Whiplash-Associated Disorders (Whiplash)

Whiplash and whiplash-associated disorders (WAD) represent a range of injuries to the neck caused by or related to a sudden distortion of the neck.[1]

Whiplash is commonly associated with motor vehicle accidents, usually when the vehicle has been hit in the rear; however, the injury can be sustained in many other ways, including falls

Four grades of Whiplash-Associated Disorder were defined by the Quebec Task Force on Whiplash-associated disorders (WADs):

• Grade 0: no neck pain, stiffness, or any physical signs are noticed
• Grade 1: neck complaints of pain, stiffness or tenderness only but no physical signs are noted by the examining physician.
• Grade 2: neck complaints and the examining physician finds decreased range of motion and point tenderness in the neck.
• Grade 3: neck complaints plus neurological signs such as decreased deep tendon reflexes, weakness and sensory deficits.
• Grade 4: neck complaints and fracture or dislocation, or injury to the spinal cord.
  

What is a whiplash neck sprain?.

A whiplash neck sprain occurs when your head is suddenly jolted backwards and forwards in a whip-like movement. This can cause some neck muscles and ligaments to stretch more than normal (a sprain). The common cause is when you are in a car that is hit from behind by another car. Being in a car hit from the side or front can also cause whiplash sprains..

Who gets whiplash neck sprains?.

Whiplash neck sprains are common. About 2 in 3 people involved in car crashes develop neck pain (with or without other injuries). Some people are surprised at having symptoms when the car crash was minor. Even slow car bumps may cause enough whipping of the neck to cause symptoms. Less commonly, whiplash neck sprains can occur with everyday activities such as jolting the neck when you trip or fall..

What are the symptoms of a whiplash neck sprain?

Pain and stiffness in the neck. It may take several hours after the injury for symptoms to appear. The pain and stiffness often become worse on the day after an injury. In about half of cases, the pain first develops the day after the injury. This may be because the inflammation or bruising around a sprained muscle can take a while to build up.
Turning or bending the neck may be difficult.
You may also feel pain or stiffness in the shoulders or down the arms.
Dizziness, headache, blurred vision, or pain on swallowing may occur for a short while, but soon go. Tell a doctor if any of these persist.
Some people become irritable for a few days and find it difficult to concentrate.

What is the outlook (prognosis) after a whiplash neck sprain?

The outlook is good in most cases. In most cases, symptoms begin to improve after a few days. In about 6 in 10 cases, the symptoms are much better or gone within 1-4 weeks. However, it is not unusual to take a few months for symptoms to go completely. In about 1 in 4 cases there is still some pain or stiffness after six months. In a small number of cases, some stiffness or pain may come and go for a long time after the injury..

What are the treatments for a whiplash neck sprain?

Exercise your neck and keep active
Aim to keep your neck moving as normally as possible. At first the pain may be bad, and you may need to rest the neck for a day or so. However, gently exercise the neck as soon as you are able. You should not let it 'stiffen up'. Gradually try to increase the range of neck movements. Every few hours gently move the neck in each direction. Do this several times a day. As far as possible, continue with normal activities..

In the past, some people have worn a neck collar for long periods after a whiplash sprain, and have been reluctant to move their neck. Studies have shown that you are more likely to make a quicker recovery if you do regular neck exercises, and keep your neck active rather than resting it for long periods in a collar..

Medicines

Painkillers are often helpful. It is best to take painkillers regularly until the pain eases. This is better than taking them now and again just when the pain is very bad. If you take them regularly, it may prevent the pain from getting severe, and enable you to exercise and keep your neck active..

• Paracetamol at full strength is often sufficient. For an adult this is two 500 mg tablets, four times a day.
• Anti-inflammatory painkillers. Some people find that these work better than paracetamol. They include ibuprofen which you can buy at pharmacies or get on prescription. Other types such as diclofenac, naproxen, or tolfenamic need a prescription. Some people with asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers.
• A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol.
• A muscle relaxant such as diazepam is sometimes prescribed for a few days if your neck muscles become tense and make the pain worse.
  

Other advice
Some other advice which is commonly given includes:.

• A good posture may help. Brace your shoulders slightly backwards, and walk 'like a model'. Try not to stoop when you sit at a desk. Sit upright.
• A firm supporting pillow seems to help some people when sleeping.
• Physiotherapy / Manual Therapy / Osteopathy. It is not clear whether these treatments makes much difference to the outcome. What may be helpful is the advice a therapist can give on neck exercises to do at home. A common situation is for a doctor to advise on painkillers and gentle neck exercises. If symptoms do not begin to settle over a week or so, you may then be referred to therapist to help with pain relief and for advice on specific neck exercises.
• Driving. To drive safely you must be able to turn your head quickly. It is be best not to drive until any bad pain or stiffness has settled.
  
• Treatment may vary and you should go back to see a doctor
  if the pain becomes worse.
  if the pain persists beyond 4-6 weeks.
  if any numbness, weakness, or pins and needles develop in an arm or hand.

(Damage to the spine or spinal cord sometimes occurs from a severe whiplash injury. This is uncommon and is not dealt with in this article. Only the common whiplash sprain to neck muscles is discussed in this article.).

by John Chaffey last review Nov 2012