Whiplash Disorders

What is a whiplash disorder?

  • A neck injury caused by sudden back and forward neck movement, often following a road traffic accident.  

How common is a whiplash disorder?

  • 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).

Should I worry?

  • 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).

Who is likely to suffer from a whiplash disorder?

  • Females more commonly affected.
  • More common following a high impact rear-end collision.
  • Shorter neck heights and neck rests increase likelihood (10).

What are the common symptoms?

  • 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.

What can I do?

  • 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.

How long will it take to recover?

  • 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).

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).


2. Signs & Symptoms

Outlined below are 4 grades of whiplash with a brief description for each grade (4, 12).

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.


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 very limited currently.

Literature around prevalence within sporting environments is also lacking currently, 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 Disorder Rehabilitation Plans

Early Plan

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 would 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 whilst 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.

Early Plan  - Rating

Intermediate Plan

Within this programme, we will look to begin to incorporate some light strengthening exercises, alongside the use of a bigger focus on the range of motion exercises within the basic programme. This helps to continue to increase the movement you have within the neck, whilst simultaneously increasing the strength and capacity of the muscles to be able 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.

Intermediate Plan  - Rating

Advanced Plan

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.

Advanced Plan  - Rating

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.


Book an Appointment

Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.

We have Pure Physiotherapy clinics across the country including Norwich, Great Yarmouth, Manchester, Stockport, Sheffield and Rotherham. Please view our clinics to find the closest physiotherapy clinic for you.


  1. Pastakia, K. and Kumar, S., (2011). Acute whiplash associated disorders (WAD). Open Access Emergency Medicine.
  2. Rosenfeld, M., Gunnarsson, R. and Borenstein, P., (2000). Early Intervention in Whiplash-Associated Disorders. Spine, 25(14).
  3.  Ninds.nih.gov. (2021). Whiplash Information Page | National Institute of Neurological Disorders and Stroke. [online] Available at: <https://www.ninds.nih.gov/Disorders/All-Disorders/Whiplash-Information-Page> [Accessed 8 February 2021].
  5.  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).
  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).
  7. 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).
  8.  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.
  9.  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.
  10.  Tameem, A., Kapur, S. and Mutagi, H. (2014). Whiplash injury. Continuing Education in Anaesthesia Critical Care & Pain, 14(4).
  11.  Freeman, M., Croft, A. and Rossignol, A. (1998). “Whiplash Associated Disorders: Redefining Whiplash and Its Management” by the Quebec Task Force. Spine, 23(9).
  12.  Binder AI. Neck pain. BMJ Clin Evid. (2008). Aug 4;2008:1103. PMID: 19445809; PMCID: PMC2907992.
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