Whiplash and Neck Pain
The most common cause of whiplash is a motor vehicle accident, particularly when sitting, stationary, and hit from behind. Whiplash injury is a term used to describe the damage done to the bone structures and soft tissues, whereas whiplash associated disorders (WADs) encompasses a more severe and chronic group of symptoms.
What is Whiplash?
The injury occurs as the body is first carried forwards and the head is thrown back, then, as the body stops, the head is flipped forwards. The muscles and ligaments in the neck can be severely stretched and even torn by this kind of trauma, and the bones may also be crushed together causing further damage. Pain and inflammation do not always appear immediately after the injury and so may not be instantly associated with the accident. The majority of people who suffer these types of accidents do not experience severe damage and usually recover within a few weeks, or months. However, some can develop chronic problems and suffer serious complications.
The Symptoms of Whiplash
Commonly, those with whiplash suffer from neck pain and stiffness, headache, shoulder pain and stiffness, dizziness and visual disturbances, temporomandibular joint (jaw) problems, weakness and pain in the arms, fatigue, back pain, and tinnitus.
Whiplash Associated Disorder
In severe cases, with chronic neck pain, the sufferer may also experience depression, mood swings (anger and anxiety), irritability, sleep disturbances, post-traumatic stress syndrome, and even drug dependency connected to the incident. Sterling (2010) found that those suffering psychological stress were considerably more likely to experience higher levels of pain from whiplash injuries. The perception of pain also varied according to the fear of pain and the amount of time patients spent in an upright position.
There is some suggestion that this disorder is not always actually present, and, in the absence of any physical pathology, can be treated with suspicion if the claimant is pursuing damages from another party. Clearly, the presence of post-traumatic stress disorder can account for some of the physical symptoms, if the person involved in the accident felt particularly stressed by the collision.
How is Whiplash Diagnosed?
If an individual is inovlved in this type of accident they should consult a doctor for an examination. The pain may not occur instantly, and it is important to reduce further trauma to the neck if the structures have been damaged (not engaging in contacting sports for example). If the physician deems it necessary they may advise the use of a collar to hold the neck in place while the muscles and ligaments heal. X-rays can be conducted to check for fractures, or other serious injury in the neck, shoulders and spine.
Structures Commonly Damaged by Whiplash
Cervical Injury due to Whiplash
The anterior longitudinal ligament is often stretched and even torn in whiplash injuries. As various cervical spine structures receive nociceptive innervation these may be the cause of chronic pain. Malanga (2005) identifies the zygapophyseal joints (facet joints) as a potential pain generator and suggests that temporary pain relief may be achieved through facet joint injections.
If no damage is clear on the x-rays, but the patient is still experiencing pain, then they may be advised to continue wearing the neck collar and return for a further examination after a week or so. Dynamic x-rays, where the head is tilted forward or back, may reveal soft tissue damage not obvious on standard x-rays. MRI scans may also be used for further clarity.
If neck pain returns after having initially ceased then it is important to seek medical attention again to check for the underlying cause. If loss of bladder function is experienced or numbness in the legs and arms is then immediate medical advice should be sought.
Cervical collars should not normally be worn for more than three days, as the neck musculature may find it difficult to recover after longer periods of inactivity. Non-steroidal anti-inflammatory drugs are often used to treat whiplash, although these should not be considered a long-term solution and are not normally suggested for use longer than three weeks. Alternative anti-inflammatories and pain-relievers are available.
Other Accidents that Cause Whiplash
Car collisions are not the only way of suffering whiplash although this does account for a large proportion of the claims made on car insurance in many countries. Other accidents, such as simply falling off a chair, bike, or a horse, can cause similar trauma and are treated similarly to a shunt accident.
Prevention of Whiplash from Car Accidents
Improvements in car safety, airbags, and head rests have reduced the severity of injury associated with shunt accidents. To try to limit the damage in just such a collision, the driver should check all head rests are at the correct height for the person in the seat, and that air bags are replaced and checked as appropriate. Some manufacturers have installed specific whiplash prevention devices, such as Mercedes with their Proactive Head-Restraint (pictured) which brings the head rest forward and up to meet and cushion the head as it is thrown backward (Thatcham, 2010). In fact, some car seats are now more rigid in order to withstand other impacts, and may actually increase the risk of whiplash.
Ensuring adequate safety in terms of car head rests, and using strengthening neck exercises daily can help to ameliorate any effects suffered as a result of trauma such as whiplash. The acute and chronic pain experienced with this condition can leave the individual seriously debilitated but may be helped by anti-inflammatory medications, cervical collars, and simple rest. Please visit types of neck pain page for information on other neck pain types.
Sterling, M., Chadwick, B.J., (2010), Psychologic processes in daily life with chronic whiplash: relations of posttraumatic stress symptoms and fear-of-pain to hourly pain and uptime, Clin J Pain, Vol.26, No.7, pp.573-82. PMID: 20639737
Malanga, G., Peter, J., (2005), Whiplash injuries, Curr Pain Headache Rep., Vol.9, No.5, pp.322-5.
Thatcham, (2010), Thatcham: Whiplash 2010 Update, http://www.thatcham.org/ncwr/