What is whiplash?
Whiplash is a term that covers the symptoms that occur after a sudden and severe jolt of movement causes the neck to flick forwards and then backwards or vice versa in a violent whipping manner. Whiplash is normally associated with car accidents but can be experienced from anything else that would cause this type of severe movement. The injury mechanism of whiplash is essentially like a neck sprain; however instead of spraining one single joint like most neck sprains the violent movement injures the majority of the neck joints, ligaments and muscles.
Your cervical spine (neck) is made up of 7 connected bones called vertebrae. The vertebrae are connected to each other above and below through strong discs and joints on either side called facet joints. Your discs protect your spine by acting like shock absorbers to distribute weight through your neck evenly. The facet joints on the other hand not only control but allow the movement of your neck. Think of your facet joints as the steering mechanism of your spine. It is their job to determine what movements can be made and the extent of those movements. The disc in the middle and the facet joints either side form what professionals refer to as the “three joint complex” that makes your spine a strong and durable structure.
Individually these joints are susceptible to injury. A strong capsule that forms around the facet joint encapsulates it and prevents either boney ends from connecting or impacting. The capsule is filled a small amount of thick fluid called synovial fluid that acts like a cushion and there is protective layer of articular cartilage that covers both boney surfaces. The cartilage, fluid and strong capsule allow the joint to move in a smooth, flexible manner. Ligaments surround the facet joint and are made of thick, tough, fibrous tissue and they overlap the joint to provide protection and stability. This stability is reinforced by the muscles that surround the joint. Your muscles are not only there to create movement but they are strategically placed to protect the structures they support.
In essence the facet joints in your spine are no different to your ankle joint and it is safe to assume everyone is familiar with the feeling of going over on their ankle and spraining it. Your facet joints like the ankle have a limit to their movement which is termed the joints “end range of motion”. Normal slow and gentle movements don’t harm your facet joints, however sudden and excessive movements like going over your ankle have the ability to stretch the joint past its end range. The result is damage to the facet capsule, ligament or surrounding muscles. When the capsule or ligament is injured then it is known as a cervical facet sprain and when the muscles surrounding the joint are injured then it is known as a cervical facet strain. Whiplash on the other hand is exactly this but on a much greater scale affecting multiple facet joints, ligaments and muscles.
What does whiplash feel like?
Whiplash symptoms are unpredictable and can range from severe to very mild. The pain can be immediate or can take anything from a few hours to a few days to completely materialize. Pain and stiffness are the most common symptoms. The initial pain can be an intense sharp pain in the neck or a dull ache. The pain and stiffness will involve most of the neck and quite often creeps into the tops of the shoulders, into the upper back and down into the arms. It is very common for the neck pain to radiate up causing headaches.
It is quite common to injure the lower back at the same time as it strains against the lap portion of your seat belt. Similar symptoms of pain and stiffness are experienced however these symptoms are normally over shadowed by the severity of the neck pain.
In some cases nausea, dizziness and blurred vision will happen immediately after the injury but will most likely only last for a short while. If you experience any of these symptoms or if they persist then you must seek medical attention. In more severe circumstances spinal fractures and even damage to the spinal cord can occur (please see cervical herniated disc or myelopathy articles). If you experience any periods of unconsciousness, memory loss, arm or leg weakness, numbness, pins and needles or intense pain at the back of the skull then you should alert your doctor or attend your nearest A&E to allow them to rule out any serious neck injuries.
Why & when does whiplash happen?
Whiplash symptoms are unpredictable and are not always reflective of the severity of an accident. Some cases have shown people who have been involved in head on collisions and only suffered with mild stiffness whereas cases of mild rear end bumps at a junction have resulted in severe symptoms. Research has suggested that whiplash can be experienced at speeds as little as 8 mph. Whiplash is not only confined to car accidents but can be sustained after falling from certain sporting tackles or even whilst skiing or horse riding.
Whiplash can happen at any age; however women are more susceptible to whiplash injuries due to the fact that their neck muscles are generally not as strong as their male counterparts. Most cars are now designed with head restraints that try to minimise the heads movement during a collision and prevent whiplash symptoms. These new designs will remain ineffective unless a head rest is positioned and adjusted properly to the individual.
How long does whiplash take to heal?
