Whiplash Disorders
1. Introduction
This condition will usually present with pain around the neck, upper back and/or shoulder regions, with referral into the arms/hands in some cases. It will usually occur after a road traffic collision but can be seen in a sporting environment, although this is less frequent. Whiplash injuries are caused by a rapid acceleration-deceleration movement of the neck and spine, causing bony/soft tissue damage (1).
Current evidence suggests that a combined approach of progressive exercise, use of anti-inflammatories and hot/cold packs as instructed by a health professional is most effective in reducing pain and improving function in whiplash injuries in the early stages. Physiotherapy can be beneficial alongside these other treatments however, self-management and use of exercise are encouraged initially (10, 12).
Frequently Asked Questions
- A neck injury caused by sudden back and forward neck movement, often following a road traffic accident.
- Whiplash covers a range of symptoms affecting the neck and upper back following external stop/start injures.
- Whiplash is a common condition often experienced following a road traffic collision.
- In the general population, it affects 0.009% of people (10).
- The prognosis can be variable but early intervention and use of exercise is key to recovery (2).
- No.
- Whiplash generally recovers well with the right rehabilitation and natural healing.
- Whiplash is not linked to other serious pathologies.
- However, if you experience a metallic feeling in the mouth, difficulties swallowing or if you have vision problems and/or are fainting then seek medical advice (7).
- Females more commonly affected.
- More common following a high impact rear-end collision.
- Shorter neck heights and neck rests increase likelihood (10).
- Pain in both or one side of the neck and/or upper back.
- Stiffness and loss of movement in the neck and upper back.
- Headaches – coming from the increased tension in the muscles of the neck.
- Pain and bruising along the path of the seatbelt.
- Possible radiating pain into the arms/hands.
- Keep the neck and back moving regularly.
- Use painkillers and anti-inflammatories as instructed by a medical professional/pharmacist.
- Try to perform your usual daily tasks as you would have done before the accident as pain allows.
- Often, neck or head pain will clear within a few days of the accident and most people recover within 3 months of the injury (3).
- Approximately 50% of people fully recover within 1 year (10).
- Approximately 40% of patients can experience some pain beyond 3 months (10).
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk. Book online with us today to get a programme tailored to your specific needs.
2. Signs and Symptoms
- Pain in the neck and/or upper back.
- Stiffness and a restriction in the range of motion – usually worse in the morning or after prolonged time in one position.
- Radiating pain into the arms, hands and fingers – sometimes you can also experience pins & needles or numbness that comes and goes (note – if the numbness becomes constant in the arm/hand with loss of power and control then we recommend attending A&E as this could require further investigation).
- Headaches – due to an increase in the tension of the neck muscles; these can vary in severity and duration.
- Pain in/around the wrist and hands – often where you have gripped the steering wheel or braced upon impact.
- In some cases, you can experience pain around the upper arm – also resulting from bracing/gripping the steering wheel.
- Pain along the path of the seatbelt and sometimes bruising along this region.
Outlined below are 4 grades of whiplash with a brief description for each grade (4, 12).
- Grade I – neck pain, stiffness or tenderness with the absence of physical signs.
- Grade II – neck pain, stiffness or tenderness with the presence of physical signs but the absence of neurological symptoms.
- Grade III – neck pain, stiffness or tenderness with the presence of both physical and neurological symptoms.
- Grade IV – neck pain, stiffness or tenderness with the presence of fracture or dislocation.
3. Causes
Whiplash associated disorders are a result of the rapid acceleration and deceleration that the structures in the neck go through. This sudden change of speeds can cause soft tissue sprains to occur in the local structures and cause inflammation. As a protective measure, local muscles will often go into spasm to attempt to limit the movement and function. This can lead to reports of the muscle feeling ‘tight’ and ‘sore’. The tightness stems from a reluctancy for the muscle to be stretched out and lengthened, whereas the soreness is a result of the microtrauma that the muscle fibres have undergone in the accident.
You may find that the feeling of stiffness in the neck is more noticeable in the morning. This is due to an increase in tone of the muscle whilst you have been asleep and remaining in one position; it is important to keep the neck moving regularly throughout the day to decrease this tone. Towards the end of the day, you may feel an increase in soreness of the neck – this is due to the muscles working harder than usual when they are in spasm and fatigue quicker as a result whilst supporting the head.
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing a whiplash injury. It does not mean everyone with these risk factors will develop symptoms.
- Gender – women are more prone than men as they often have thinner necks.
- Neck height – shorter necks are at a higher risk.
- Site & impact of collision – a rear-end collision by a heavier vehicle increases the likelihood of developing a whiplash injury.
- Neck rest height – shorter neck rests increase the likelihood of whiplash (10).
5. Prevalence
A whiplash-associated disorder is most common following road traffic collisions, however, the actual statistics around the number of whiplash injuries per accident is currently very limited.
Literature around prevalence within sporting environments is also lacking; however, it is known to be far less common within the sporting environment than within a road traffic collision.
6. Assessment & Diagnosis
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.
Your treating clinician will want to know how your condition affects your day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made.
7. Self-Management
As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from your whiplash injury. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference. Key to the recovery of a whiplash associated disorder is self-management; this includes, but is not limited to:
- Engaging regularly with an exercise programme prescribed by your musculoskeletal physiotherapist.
- Activity modification.
- Use of regular painkillers and anti-inflammatories – as advised by a health professional.
- Use of heat/cold as advised by your musculoskeletal physiotherapist or another healthcare professional (9).
8. Rehabilitation
Rehabilitation of whiplash-associated disorders, much like other musculoskeletal injuries, focuses on increasing the strength and capacity of the muscles in order to cope effectively with the load placed on them when performing your usual daily activities.
