Whiplash Injuries

Neck whiplash is the term given to an acceleration / deceleration injury of the neck. This may cause damage to numerous structures within the neck.

The spine (neck) comprises of many bones known as vertebrae. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the disc centrally (figure 1). In addition, the spine has muscles situated at the front, back and sides of the neck supporting these joints.

During an acceleration / deceleration injury of the neck, stretching and compressive forces are placed on the joints, muscles, ligaments and nerves primarily at the front and back of the neck. This may cause widespread damage to these structures if the forces are beyond what the tissues can withstand. When this occurs the condition is known as neck whiplash.

Causes of neck whiplash

Whiplash injuries most commonly occur in motor vehicle accidents whereby the neck is thrown forcefully forwards and then backwards. This condition is also frequently seen in contact sports, whereby the usual mechanism of injury is a forceful collision with another player resulting in a jolting force to the head and neck.

Signs and symptoms of neck whiplash

Patients with this condition usually experience a sudden onset of neck pain during the causative activity. However, occasionally patients may experience little or no pain at the time of injury. In these instances, symptoms typically increase over the following 2 to 3 days and may be prominent at night or first thing in the morning.

The pain associated with neck whiplash can be sharp or dull and may increase with movement or sustained postures (e.g. sitting at a computer in poor posture). Pain is usually felt in the neck and occasionally radiates into the shoulders, arm(s) or head (causing a headache).

Patients with whiplash also commonly experience stiffness or restricted movement in their neck. Occasionally patients may feel that their head is heavy and can experience difficulty lifting their head off a pillow. Pins and needles, numbness or weakness may also be felt in one or both arms, hands and fingers, although this is less common.

Diagnosis of neck whiplash

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose neck whiplash. Investigations such as an X-ray, MRI or CT scan are usually required to rule out serious injury.

Physiotherapy for neck whiplash

Physiotherapy treatment for this condition is vital to hasten the healing process and ensure an optimal outcome. Treatment may comprise:

Joint mobilization

Soft tissue massage

Dry needling

Electrotherapy (e.g. ultrasound)

Postural taping

Postural bracing

The use of a lumbar roll for sitting

Education

Anti-inflammatory advice

Activity modification advice
The use of an appropriate pillow for sleeping

Ergonomic advice

Exercises to improve flexibility, strength and posture

Clinical Pilates
Neural stretches