Technically it can take injured ligaments and muscles up to six weeks to heal adequately. However most mild cases see pain levels start to ease from anything as early as 24 hours up to 2-3 weeks. The pain levels are normally most severe to begin with, fading to a dull background ache towards the end. More severe injuries on the other hand can take anything from 3 to 6 weeks and even longer in some cases to completely recover. If after 6 weeks your still experiencing severe symptoms then report back to your GP. Even when pain levels start to ease you must be careful returning to your activities as once the joint has been injured it is weaker and more susceptible to further injury. Many people experience recurring neck sprains after whiplash, this is a strong indication of a weakened neck.
How is whiplash diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. Normally the practitioner will examine your neck and arms testing you'r muscles strength, reflexes and skin sensation to confirm there is not nerve or spinal damage. In some instance X-rays, MRI or CT scan may be requested to rule out any fractures or spinal cord injuries. A practitioner will normally assess your whiplash using the grading scale from the Quebec Task Force on Whiplash-Associated Disorders.
There are five whiplash-associated disorder grades.
Grade 0: no neck pain, stiffness, or any physical signs are noticed
Grade 1: neck complaints of pain, stiffness or tenderness only but no physical signs are noted by the examining physician.
Grade 2: neck complaints and the examining physician finds decreased range of motion and point tenderness in the neck.
Grade 3: neck complaints plus neurological signs such as decreased deep tendon reflexes, weakness and sensory deficits.
Grade 4: neck complaints and fracture or dislocation, or injury to the spinal cord.
What treatments are there for whiplash?
Your GP may prescribe a short course of anti-inflammatory painkillers to reduce and control the painful inflammation that occurs. Applying a covered ice pack to the area after the initial injury may also significantly hasten the healing process by reducing the pain and swelling. Make sure the ice pack is covered to avoid direct contact between the skin and ice to prevent any ice burn and for best results use the icepack use regularly for 10-15 minutes with intervals of 30 minutes. Avoiding all aggravating movements and postures is advisable, however complete rest is not. Try to move gently and often this will prevent stiffness levels from building in your neck. When you have to sit for a long time don’t try to over force a good or correct posture. Instead go with what is comfortable for you even if that is slouching a little, the key element is not to stay in that posture for too long. The golden rule basically is be a fidget!
The neck will be left slightly weakened after the injury, before in these instances a cervical collar would have been used to support the neck; however the use of a collar is now believed to actually further the weakness of the neck muscles. Due to this practitioners only tend to use collars for more serious neck injuries. To prevent the neck weakness from progressing it is important to strengthen the muscles of the neck and upper back to avoid suffering from a recurring neck sprain. Starting with simple stretches and progressing to strengthening exercises will counteract any stiffness and weakness that has developed. Your therapist, trainer or GP will be able to advise you on appropriate exercises.
Many people seek out alternative treatment to speed up the recovery process. Manual manipulative and massage therapies have been seen to alleviate pain and stiffness levels quickly and help towards preventing future flare ups. The Quebec Task Force recommend that grade 1–3 whiplash associated disorders should receive a combination of treatment that should include manipulation, mobilizations and a range of motion exercises. It goes on to advise that medications should not be used any longer than 3 weeks for grades 2 and 3. A cervical collar may be used but it is not recommended that it be used for any longer than 72 hours as it may lead to prolonged inactivity.
Whiplash insurance claims
The Association of British Insurers (ABI) has renamed the UK as the 'whiplash capital of Europe', with one out of every 140 people claiming for a whiplash injury each year. It is thought that in the UK roughly 1,200 whiplash claims were made each day in 2011. Making whiplash one of the main injuries covered by the car insurers and accounting for 20% of every driver’s premium. The ABI are calling for a dramatic revision of the medical guidance regarding accurately diagnosis and treatment of genuine whiplash. This in attempt to reduce the extremely high numbers of fraudulent cases and streamline the compensation system so that genuine claimants get the treatment and rehabilitation they deserve and quickly.
The term road traffic accident has been altered to road traffic collision. The stance on this being that there is always someone to blame even if that blame is shared 50/50 between both parties. ABI want to raise awareness about the importance of keeping a safe breaking distance between vehicles, as tailgating is the main cause of the injury.