Dealing with Whiplash Injury: Causes, Symptoms, and Treatments

Dr. James - Orthopaedic Surgeon in Singapore

Medically reviewed by Dr. James Tan

Whiplash injury is a common issue that happens after a violent back-and-forth motion of the neck, which is often caused by car accidents. Understanding the basics of your neck anatomy, telltale whiplash symptoms, and modern treatment options helps to ensure an optimal recovery if you have whiplash. 

If you think that you may have seriously injured your neck, it is vital to take it seriously. In this comprehensive guide, we will cover key whiplash causes, risk factors, symptoms, diagnostic techniques, treatment options, self-care tips, and advice for managing pain.

What Is Whiplash? 

whiplash
Image Credits: NeuPhysio

Whiplash is a neck injury that occurs when the head is suddenly jerked in an unnatural way. This rapid back-and-forth motion of your head and neck can strain or damage the soft tissues (muscles, ligaments, and tendons) of your neck.

What Causes Whiplash? 

The most common cause of whiplash is a car accident, particularly rear-end collisions. The impact from behind creates the ideal conditions for whiplash, but it is not the only cause. Here are complete list of things that can cause whiplash:

  • Car Accidents: Rear-end collisions are the most common cause of whiplash. When a car is hit from behind, the passengers’ bodies can be forced forward while their heads snap backwards. This causes that distinct whipping motion of the neck.
  • Sports Injuries: Contact sports like rugby and hockey as well as horseback riding can lead to whiplash injuries. When you’re doing these activities, you can fall in a way that creates a sudden movement of your head and neck.
  • Physical Assault: A sudden blow to your head or having your head forcefully shaken can cause whiplash-like injuries. Physical assaults and being shaken (causing symptoms of shaken baby syndrome) can cause whiplash. 
  • Roller Coasters and Amusement Rides: Some amusement park rides create sudden and intense motion that can lead to whiplash-like injuries if proper safety measures are not in place.
  • Slip and Fall Accidents: Falling backwards and hitting your head can cause whiplash injuries. This is especially common in older people who may have less neck muscle strength and flexibility.
  • Work-Related Accidents: Workplace accidents like falling from high up or being hit with a heavy object can cause an injury.
  • Exercise: While less common, excess physical exertion can lead to whiplash-like injuries, especially if you’re using an improper technique or have an accident that causes a sudden unexpected force on the neck.

Who Is At Risk for Whiplash?

Whiplash can happen to anyone at any time. While there is no one immune to it, there are certain people who are at a greater risk. Here are some of the key factors that increase your risk:

  • People with Previous Neck Injuries: If you’ve injured your neck in the past, you are more likely to injure it again. 
  • People with Neck Arthritis: When you have arthritis, you are more vulnerable to injuries. 
  • Women: Statistically women are more likely to get whiplash. That’s possibly because of differences in sitting posture, head-neck proportions, and neck strength.
  • Older People: Because of typically weaker neck musculature and degenerated spines, elderly people are more likely to be injured in accidents. 
  • Young Children: Like older adults, young children also tend to have weaker necks and spines. This makes them more susceptible. 

Factors That Increase Your Risk of Neck Injuries 

In addition to having certain risk factors, there are some specific conditions that make you more likely to have a neck injury, including the following: 

  • Lack of a Headrest: When you are a passenger in a car without a headrest or with improper headrest positioning, you’re more likely to be hurt in an accident. Making sure that you have a proper headrest at the right height can greatly reduce your risk.
  • Inattentive Driver: Distracted and impaired drivers are slower to react during an accident, which means that they break later or not at all before impact. This creates a harder collision and a higher risk of injury.

Do I Have Whiplash?