Below are three rehabilitation programmes put together by our musculoskeletal physiotherapists in order to begin to ease your pain and increase movement. Start with the basic programme and progress onto the intermediate and advanced as you feel able. Sometimes your physiotherapist may use manual therapies alongside exercises to effectively treat neck pain and headaches (5, 6, 8).
9. Whiplash Disorders
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
The main focus of this programme is to encourage gentle movements of the neck and upper back, aiming to increase the range of movement that you currently have. We recommend doing these gentle movements 3 times a day to encourage the tightness of the muscles to reduce and enable you to have a larger range of movement throughout the day. We recommend doing them in the morning after you wake up due to the tightness that can develop from being in one position for a prolonged period while you are asleep. Ideally, the level of pain/discomfort you are experiencing when performing the exercises should not exceed 5/10 on the perceived pain scale.
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- 910
Within this programme, we will begin to incorporate some light strengthening exercises, alongside a bigger focus on the range of motion exercises within the basic programme. This helps to continue to increase your movement within the neck, while simultaneously increasing the strength and capacity of the muscles to cope with the load being applied. Again, when performing the exercises, stop if you experience any pain above a 5/10 on the perceived pain scale.
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- 2
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- 4
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- 910
In the advanced programme, there will be the incorporation of more functional movements that involve both the muscles within the neck and those around, such as in the shoulder or upper back. The loading of the muscles will gradually increase within this programme and the muscle strength will increase alongside this increased loading. As above, some discomfort is expected but do not exceed 5/10 on the perceived pain scale.
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- 910
10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain reliving treatments to support symptom relief and recovery. Whilst recovering you might benefit from further assessment to ensure you are making progress and establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.
11. Other Treatment Options
Alongside whiplash injuries, it is possible that you may experience flashbacks to the accident or anxiety when travelling. Onward referrals to psychologists can be beneficial in recovery, although they can often resolve naturally.
In severe cases, grade IV, surgical intervention may be required, however, these cases are rare.
12. Links for Further Reading
25 locations and counting across the UK
References
- Pastakia, K. and Kumar, S., (2011). Acute whiplash associated disorders (WAD). Open Access Emergency Medicine.
- Rosenfeld, M., Gunnarsson, R. and Borenstein, P., (2000). Early Intervention in Whiplash-Associated Disorders. Spine, 25(14).
- NHS Choices (2020). Whiplash. [online] NHS. Available at: https://www.nhs.uk/conditions/whiplash/.
- THE QUEBEC CLASSIFICATION OF WHIPLASH-ASSOCIATED DISORDERS*. (1995). Spine. 20 (8).
- Côté, P., Yu, H., Shearer, H., Randhawa, K., Wong, J., Mior, S., Ameis, A., Carroll, L., Nordin, M., Varatharajan, S., Sutton, D., Southerst, D., Jacobs, C., Stupar, M., Taylor‐Vaisey, A., Gross, D., Brison, R., Paulden, M., Ammendolia, C., Cassidy, J., Loisel, P., Marshall, S., Bohay, R., Stapleton, J. and Lacerte, M., (2019). Non‐pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration. European Journal of Pain, 23 (6).
- Chou, R., Côté, P., Randhawa, K., Torres, P., Yu, H., Nordin, M., Hurwitz, E., Haldeman, S. and Cedraschi, C. (2018). The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities. European Spine Journal, 27 (S6).
- Finucane, L., Downie, A., Mercer, C., Greenhalgh, S., Boissonnault, W., Pool-Goudzwaard, A., Beneciuk, J., Leech, R. and Selfe, J. (2020). International Framework for Red Flags for Potential Serious Spinal Pathologies. Journal of Orthopaedic & Sports Physical Therapy, 50(7).
- Morikawa, Y., Takamoto, K., Nishimaru, H., Taguchi, T., Urakawa, S., Sakai, S., Ono, T. and Nishijo, H., (2017). Compression at Myofascial Trigger Point on Chronic Neck Pain Provides Pain Relief through the Prefrontal Cortex and Autonomic Nervous System: A Pilot Study. Frontiers in Neuroscience, 11.
- de Zoete, R., Armfield, N., McAuley, J., Chen, K. and Sterling, M. (2020). Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials. British Journal of Sports Medicine, pp.bjsports-2020-102664.
- Tameem, A., Kapur, S. and Mutagi, H. (2014). Whiplash injury. Continuing Education in Anaesthesia Critical Care & Pain, 14(4).
- Freeman, M., Croft, A. and Rossignol, A. (1998). “Whiplash Associated Disorders: Redefining Whiplash and Its Management” by the Quebec Task Force. Spine, 23(9).
- Binder AI. Neck pain. BMJ Clin Evid. (2008). Aug 4;2008:1103. PMID: 19445809; PMCID: PMC2907992.
Other Conditions in
Neck, Shoulders, Upper Back, Neurological, Pain
Thoracic Outlet Syndrome
A condition presenting with pain in the arm as a result of compression of structures around the neck/shoulder.
Neck Pain
Pain or discomfort in the neck and/or shoulder girdle, with or without pain referred to the arms.
Cervical Spinal Stenosis
Narrowing of the spaces through which the neck spinal nerves travel which can result in weakness, pain and reduced function.
Cervical Radiculopathy
Nerve pain originating from the neck and causing pain, altered sensation or weakness in the arm.
Cervical Disc Dysfunction
Disk/joint-related issues that can cause pain, weakness and altered sensation in the neck and arms.
Cervical Arterial Dysfunction
An umbrella term for rare vascular (blood vessles) problems of the neck.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Acute Torticollis
Sometimes referred to as “wry neck”, this is a condition causing muscle spasms and associated neck pain.