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Whiplash Injuries

Whiplash is an injury caused by a sudden and/or violent jolt of the neck in one direction and then another, creating a whip-like movement. Whiplash is most commonly seen in people involved in motor vehicle accidents, but it can also occur from falls, sports injuries, work injuries, and other incidents. Talk to your patients about whiplash and its treatment.

 What structures are injured in a whiplash?

The ligaments that help support, protect, and restrict excessive movement of the vertebrae are torn, which is called a sprain.
The muscles and tendons are strained—stretched beyond their normal limits. The discs between the vertebrae, which are essentially ligaments, can be torn, potentially causing a disc herniation.
The nerve roots between the vertebrae may also be stretched and become inflamed.
In very rare cases, vertebrae can be fractured and/or dislocated.
What are the signs and symptoms of whiplash?
Approximately two-thirds of people involved in motor vehicle accidents develop symptoms of whiplash. The symptoms often do not develop until 2 to 48 hours after the injury.
Whiplash mostly results in pain and stiffness in the neck areas that are “whiplashed” and in the front and back of the neck. Turning the head often makes the pain and discomfort worse. The pain and stiffness may extend down into the shoulders and arms, upper back, and even the upper chest.
Headache, especially at the base of the skull, is also common in more than two-thirds of patients.
Some patients also experience dizziness, difficulty swallowing, nausea, and even blurred vision after a whiplash injury. In most cases, these symptoms disappear relatively quickly. If they persist, it’s important to inform the doctor that they are not resolving.
Vertigo and ringing in the ears may also occur. Some patients may also feel pain in the jaw. Others will even complain of irritability, fatigue, and difficulty concentrating. These symptoms also resolve quickly in most cases.
How is whiplash diagnosed?
A thorough history of the injury and the patient’s previous medical history are taken. Pre-existing conditions, such as arthritis and/or previous injury, may increase the severity of whiplash.
An in-depth physical examination, with concentration on the neuromusculoskeletal system, is also performed.
When appropriate, X-rays of the neck may be taken.
If the doctor suspects that the soft tissues (e.g., discs, ligaments) in the neck are injured, more advanced imaging studies, such as magnetic resonance imaging (MRI), may be ordered.
How is whiplash treated?
Unless whiplash injury requires immobilization, staying active is important. An exercise or stretching program is often helpful.
Some suggest that soft-cervical collar use is inappropriate, as it acts as a “crutch” and encourages a patient to avoid activity. Others suggest that it can help a patient slowly return to normal activities. When recommended, the collar should be worn for no more than one week.
Ice and/or heat can often help control pain and reduce the muscle spasm.
Electrical stimulation and ultrasound may provide some short-term relief. They should not replace exercise and stretching, however.
Spinal manipulation and/or mobilization provided by a chiropractor can also provide relief.
Surgery, injections, and other invasive options are rarely necessary. They are generally reserved for more severe injuries to the discs, vertebrae, and nerves in the neck region.
Can whiplash be prevented?
Whiplash cannot be “prevented,” but appropriate motor vehicle safety measures may reduce the chances of a more severe injury.
Always wear restraints (lap or shoulder belt), and ensure that the headrest in your vehicle is adjusted to the appropriate height.

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