You might experience symptoms of whiplash immediately or you may be delayed up to 48 hours post-injury. If you have recently had an accident, look for some of the following symptoms:

  • Neck pain with particular tenderness at the back of your neck and shoulders: This is often the earliest and most noticeable symptom. 
  • Stiffness and reduced range of motion in your neck: Simple movements, especially turning your head, can be painful. 
  • Headaches: The irritation in your nerves and joints can cause pain that usually starts at the base of the skull.
  • Pain or numbness in your arms: Having nerve root compression or a pinched nerve in your neck can cause pain that will radiate down one or both arms.
  • Dizziness, ringing in the ears, nausea, and unsteadiness: A general discomfort can be caused by trauma to your cervical vertebrae.
  • Jaw pain or tooth pain: A jaw misalignment can cause an onset of pain. 
  • Neck muscle spasms: Involuntary contraction of your neck muscles can be caused by whiplash.
  • Upper back pain between the shoulder blades: Pain in this specific area can indicate a thoracic spine strain.
  • Cognitive issues: Problems like trouble concentrating or memory lapses can be caused by an undetected concussion.
  • Emotional symptoms: Anxiety, irritability, and depression are common reactions to trauma and dealing with persistent pain.

Remember that your neck injury symptoms can vary. That is why it is crucial to get prompt medical care after a car accident or other trauma that violently shakes your head and neck. Early diagnosis and treatment will greatly reduce the long-term effects. 

Diagnosing Whiplash

To diagnose whiplash, healthcare professionals first perform a physical examination, to check for reduced neck mobility, muscle tenderness, and neurological symptoms. You will be asked about accident details and any pre-existing medical conditions. In most cases of acute whiplash, your medical history and exam will be enough for a diagnosis.

In some cases, your doctor may recommend medical tests such as CT and MRI scans:

  • Cervical spine X-rays: This shows your neck vertebrae and alignment, and it will help your doctor rule out a fracture.
  • CT scan: A cross-sectional neck view from this scan allows your doctor to assess the bone. This is able to show certain fractures that may not be seen on X-ray.
  • MRI: This test can evaluate your soft tissue structures including discs, nerves and ligaments so it’s useful for investigating neurologic symptoms.
  • EMG:  By measuring electrical activity in your muscles with an EMG, your doctor is able to check for nerve injury in severe whiplash cases.  
  • Neurological exam: Testing your sensory function, reflexes, balance and coordination is one of the keys to diagnosing whiplash. 

This range of tests also helps your healthcare professional confirm that the injury is consistent with trauma mechanisms. The physical examination for whiplash focuses on assessing the cervical vertebrae, facet joints, and muscles. Tenderness, reduced mobility, and pain with certain motions help pinpoint the tissues involved. Spurling’s manoeuvre assesses nerve root impingement while cranial nerve examination screens for concussion. Imaging like X-ray and MRI looks for bone fractures, disc derangement, and ligament tears that could complicate recovery. Diagnostic testing aims to confirm the whiplash injury, identify the sources of symptoms, and rule out additional injury or underlying disease processes that could complicate recovery. An accurate diagnosis lays the groundwork for proper treatment.

Treating Acute Whiplash Injury

During the first two weeks or one month after whiplash trauma, your treatment is going to focus on reducing inflammation and managing pain. Common therapies include:

  • Over-the-counter anti-inflammatory medication like ibuprofen to reduce swelling and pain: NSAIDs inhibit prostaglandins that sensitise pain receptors.
  • Putting ice packs on your neck for 15 to 20 minutes several times a day: Ice reduces local inflammation by constricting your blood vessels. 
  • Prescription muscle relaxants: This will help to alleviate spasms and pain while restoring mobility.
  • Resting your neck: By wearing a soft cervical collar or using a neck pillow, you can prevent further injury in the acute stage.
  • Gentle neck stretches and mobility exercises: Once the pain subsides, you can start moving to reduce stiffness long-term and help your body heal the injured tissues.
  • Physical therapy modalities: Options like ultrasound, TENS, traction, and massage will reduce acute symptoms.
  • Corticosteroid injection: Directing medication directly to the highly inflamed tissues offers localised pain relief with powerful anti-inflammatory effects.

