Whiplash, or acceleration / deceleration injury as it is also known is injury to the neck, caused by a rapid forwards and backwards motion of the head. This occurs most commonly from a car accident, although can also be sustained through sports involving direct contact or a fall onto the head.
The patient will feel stiffness and pain in the neck which may not come on immediately at the time of injury, but develop over the following 24 to 48 hours. They will likely have a significantly reduced range of movement in the cervical spine (neck) with headaches, dizziness and blurred vision (this should go within 24 hours, if they persist consult your doctor). The pain and stiffness can list for just a few days to a few weeks depending on severity.
Watch out for the following:
- Severe pain in the back of the head
- Pins and needles or numbness in the shoulders or arms
- Memory loss
All of these symptoms could indicate a more serious injury or concussion. If any of these symptoms are present you should return to the Doctor or hospital.
What is whiplash?
Whiplash is basically a neck muscle strain and / or ligament sprain within the neck. The most commonly injured muscles are the Sternocleidomastoid, Levator scapulae and Longus colli. In more severe cases of whiplash there can also be nerve damage and fractures of various processes of the cervical vertebrae
If the injury is severe, visit your Doctor or local hospital to get the neck region fully assessed for injuries such as fractures or nerve damage. Symptoms of a possible nerve injury may include pins and needles, tingling (paraesthesia in the neck, shoulders or arms or even numbness (anaesthesia) in the same area) and these should not be ignored.
In the early stages of the injury, apply the principles of P.R.I.C.E to reduce inflammation in the area and to reduce pain. This includes possibly using a collar for a short period of a day or two, relative rest (some minimal movement, not NO movement) and cold therapy.
Advice to use neck collars for more than a day or two (maximum) as a treatment for whiplash injuries has significantly reduced over recent years because early but controlled movement exercises of the neck are strongly encouraged to improve the overall outcome and decrease recovery time.
Applying cold therapy can help relieve pain and inflammation in the first 24-48 hours. Do not apply ice directly to the skin as it can cause ice burns but use a wet towel or better still a commercially available ice pack. Cold can be applied for 10 minutes every hour initially. This will help stop any bleeding in the muscles, reduce pain, reduce inflammation and have a muscle relaxing effect when the ice is removed.
Your Doctor may choose to prescribe painkillers or anti-inflammatories, such as ibuprofen or diclofenac sodium (voltarol). These will reduce pain in the area and hopefully encourage the muscles to relax which will allow for more movement and therefore better recovery.
Supports and Braces
Neck collars can sometimes be used for the first 24 to 48 hours to reduce pain in the area and allow the muscles to relax, however their use must be limited to the early stages.
The main aim of treatment for whiplash is to slowly get the neck moving without making the pain worse. Keeping the neck still after the first 24 hours is not advised as it will stiffen and cause more pain in the long term. Gentle exercises to move the neck are strongly encouraged as soon as the pain starts to settle as these encourage normal movement and restore normal function of the neck muscles and ligaments.
Try to gently move your neck in all directions as soon as you are able to, and repeat this every 2 – 3 hours. Each time, aim to move the neck further to increase its’ overall range of movement but make sure that the exercises are always performed within pain free limits.
In addition to the gentle mobility exercises described above, the following exercises can also be used:
- Pulling your chin horizontally backwards to tuck your chin in. This movement is called retraction.
- Flexing the upper part of the neck by holding the neck straight and trying to pull your chin to your chest without flexing the neck. This exercise is used to strengthen the deep muscles of the neck and can also be performed in lying to fully relax the neck
- Gently pull your shoulder blades back towards each other and gently downwards to strengthen the muscles in the upper back to improve posture and take some of the strain off the neck region.
Finally, make sure you use pillows at night to fully support the neck and to allow the muscles to relax overnight. Sleep can sometimes be affected by whiplash which is why it is very important to ensure that you use the correct number of pillows and ensure they are comfortable but not too soft. A guide to correct pillow height and position is to lie on your side and ask someone to see whether your neck is horizontal.
Once the acute inflammatory phase (minimum 72 hours) has passed, massage may help to reduce possible muscle spasm in the area and restore normal function to the neck.
An alternative to seeing a therapist is to consult an osteopath or chiropractor who will also carry out a full assessment of the neck and shoulders and may choose to manipulate the joints of the neck and back to reduce stiffness and pain in the area. may be advised to see an osteopath or a chiropractor to assess the neck