Whiplash is an injury to the neck resulting from a sudden jerking of the head. This trauma strains tissues and joints beyond their normal range of motion, which may cause pain and stiffness either right after the injury or at a later time.

Motor vehicle accidents are the most common causes of whiplash. According to the American Academy of Orthopaedic Surgeons, about 20 percent of individuals who experience rear-end collisions later exhibit symptoms in the neck region. Other sources of whiplash include amusement park rides, sports injuries and being punched or shaken.

Whiplash is usually diagnosed through a physical examination and use of imaging tests such as x-rays or MRI.

Treatment for whiplash may include medications and physical therapy. Some patients may also experience relief by using a cervical collar that secures the neck vertebrae in their normal position. With proper treatment, most patients fully recover within a few months after the injury.

Whiplash is an injury to the soft tissues and sometimes other parts of the neck. Also known as neck sprain or strain, it involves symptoms that usually result from a sudden jerking of the head that causes hyperextension (excessive bending backward) or hyperflexion (excessive bending forward) of the neck. This trauma strains the tissues and joints of the neck beyond their normal range of motion.

The neck (cervical) region is the most flexible region of the spine. It includes seven vertebrae and shock-absorbing intervertebral discs, along with muscles and vertebral ligaments to hold these spinal bones in place. The top cervical disc connects the spinal column to the base of the skull. The spinal cord (responsible for transmitting nerve impulses to the body) runs through a canal in the cervical vertebrae and continues down the spine.

Whiplash may damage the intervertebral discs, joints, ligaments, cervical muscles or nerve roots. It can also lead to other injuries, including:

• Contusion. An injury in which the skin is not broken, such as a bruise.
  
  
• Fracture. A break, rupture or crack in bone or cartilage.

• Concussion. Jarring or shock to the head that causes a jolt to the brain.
  
  
• Hematoma. Bleeding or pooling of blood between the tissue layers covering the brain or inside the brain.

Automobile accidents are among the common causes of whiplash. When a vehicle stops suddenly or is hit from behind, the head may snap forward, then backward. When the head is jerked backward, it causes acute hyperextension of the cervical spine. About 20 percent of individuals who experience rear-end collisions later exhibit symptoms in the neck region, according to the American Academy of Orthopaedic Surgeons.

Other sources of whiplash injuries include roller coasters and other amusement park rides, a blow to the head and being shaken. Whiplash can also result from sports injuries, including those that occur during:

• Contact sports, such as football, rugby, wrestling or boxing
• Mountain climbing
• Horseback riding
• Diving
• Gymnastics
• Rodeo

Whiplash is also associated with shaken baby syndrome, a severe form of head injury resulting from shaking an infant or child.

Symptoms of whiplash do not always appear right away. Typically, symptoms do not emerge for the first 12 to 24 hours after the injury, and it may take days or even weeks before they are present. In other cases, patients may feel pain and stiffness in the neck following the injury that disappears for a few days before returning. Muscles groups that may be affected include those in the head, chest, shoulders and arms.

 In addition to neck pain and stiffness, symptoms can include:

• Headaches
• Dizziness
• Sensations such as burning or prickling (paresthesias)
• Shoulder pain
• Back pain
• Arm pain
• Ringing in the ears (tinnitus) or difficulty hearing
• Blurred vision
• Excessive sweating

In addition to pain, some people with whiplash experience cognitive, somatic (relating to the body) or psychological symptoms. These include:

• Loss of memory
• Impaired concentration
• Nervousness or irritability
• Sleep disturbances
• Fatigue
• Depression

Whiplash injuries can also result in damage to the esophagus, the muscular tube that serves as the passage between the mouth and the stomach. Damage to the vocal cords that causes hoarseness has also been reported. Patients should call their physician if they experience a violent injury to the neck that is followed by pain. 

It is common for the joints between the cervical vertebrae to get displaced or pulled during a whiplash injury. A physician’s care should especially be sought for those who experience any of the following:

• Neck pain and stiffness that returns after it had disappeared
• Pain that spreads into the shoulders or arms
• Pain experienced when moving the head
• Numbness, tingling or weakness in the arms
• Bladder or bowel dysfunction

People with potential whiplash injuries from causes such as motor vehicle accidents are often evaluation by emergency medical personnel. If an injury to the spinal cord or vertebrae is suspected, patients may be immobilized with a neck brace and back board. Further evaluation at an emergency room may include imaging tests.