It is important to note that the first days after your injury should be focused on rest. You can gradually increase your activity to avoid stiffness but you need to always listen to your body. Get emergency care for symptoms of a dramatic loss of strength or neurological changes like confusion or dizziness.

Whiplash Recovery  

After the initial inflammation decreases (which will likely happen after two to four weeks), your treatment will shift to restoring your neck mobility and strength with either a chiropractor, physiotherapist or osteopath. This may involve:

  • Physical therapy exercises to improve posture, neck muscle strength, proprioception, and endurance. You will start with isometric exercises and then move on to resistance training.
  • A therapist to help you with continued stretching and manual techniques like massage, and joint mobilisation to help realign your cervical vertebrae.
  • Low-level laser therapy to stimulate tissue healing while decreasing inflammation and pain. This red and infrared light increases your cellular metabolism.
  • Chiropractic spinal manipulation or osteopathic manipulative therapy to improve mobility.
  • Posture training and ergonomic advice to prevent re-injury long-term. This helps you to avoid prolonged positioning that will stress your neck.
  • Psychological counselling for managing whiplash-induced anxiety, fear of movement, and depression. 
  • Use of NSAIDs, muscle relaxers, or topical analgesics for residual pain.

With diligent rehabilitation and therapy, most people will see significant improvement within six weeks to three months. In this case, pain can persist for up to a year, at which point the condition is considered chronic.

Coping with Chronic Whiplash

For those still struggling with neck pain and limited function after six months, it is essential to remain active and take proactive measures such as the following:

  • Pacing activities to improve your range of motion while not pushing yourself too hard and creating a setback.
  • Practice stress management techniques and maintain social connections to keep yourself busy and feeling positive. 
  • Optimise your sleep habits, nutrition, and health behaviours that affect pain perception. 

Whiplash symptoms often plateau after the one-year mark. At that point, developing self-management skills, making lifestyle modifications where needed, and emphasising abilities over disabilities become the keys to success.

Preventing Whiplash Injury

The adage that “an ounce of prevention is worth a pound of cure” certainly applies to whiplash. While not all injuries can be avoided, certain protective measures can go a long way, such as:  

  • Properly adjusting headrests to minimise your head’s hyperextension in the case of an accident. Your goal is to have the top of the headrest even with the top of your head.
  • Keeping your focus on the road to avoid crashes. Avoid distractions like your phone and stay alert.
  • Wearing your seatbelt to help prevent the force on the body during a potential accident. 
  • Exercising your neck muscles to build strength and resiliency. 
  • Managing existing neck arthritis through posture, ergonomics, and anti-inflammatory care. 
  • Addressing a possible neck injury early before complications develop. 
  • Seeing a physical therapist as soon as possible to maximise recovery. After your visit, strictly following the at-home whiplash treatments makes a major difference. 
  • Having children ride in age-appropriate car seats will reduce potential injury forces. 

Getting Treatment for Whiplash in Singapore

Whiplash can typically be resolved within a few months. When it is addressed early and treated with proper rest, medication, and therapy, you can significantly reduce your downtime. 

It is important to note that in the case of moderate to severe whiplash, there is a relapse rate of up to 50% when you go back to your normal routine too quickly. Lingering stiffness, muscle guarding, poor posture, and mood disorders can slow down recovery. That’s why it is so important to get care early on and stick with it. If you have any lingering symptoms, it is crucial to take them seriously to avoid chronic pain and disability. With proper care, most cases of whiplash do eventually resolve. Having a collaborative team including physicians, therapists, and mental health professionals optimises your outcome for lasting relief.

Ray of Health has orthopaedic doctors who specialise in shoulder dislocation as well as sports injury specialists who can help you treat and manage pain caused by your injuries. Ready to get on the path to recovery?

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Dr. James - Orthopaedic Surgeon in Singapore

About the Author

Dr James Tan is a skilled orthopaedic surgeon who has more than 10 years of experience in sports surgery and exercise medicine. He is a member of the elite Asian Shoulder and Elbow Group and a founding member of the Singapore Shoulder and Elbow Surgery Society.

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