Occur with Whiplash

The mechanism of injuries that are involved with whiplash can also produce concussion or neurological symptoms as well. As stated before, after a car accident, a significant amount of force is transferred to the head and neck. This injury can also cause your brain to experience a cue and contra-cue injury inside your skull. Essentially, this means that your brain “rattles” inside your head, thus, producing a concussion or brain injury. It is vital that you notify your healthcare professionals about any symptoms of confusion including dizziness, slow processing time, decreased memory, balance deficits, fogginess, and nausea/vomiting. Some therapies can help to deal with the deficits from concussions. This can include balance training, cognitive training, and speech pathology. Mostly, your brain needs to rest and heal after a concussion.

Conclusion

Whiplash injuries can develop through high impact collisions such as motor vehicle accidents, physical assault, workplace accidents, or slip and falls. Each of these methods of injury can come with different problems and concerns. There are a wide variety of treatment methods that can help a patient who is experiencing whiplash; however, there may be some long term effects that linger for most people who experience whiplash. It is essential that you immediately address whiplash injuries after a fall or accident by visiting a doctor that is experienced in diagnosing and treatment of whiplash injuries.