Before diagnosing whiplash, a physician will review the patient’s medical history and perform a physical examination. Particular attention will be paid to assessing sensation, strength and reflexes in various parts of the body to help pinpoint which nerves or portion of the spinal cordspinal cord are affected. A pain assessment may be conducted.

Imaging tests may be used to reveal any damage to nerve roots, spinal cord, vertebrae or intervertebral discs. Sometimes most of these diagnostic tests are negative and diagnosis is made only by detailed history and physical examination. These tests may include:

• X-rays. Use low doses of radiation to produce images on film or fluorescent screens.
  
  
• MRI (magnetic resonance imaging). Uses powerful magnets to produce images on a computer screen and film.
  
  
• CAT scan (computed axial tomography). Uses multiple x-rays to create cross-sectional images of the body.

People who suffer mild symptoms that appear to be related to a whiplash injury can try several remedies. These include temporary rest and over-the-counter medications such as aspirin, acetaminophen or ibuprofen. Patients are advised not to take any medications before consulting their physician.

Prescription medications also are used to treat whiplash. These may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Other anti-inflammatories and painkillers (analgesics)
• Antidepressants
• Muscle relaxants

Some patients may also experience relief by using a cervical collar for a few weeks. This is a foam, plastic or gel-filled neck brace that secures the cervical vertebrae in their normal position.

Heat (thermotherapy) can be applied to relieve tension and increase range of motion. This may be combined with hydrotherapy. In addition, many physicians recommend that patients refrain from activities that aggravate pain, such as heavy lifting and participation in sports, for two to three weeks after injury.

Other treatments that may help relieve symptoms associated with whiplash include:

• Cryotherapy. The use of cold to treat pain. Cold treatments may be applied to the affected area in the first 24 hours after the injury.
  
  
• Manipulation therapy. Techniques involving manipulation of soft tissues, and sometimes joints, through pressure and movement. Examples include chiropractic and massage therapy.
  
  
• Ultrasound therapy. Method of applying heat deep into tissues with the use of high-frequency sound waves.
  
  
• Electrical therapy. Techniques including transcutaneous electrical nerve stimulation (TENS), which patients can be trained to perform at home.
  
  
• Acupuncture or acupressure. Ancient Eastern therapies that may reduce pain.
  
  
• Injection therapy. May be recommended for patients not getting better with noninvasive treatments. Usually these injections include facet joint injections (into joints between vertebrae) and epidural corticosteroid injections.
  
  
• Traction. A procedure in which a mechanical device is used to relieve pressure from the affected area. It is very rarely used in whiplash injury.

Once a whiplash injury has healed, activities such as range of motion exercises and physical therapy may further rehabilitate tissues. Patients may be instructed in posture and ergonomics.

Patients who receive proper treatment for whiplash injuries generally have a good prognosis. Neck and head pain often resolves within a few days or weeks, and most patients fully recover within a few months after the injury. In fact, according to the American Academy of Orthopaedic Surgeons, about 75 percent of individuals who have whiplash recover within several months.

Some patients, however, may continue to experience some lingering neck pain and headaches. In such patients, it may be necessary to have additional treatment, such as a nerve block with a local anesthetic. 

Other pain management techniques that may address chronic pain include cognitive behavioral therapy or biofeedback. In rare cases, damage to tissues may need to be repaired by surgery.

Some patients have suffered balance disorders after a whiplash injury. Treatments that may help include physical or occupational therapy or acupuncture.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about whiplash:

1. What happens during a whiplash injury, and which of my tissues can be damaged?
   
   
2. How can I tell distinguish minor whiplash I can treat myself from an injury that needs medical attention? Are there additional symptoms I should watch for?
   
   
3. I felt no pain initially after the accident, but I feel pain now. Should I be concerned?
   
   
4. What diagnostic tests will I undergo if whiplash is suspected?
   
   
5. What do these tests involve? Do I need to do anything to prepare for them?
   
   
6. What do my test results show?
   
   
7. What are my treatment options, and which do you recommend?
   
   
8. How long will it take before my symptoms subside?
   
   
9. Could I need surgery if medication, thermotherapy and other noninvasive measures do not work? 
   
   
10. How can I prevent future injuries?