Whiplash

Whiplash-a soft tissue injury to the neck-is also called neck sprain or neck strain. It is characterized by a collection of symptoms that occur following damage to the neck, usually because of sudden extension and flexion. The disorder commonly occurs as the result of an automobile accident and may include injury to intervertebral joints, discs, and ligaments, cervical muscles, and nerve roots. Symptoms such as neck pain may be present directly after the injury or may be delayed for several days. In addition to neck pain, other symptoms may include neck stiffness, injuries to the muscles and ligaments (myofascial injuries), headache, dizziness, abnormal sensations such as burning or prickling (paresthesias), or shoulder or back pain. In addition, some people experience cognitive, somatic, or psychological conditions such as memory loss, concentration impairment, nervousness/irritability, sleep disturbances, fatigue, or depression.

When to seek medical advice

Contact your doctor promptly if:

- (Involved in an automobile accident.)

- The pain spreads to your shoulders or arms

- It becomes painful to move your head

- You experience numbness, tingling or weakness in your arms

Tests and diagnosis

Your doctor will ask how the injury occurred and will measure how far your neck can move in different directions. He or she will also check to see if any parts of your neck are especially tender to pressure. X-rays may help to rule out other causes of neck pain such as vertebral fractures, dislocations or arthritis. CT or MRI scans might be requested to check for soft-tissue damage or pressure on nerves.

Is there any treatment?

Treatment for individuals with whiplash may include pain medications, nonsteroidal anti-inflammatory drugs, antidepressants, muscle relaxants, and a cervical collar (usually worn for 2 to 3 weeks). Range of motion exercises, physical therapy, and cervical traction may also be prescribed. Supplemental heat application may relieve muscle tension.

Treatments and drugs

Medications
Over-the-counter pain relievers, such as acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin, others), often can control mild to moderate whiplash pain. People with more severe pain may benefit from short-term treatment with prescription pain relievers containing codeine. Muscle relaxants also may be prescribed, but these drugs often cause drowsiness so your doctor may want you to take them only at bedtime.

Ice, heat and exercise
Many people with whiplash pain find it helpful to use ice or heat on their necks and upper backs. In general, ice should be used early in the recovery period, to reduce inflammation, while heat is especially helpful to relax muscles before range-of-motion exercises.

Once your pain is under control, your doctor will likely want you to regularly perform gentle stretching exercises to help restore your neck's range of motion. These usually involve rotating your head from side to side, and bending your neck forward, backward and to the sides.

If pain persists for several months, your doctor may recommend physical therapy to help strengthen the muscles supporting your head.

Injections
An injection of corticosteroid medicine or lidocaine (a numbing medicine) into painful muscle areas may relieve the muscle spasms that can be associated with whiplash injuries. This will make it easier for you to perform the stretching exercises that are crucial to recovery.

Cervical collars
Although soft foam cervical collars were once commonly used for whiplash injuries, they no longer are recommended routinely. Immobilizing the neck for long periods of time can lead to decreased muscle bulk and strength and impair recovery.

During the day, cervical collars should be worn for no longer than three hours at a time and for only the first few weeks after the injury. If you're continually being awakened at night by whiplash pain, wearing a cervical collar may help you sleep.

What is the prognosis?

Generally, prognosis for individuals with whiplash is good. The neck and head pain clears within a few days or weeks. Most patients recover within 3 months after the injury, however, some may continue to have residual neck pain and headaches.

Complications

Between 15 percent and 40 percent of people who experience whiplash will continue to have pain months after the injury occurred. In some people, this chronic pain can be traced to damage in the joints, disks and ligaments of the neck. But in many cases, no abnormality can be found to explain this persistent neck pain.