Whiplash

What is whiplash?

Whiplash describes a sudden acceleration-deceleration movement of the neck. The head and neck are thrown backward and then forward, often referred to as a 'whiplash' motion.

So, 'whiplash' is simply a term to describe the mechanism of injury. However, whiplash can lead to various symptoms, in which case we refer to it as a whiplash-associated disorder.

To better understand why this movement can injure your neck, consult our guide on cervical anatomy. It explains how the structures in your neck normally work.

What are the symptoms of a whiplash-associated disorder?

The main symptoms of a whiplash-associated disorder are similar to those of a cervical sprain, including:

• Neck pain and stiffness
• Spasms in the neck muscles
• Headaches (caused by the neck problem)

In general, neck movements and certain arm movements trigger the pain.

However, in addition to these symptoms, you might also experience others, such as:

• Dizziness or vertigo
• Problems controlling eye movement
• Tinnitus (ringing in the ears)
• Loss of balance
• Concentration or memory problems
• Changes in sleep patterns
• Anxiety or depression

Symptoms can appear immediately after the accident or up to 48 hours later. If you also feel pain, numbness, or tingling extending into your arms, you likely have cervicobrachialgia or cervical radiculopathy. This happens when a nerve is irritated.

It's also possible to have sustained a concussion after whiplash. If you experience symptoms like confusion, nausea, or vision problems, speak to your physiotherapist or doctor.

To learn more about neck pain in general and all its possible causes, consult our complete guide on neck pain.

What are the serious symptoms of a whiplash-associated disorder?

Serious symptoms are rare, occurring in less than 1% of cases. However, you should seek immediate emergency care or see a doctor if you have:

• Severe weakness or paralysis in one or both arms
• Significant or complete loss of sensation in one or both arms
• Recent Loss of Balance While Walking
• New incoordination of the arms or hands
• New difficulties holding your urine or stool
• Loss of sensation in the genital area or when wiping after a bowel movement

Rest assured, most of the time, even though the pain can be very unpleasant, the condition usually improves well.

What are the causes of a whiplash-associated disorder?

You must have experienced an accident or trauma that causes whiplash. For example:

• A car accident (the most common cause)
• A sudden neck movement
• An impact to the head
• A fall

Whiplash often happens during a rear-end collision. When a car hits you from behind, your body is propelled forward, but your head remains stationary for a moment. Then, your head is rapidly thrown backward and then forward. This quick movement can injure the ligaments, muscles, and even the discs in your neck.

How is whiplash-associated disorder diagnosed?

Diagnosis is made based on your symptom history and a clinical examination. If you've had an accident that resulted in whiplash and you develop symptoms afterward, we can confirm the presence of a whiplash-associated disorder.

In some cases, a neck X-ray may be necessary to ensure there is no fracture. Here are some criteria that justify an X-ray:

• Falling from more than one meter or five steps
• Having had a crushing force applied to the head (for example: diving into a pool)
• A car accident at over 100 km/h, being ejected from a car, or the car rolling over
• Having an accident in a motorized recreational vehicle (snowmobile, quad bike, motocross, ATV, etc.)
• Cycling and having a collision with a car

When should you consult a physiotherapist for a whiplash-associated disorder?

You should consult a physiotherapist if you have symptoms as described above, or if your doctor has already ruled out any other cause that may explain your pain.

You don't need to see a doctor before a physiotherapy consultation. If your condition requires medical attention, your physiotherapist will inform you.

Physiotherapy is particularly effective for whiplash-associated disorders. Your physiotherapist has the expertise to assess all systems that may have been affected by whiplash. To learn more, consult our guide on physiotherapy for neck pain.

What physiotherapy treatments are available for whiplash-associated disorder?

Physiotherapy treatment for whiplash-associated disorder is divided into three parts:

• Assessment and treatment of the different body systems that may be responsible for the symptoms.
• Planning Your Return to Work or School (Cognitive Activities)
• Planning your return to sports and other leisure activities

Step 1 - Assessment and Treatment of Body Systems

Your physiotherapist is the only healthcare professional with the expertise to assess the three systems that may have been injured by whiplash, namely:

• The vestibular system (responsible for balance)
• The oculomotor system (responsible for eye coordination)
• The cervical spine (the neck vertebrae)

To assess your neck, your physiotherapist will evaluate the following:

• Your joint mobility
• The gliding of your nerves
• Your postural habits
• The quality of your movements
• Your strength and stability

Based on the assessment results, your physiotherapist will:

• Mobilize the joints, muscles, and nerves in your neck to reduce pain and improve movement
• Give you specific exercises to do at home to address the cause of the problem and relieve pain
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Give you advice for your postural habits and movements

Step 2 - Planning Your Return to Work or School (Cognitive Activities)

Your physiotherapist will guide you through the progression of returning to school or work. They will provide advice to ensure this return is done correctly without symptoms recurring. Follow-up will continue until you achieve a full return to work or school without symptoms.

Step 3 - Planning Your Return to Sports and Other Leisure Activities

Your physiotherapist will guide you in returning to physical activity. They will provide advice to ensure this return is done correctly without symptoms recurring. Follow-up will continue until you achieve a full return to physical activities without symptoms.

What to do at home for a whiplash-associated disorder?

Temporarily stop movements that cause too much pain and gradually resume them afterward. It's important to stay active, but without overexerting yourself.

Here are some other tips that can help at home:

• Move your neck in movements that do not hurt at all.
• Perform gentle movements several times a day.

• With a cushion under the armpit
• With the armrests of a chair or sofa
• By putting your hand in your pants pocket while standing

• Limit the time spent in the same position (computer, television, reading). Get up for a few minutes to move your neck and shoulders a little.
• Ensure your neck is well supported while sleeping at night with a pillow that fills the curve of your neck. Sleeping on your stomach should be avoided (especially if you experience morning stiffness or pain, or pain during the night).

If you don't see any improvement after 10 days, you should consult a physiotherapist.

Sources

• Gwilym SE, Stace RM. Whiplash associated disorder: a review of current pain concepts. Bone & Joint 360. 2015 Feb;4(1):37-9.
• Carroll LJ, Holm LW, Hogg-Johnson S, Côté P, Cassidy JD, Haldeman S, Nordin M, Hurwitz EL, Carragee EJ, van der Velde G, Peloso PM. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Journal of manipulative and physiological therapeutics. 2009 Feb 1;32(2):S97-107.
• Ioppolo F, Rizzo RS. Epidemiology of whiplash-associated disorders. InWhiplash Injuries 2014 (pp. 13-16). Springer, Milano.