Whiplash

Definition
Whiplash is a neck injury caused by a sudden, forceful back-and-forth movement of the head, resembling the cracking of a whip. It most commonly results from rear-end motor vehicle collisions but can also occur in sports injuries, falls, or physical assaults.

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Mechanism of Injury

• Rapid acceleration–deceleration forces cause hyperextension of the neck followed by hyperflexion (or vice versa)

• These forces strain or sprain the muscles, ligaments, tendons, and sometimes intervertebral discs in the cervical spine

• In some cases, nerve roots, facet joints, or the spinal cord may be involved

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Causes

• Rear-end car accidents (most common)

• Sports trauma (e.g., rugby, boxing, football)

• Falls with sudden head jerking

• Physical assault or shaking injuries

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Symptoms
Symptoms often develop within 24 hours but may appear after several days

• Neck pain and stiffness

• Reduced range of motion in the neck

• Headaches (often starting at the base of the skull)

• Shoulder or upper back pain

• Tingling or numbness in arms

• Fatigue

• Dizziness

• In some cases: blurred vision, tinnitus, memory problems, irritability, difficulty concentrating, or sleep disturbances (post-whiplash syndrome)

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Diagnosis

• Clinical evaluation: Detailed history and physical examination of neck mobility, tenderness, and neurological signs

• Imaging:

  • Not always required unless red flags (severe pain, neurological deficits, suspected fracture) are present

  • X-rays for suspected fractures

  • CT scan or MRI for suspected ligament, disc, or spinal cord injury

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Grading (Quebec Task Force Classification)

• Grade 0: No complaints or physical signs

• Grade I: Neck pain, stiffness, or tenderness without physical signs

• Grade II: Neck complaints with musculoskeletal signs (decreased range of motion, tenderness)

• Grade III: Neck complaints with neurological signs (weakness, sensory deficits, reflex changes)

• Grade IV: Neck complaints with fracture or dislocation

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Treatment

Acute Management

• Pain control:

  • Paracetamol/acetaminophen: 500–1000 mg every 4–6 hours (max 4 g/day)

  • NSAIDs (e.g., ibuprofen 400 mg every 6–8 hours, max 1200–2400 mg/day if tolerated)

  • Short course of muscle relaxants (e.g., cyclobenzaprine 5–10 mg at bedtime) for severe muscle spasm

• Activity modification:

  • Encourage gentle neck movement; avoid prolonged immobilization

  • Soft cervical collar may be used for short-term comfort (≤48 hours) if pain is severe, but prolonged use delays recovery

• Ice or heat therapy:

  • Ice for first 24–48 hours (15–20 min every 2–3 hours) to reduce inflammation

  • Heat thereafter to relax muscles

Rehabilitation

• Early physiotherapy with range-of-motion and strengthening exercises

• Posture correction and ergonomic adjustments

• Gradual return to normal activities and sports

• Psychological support if chronic symptoms develop (for post-whiplash syndrome)

Chronic Whiplash Syndrome Management

• Multidisciplinary approach: pain specialists, physiotherapy, cognitive-behavioral therapy

• Gradual exercise programs and pain education

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Prognosis

• Most patients recover within days to weeks

• 20–30% may develop chronic symptoms lasting months or years

• Poor prognostic factors: severe initial pain, high disability scores, older age, previous neck injury, psychological distress

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Prevention

• Properly adjusted car headrests at the correct height and position

• Use of protective sports gear in contact sports

• Workplace ergonomic adjustments to prevent neck strain