(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 that typically occurs during motor vehicle accidents or contact sports. This may cause damage to numerous structures within the neck resulting in a variety of symptoms such as pain and stiffness in 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 a typical acceleration / deceleration injury of the neck involving a forward / backward movement, 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.
Figure 1 – Anatomy of 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.
Whilst a forward, backward movement of the neck is the typical mechanism of injury in patients with this condition, it is also common for whiplash injuries to involve a sideways or rotation force either in isolation or in addition to the typical forward / backward movement of the head and neck. When this occurs, tissue damage and symptoms are typically distributed more unevenly across the neck, with symptoms usually being worse on one side of the body.
Signs and symptoms of neck whiplash
Patients with this condition usually experience a sudden onset of neck pain during the causative activity. However, occasionally, in less severe cases, 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 most prominent at night or first thing in the morning.
Patients with neck whiplash usually experience pain in the front, back or sides of the neck that sometimes may be accompanied by pain radiating down one or both arms (sometimes as far as the hand and fingers) or into the shoulder blade region, or in some cases, headaches.
Pain may be sharp or dull, with symptom intensity varying between mild and severe usually based on the forces involved at the time of injury. Patients with this condition also commonly experience stiffness or restricted movement in their neck which can range from mild to severe. Muscle spasm, pins and needles, numbness, a burning sensation or weakness may also be present. Occasionally the neck may be noticeably out of alignment, with pain preventing the patient from straightening the neck. Some patients may also feel that their head is too heavy and can experience difficulty lifting their head off a pillow.
Symptoms associated with whiplash are often exacerbated by sustained postures such as reading, driving, sitting at a computer, using a mobile phone or watching television. Symptoms may also increase during activities using the arms in front of the body (such as cooking, ironing, vacuuming etc.), prolonged sitting (especially if slouched), lifting and with certain neck movements involving rotation, side bending, bending forwards or backwards. Sneezing may also aggravate symptoms. Patients with neck whiplash often experience pain and stiffness that is worse first thing in the morning.
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 (neck arthritis) resulting in potential long term problems with restricted movement and pain.
Treatment for neck whiplash
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Physiotherapy for neck whiplash
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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 provided they do not cause or increase symptoms.
Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should only take place provided there is no increase in symptoms.
The following initial exercises should generally be performed 3 – 5 times daily and only provided they do not cause or increase symptoms.
Begin sitting or standing tall with your back and neck straight. Your shoulders should be back slightly (figure 6). Tuck your chin in as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Keep your eyes and nose facing forwards. Hold for 2 seconds and repeat 10 times provided the exercise does not cause or increase symptoms. Repeat 3 – 5 times daily.
Figure 6 – Chin Tucks
Shoulder Blade Squeezes
Begin sitting or standing tall with your back and neck straight (figure 7). Squeeze your shoulder blades together as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Hold for 5 seconds and repeat 10 times provided the exercise does not cause or increase symptoms. Repeat 3 – 5 times daily.
Figure 7 – Shoulder Blade Squeezes
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Rehabilitation Protocol for neck whiplash
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Physiotherapy products for neck whiplash
Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:
- Postural Supports
- Therapeutic Pillows
- Ice Packs or Heat Packs
- Lumbar Supports for Sitting
- Sports Tape (for postural taping)
- McKenzie Cervical Rolls (for sleeping)
- McKenzie Treat Your Own Neck Books
- TENS Machines (for pain relief)
- Foam Rollers (for upper back stretches and Pilates exercises)
- Resistance Band (for postural strengthening and Pilates exercises)
- Cervical collars
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- Neck Stretches.
- Upper Back Stretches .
- Arm Stretches.
- Leg Stretches.
- Beginner Pilates Exercises.
- Cardiovascular Exercise.
- Core Stability Exercises.
- Arm Strengthening Exercises.
- Leg Strengthening Exercises.
- Upper Body Gym Exercises.
- Lower Body Gym Exercises.
- Correct Posture.
- Postural Taping.
- Mobile Phone Ergonomics.
- Ergonomic Computer Setup.
- Correct Lifting.
- Ice or Heat.
- R.I.C.E. Regime.
- Choosing a School Bag.
- Understanding Pain
- Neck Diagnosis Guide.
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Neck whiplash is the term given to an acceleration / deceleration injury of the neck that typically occurs during a motor vehicle accident. This may cause damage to numerous structures within the neck resulting in a variety of symptoms such as pain and stiffness in the neck. Assessment and treatment by a physiotherapist is vital for an optimal outcome.
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