Whiplash the Cause, the Symptoms and the Diagnosis

Carol Sue Carlson, MD
Physical Medicine & Rehabilitation
Chippewa Valley Orthopedics & Sports Medicine
Eau Claire

 

Whiplash is a common bony and soft tissue injury to the neck caused by an “acceleration-deceleration” transfer of energy to the spine. In 1867, neck pain in railroad workers after rear-end collisions was first referred to as “railroad spine.” In 1928, the term “whiplash” was introduced to describe neck pain after motor vehicle accidents. We typically think of whiplash as occurring from motor vehicle accidents, but it can also be caused by diving accidents or collisions during contact sports.

What causes whiplash?

whiplash symptomsThe initial theory was that injury to the neck occurred because the muscles, tendons and ligaments of the neck were “overstretched” after the neck was “whipped” first into extension and then into flexion during accidents.

The soft tissue injuries to the muscles, ligaments, discs and joints in the neck are caused by the abnormal S-shape which occurs just milliseconds after impact in a car or sporting accident. “Whiplash” refers to the injuries to these structures while “Whiplash-Associated Disorder” (or WAD) refers to chronic neck pain after a whiplash injury that does not resolve despite appropriate treatment and is usually associated with psychological distress, such as depression and anger.

 

What are the symptoms of whiplash?

Common symptoms of whiplash include: neck pain and stiffness, headaches, jaw pain, shoulder pain, arm pain and weakness, ringing in the ears, visual disturbances, dizziness, numbness, tingling and back pain. Common symptoms of WAD include the symptoms described for whiplash but also include: depression, anxiety, anger, frustration, sleep disturbances, stress, social isolation and post-traumatic stress.

 

How is whiplash diagnosed?

A patient may be seen and examined by either an emergency room physician or a primary care physician and evaluated for any evidence of whiplash injury. If bony injury to the spine is suspected, x-rays may be ordered to rule out fracture or dislocation. Dynamic x-rays with views of the cervical spine in both flexion and extension may also be done to rule out a serious ligament injury which can cause instability of the spine. A CT scan or MRI may also be performed if there is any reason to suspect damage to the spinal cord or nerve roots.

CT scan or MRI

There is also a possibility that you may be told that your MRI study shows degenerative changes such as a “disc bulge” or “arthritis.” It is important to correlate the MRI findings with your physical signs and symptoms and not to attribute the whiplash or soft tissue pain to the degenerative changes noted on your MRI study. It is essential that you do not worry excessively about degenerative changes to the discs and joints because they are very common and are found just as often in people without pain as in those with whiplash injuries. These changes were more than likely present before your accident when you did not have any pain and are unlikely to be the source of your whiplash pain.

 

How can my X-rays be normal when I have pain?

Injuries to the discs and facet joints in the spine have consistently been found in studies done on victims of fatal motor vehicle accidents. These injuries are often present but are not seen on X-rays or CT scans and may not even be seen on MRI studies. We know that small fractures and joint hemorrhage are the source of pain in other joints, so it is reasonable to deduce that they are also painful when found in the joints of the neck.

 

How is whiplash treated?

After a whiplash injury, patients are frequently treated initially with anti-inflammatory medications and referred to physical therapy for treatment of their neck pain and stiffness. Therapy programs which focus on active exercises and range of motion exercises lead to better patient outcomes and more complete recovery than passive therapy programs in which ultrasound, massage and heat are the primary treatment modalities.

Soft collars may also be prescribed to help alleviate neck pain related to whiplash. Patients with whiplash who avoid use of a soft cervical collar have improved outcomes and speedier recoveries. Patients who are encouraged to resume their normal activities and are told that they can act as they normally would also have improved outcomes following whiplash injuries.

Understanding that the pain and stiffness associated with whiplash are due to soft tissue injuries of the neck and that these symptoms are very normal following an acute injury is beneficial. Knowing that the vast majority of patients do not have any long-term problems or chronic pain related to their injury and that most patients recover within 6 weeks is encouraging for patients with an acute whiplash injury.

whiplash injury

 

Are there any other treatment options if I continue to have pain?

While many patients will have resolution of their symptoms in a matter of weeks, there are patients that may continue to have pain despite appropriate treatment and exercise. Up to 60% of whiplash patients with chronic neck pain have facet joint-related pain and may benefit from diagnostic medial branch blocks of the facet joints under x-ray guidance.

If the block is successful in alleviating your pain and we have confirmed the joint as the source of your pain, then we may be able to treat that joint with more permanent procedures, such as radiofrequency ablation.