(Also known as Whiplash, Whiplash Syndrome, Acceleration / Deceleration Injury, Neck Sprain)
What is neck whiplash?
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.
Prognosis for neck whiplash
Most patients with mild to moderate cases of neck whiplash heal quickly and have a full recovery with appropriate physiotherapy treatment. In these instances, recovery may take weeks to months. In severe cases, recovery may be significantly longer. Patients with severe neck whiplash may also have an increased likelihood of developing degenerative changes to their joints resulting in long term problems with restricted movement and pain.
Treatment for neck whiplash
Prior to commencing treatment, all patients with neck whiplash should undergo assessment from a medical professional to rule out serious injury (such as spinal fracture).
The success rate of treatment in patients with this condition is largely dictated by patient compliance. One of the key components of treatment is that the patient rests sufficiently from any activity that increases their pain until they are symptom free. Activities which place large amounts of stress through the neck should be minimized, these include: prolonged sitting, standing or lying in poor posture, head looking down activities, shoulders forward activities and lifting. Resting from aggravating activities allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the condition becoming chronic. Immediate treatment for patients with neck whiplash is essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times.
Patients with neck whiplash should follow the R.I.C.E. Regime in the initial phase of injury. The R.I.C.E regime is beneficial in the first 72 hours following symptom onset or when inflammatory signs are present (i.e. morning pain or pain with rest). For patients with this condition, the R.I.C.E. regime should primarily comprise of rest from aggravating activities and regular icing. Anti-inflammatory medication may also hasten the healing process by reducing the pain and swelling associated with inflammation.
Patients with this condition should perform early movement and postural exercises to prevent stiffness from developing and to ensure the neck is functioning correctly. The treating physiotherapist can advise which exercises are appropriate and when they should be commenced.
Patients should also pay particular attention to maintaining good posture as much as possible to minimize stress on the neck (a postural support or postural taping may be required). This is particularly important when sitting or driving. Optimal sitting posture can be obtained by sitting tall on an appropriate chair, with your bottom in the back of the chair and a lumbar support (or a pillow or rolled up towel) in the small of your back. Your shoulders should be back and your chin should be tucked in slightly (figure 2).
Patients with neck whiplash should avoid maintaining poor posture in any position, as this places considerable stress on the neck (figure 3). This may rapidly aggravate the condition.
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
- anti-inflammatory advice
- activity modification advice
- the use of an appropriate pillow for sleeping
- ergonomic advice
- exercises to improve flexibility, strength (particularly the deep cervical flexors) and posture
- clinical Pilates
- neural stretches
Other intervention for neck whiplash
Despite appropriate physiotherapy management, a small percentage of patients with neck whiplash fail to improve and may require other intervention. This may include pharmaceutical intervention, corticosteroid injection, investigations such as an X-ray, CT scan or MRI, or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition.
Exercises for neck whiplash
The following exercises are commonly prescribed to patients with neck whiplash. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.
Begin this exercise by sitting or standing tall with your back and neck straight, shoulders should be back slightly (figure 4). Tuck your chin in until you feel a mild to moderate stretch in your neck pain-free. Keep your eyes and nose facing forwards during the movement. Hold for 2 seconds and repeat 10 times provided there is no increase in symptoms.
Figure 4 – Chin Tucks
Shoulder Blade Squeezes
Begin this exercise by sitting or standing tall with your back straight (figure 5). Squeeze your shoulder blades together as hard and far as possible pain-free. Hold for 5 seconds and repeat 10 times provided there is no increase in symptoms.
Figure 5 – Shoulder Blade Squeezes
Begin this exercise by sitting with your back and neck straight and your shoulders back slightly (figure 6). Turn your head looking over one shoulder until you feel a mild to moderate stretch pain-free. Keep your neck straight and don't allow your head to poke forwards during the movement. Repeat 10 times to each side provided there is no increase in symptoms.
Figure 6 – Rotations (right side)
Find a Physiotherapist for neck whiplash
Find a physiotherapist in your local area who can treat neck whiplash.
Physiotherapy products for neck whiplash
Some of the most commonly recommended products by physiotherapists for patients with this condition include:
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