Whiplash

What is whiplash?

Whiplash refers to a sudden movement involving acceleration and deceleration of the neck. Physical therapy for whiplash supports recovery from this type of injury.¹ This movement can occur in several directions during an accident. The term “cervical whiplash” is also used.

The term "whiplash" describes the movement that occurs during an accident. The term "whiplash-related disorder" refers to the symptoms that may follow this movement.

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?

A condition associated with whiplash often causes neck pain and stiffness. Muscle tension and headaches may also occur.

Common symptoms are similar to those of a whiplash injury:

• Neck pain and stiffness
• Spasms in the neck muscles
• Headaches

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

What other symptoms can whiplash cause?

A condition associated with whiplash may also be accompanied by problems with balance, vision, hearing, sleep, concentration, or mood. A review of 53 studies describes these symptoms, which vary from person to person.² Another review reports depressive symptoms in about one in three people, six to twelve months after the injury. It reports symptoms of post-traumatic stress in about 9% to 22% of those studied during the first year. These symptoms, as measured by a questionnaire, are not sufficient to make a diagnosis.³

• 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 may begin immediately after the accident or appear later. Pain, numbness, or tingling that radiates down an arm may indicate nerve damage, such as cervicobrachialgia or cervical radiculopathy. An evaluation can help rule out this possibility.

An accident that causes whiplash can also result in a concussion. After the accident, nausea, vision problems, or other unusual symptoms require prompt medical evaluation. If you are confused, if your confusion worsens, if you are difficult to wake up, or if you are vomiting repeatedly, go to the emergency room or call 911.⁴

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?

Certain symptoms require urgent medical evaluation. Seek medical attention immediately if you experience a loss of strength or sensation, changes in your balance or hand coordination, or loss of bladder or bowel control:

• 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

Significant pain can be very uncomfortable, but it doesn't necessarily mean you're not recovering properly.

What are the causes of a whiplash-associated disorder?

A whiplash-related injury can result from an accident that causes the head and neck to accelerate and decelerate abruptly. The movement can occur forward, backward, or sideways. Car accidents are a common cause, but a fall, an impact, or a sudden movement can also trigger this mechanism.

Several events can cause the neck to accelerate and decelerate:

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

In a rear-end collision, the seat moves the body forward before the head follows. The neck then undergoes rapid acceleration and deceleration. Recovery varies from person to person. One review reports that about half of the people studied still had neck pain one year after the accident. More severe initial pain or disability, avoidance of movement, a depressed mood, and fear of moving were associated with slower recovery.⁵

How is whiplash-associated disorder diagnosed?

The healthcare professional diagnoses a whiplash-related condition based on the accident, your symptoms, and a clinical examination. He or she also checks to see if another injury might explain your symptoms.

In some cases, an X-ray of the neck is needed to rule out a fracture. To determine whether an X-ray is necessary, physical therapists and doctors use a validated protocol—the Canadian Cervical Spine Rule—designed for patients who are conscious and stable following an accident. Among other things, it covers the following situations: ⁶

• Falling from a height of at least three feet—about 90 cm—or from five or more 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.)
• Getting into a bike accident

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

You can see a physical therapist if you experience neck pain, headaches, dizziness, or stiffness after the accident.

At a private clinic in Quebec, you can see a physical therapist without a doctor's referral. If your condition requires a medical evaluation, the physical therapist will refer you to the appropriate provider.

If the accident was severe enough to possibly fracture a vertebra or injure a nerve, don't wait. Get checked out right away. ⁷

Physical therapy can be part of the initial care following a whiplash injury. Guidelines recommend providing explanations, tailored exercises, a gradual return to activities, and—depending on the situation—manual therapy rather than prolonged immobilization with a neck brace.⁸ Studies on exercise report possible improvements in pain and function, but the quality of the evidence remains low and the magnitude of the effects remains uncertain.⁹ The physical therapist will tailor your care based on your assessment and progress. For more information, see our guide on physical therapy for neck pain.

What physiotherapy treatments are available for whiplash-associated disorder?

Physical therapy assesses symptoms and affected abilities, and then helps patients prepare for a gradual return to work, school, sports, and leisure activities.

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

• Assessment of factors that may contribute to symptoms and treatment tailored to the results
• Planning Your Return to Work or School (Cognitive Activities)
• Planning your return to sports and other leisure activities

Step 1 - Which body systems does your physical therapist evaluate?

Your physical therapist can evaluate your neck, balance, and eye movements based on your symptoms:

• 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
• Will provide you with tailored exercises to improve your range of motion, strength, and endurance for daily activities
• Will help you balance your daily activities and leisure time based on your response
• Will give you advice on your posture and movement habits

Step 2 - How to Plan Your Return to Work or School?

The physical therapist will work with you to plan a gradual return to work or school. They will adjust your tasks, breaks, and the duration of your activities based on your abilities and how your symptoms respond.

Step 3 - How to Plan Your Return to Sports and Recreation?

The physical therapist will work with you to plan your return to physical activity. He or she will gradually increase the range of motion, intensity, and duration based on your activity and how you respond.

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

At home, continue with activities you can tolerate and gradually resume more challenging movements. Temporarily adjust any movement that significantly worsens your symptoms, then try it again by reducing its range of motion, intensity, or duration.

Moving your neck gently helps with recovery from a neck injury—yet another reason to keep moving rather than keeping your neck still.^{10, 11}

What other tips can help at home?

At home, you can gently move your neck, support your arms as needed, and change positions regularly.

• Gently move your neck within the range of motion you can tolerate. Mild discomfort may be acceptable. Stop the exercise and seek advice if it causes severe or unusual pain.
• Do some gentle exercises regularly throughout the 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

• When it comes to your posture, limit the amount of time you spend in the same position, whether you're at the computer, watching TV, or reading. Get up and move your neck and shoulders a little.
• Choose a sleeping position and a pillow that keep your neck comfortable. If a certain position increases stiffness or pain, try changing it.

When neck pain persists, progressive exercises for the neck muscles can help alleviate pain and improve function in some people. Manual therapy can also be incorporated into an active treatment program.¹² Results vary depending on the studies and programs.⁹

If your pain shows no signs of improving, see a physical therapist.

Sources

The following sources present the data used regarding the progression, assessment, and treatment of whiplash.

Links open in a new tab.

1. Pastakia K, Kumar S. Acute whiplash-associated disorders (WAD). Open Access Emerg Med. 2011;3:29-32. (Back to section: 1)
2. Särkilahti N, Leino S, Takatalo J, Löyttyniemi E, Tenovuo O. The symptom profile of people with whiplash-associated disorder—A mixed-methods systematic review. J Bodyw Mov Ther. 2024;40:706-725. (Back to section: 1)
3. Al-Khazali HM, Ashina H, Iljazi A, Al-Sayegh Z, Lipton RB, Ashina M, et al. Psychiatric Sequelae Following Whiplash Injury: A Systematic Review. Front Psychiatry. 2022;13:814079. (Back to section: 1)
4. Centers for Disease Control and Prevention. Symptoms of Mild TBI and Concussion. (Back to section: 1)
5. Carroll LJ, Holm LW, Hogg-Johnson S, Côtè P, Cassidy JD, Haldeman S, et al. 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. J Manipulative Physiol Ther. 2009;32(2 Suppl):S97-S107. (Back to section: 1)
6. Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841-8. (Back to section: 1)
7. NICE. Recommendations | Spinal Injury: Assessment and Initial Management | Guidance | NICE. (Back to section: 1)
8. Wong JJ, Côté P, Shearer HM, Carroll LJ, Yu H, Varatharajan S, et al. Clinical practice guidelines for the management of conditions related to traffic collisions: a systematic review by the OPTIMa Collaboration. Disabil Rehabil. 2015;37(6):471-89. (Back to section: 1)
9. Chrcanovic B, Larsson J, Malmström EM, Westergren H, Häggman-Henrikson B. Exercise therapy for whiplash-associated disorders: a systematic review and meta-analysis. Scand J Pain. 2022;22(2):232-261. (Back to sections: 1, 2)
10. Schnabel M, Vassiliou T, Schmidt T, Basler HD, Gotzen L, Junge A, et al. [Results of early mobilization for acute whiplash injuries]. Schmerz. 2002;16(1):15-21. (Back to section: 1)
11. Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J, et al. Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976). 2008;33(4 Suppl):S123-52. (Back to section: 1)
12. Bussières AE, Stewart G, Al-Zoubi F, Decina P, Descarreaux M, Hayden J, et al. The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline. J Manipulative Physiol Ther. 2016;39(8):523-564.e27. (Back to section: 1)