Whiplash

What is whiplash?

Whiplash is a neck injury to the joints of the vertebrae caused by trauma. Generally, it involves the stretching of one or more ligaments in the neck vertebrae.

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What are the symptoms of whiplash?

The main symptoms are:

• Pain and stiffness in the neck following a specific event
• Spasms in the neck muscles
• Headaches (caused by the neck problem)

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

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What are the serious symptoms of whiplash to watch out for?

The presence of certain signs and symptoms should prompt you to seek immediate medical attention at the emergency room or from a doctor. These include:

• Severe weakness or paralysis in one or both arms
• Significant or even complete loss of sensation in one or both arms
• Recent loss of balance when walking
• New incoordination of the arms or hands
• New difficulties with bladder or bowel control
• Loss of sensation in the genital area or when wiping after a bowel movement

Serious symptoms are only present in less than 1% of cases. Most of the time, although the pain can be very unpleasant, the condition resolves well.

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What are the causes of whiplash?

In general, whiplash is caused by a specific event such as:

• A car accident
• A sudden neck movement
• An impact to the head
• A fall
• More exertion than usual (for example, straining to lift something)

« Note that whiplash very often leads to a cervical sprain. See the whiplash section. »

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How is a cervical sprain diagnosed?

Diagnosis is based on a review of your symptoms and a clinical examination. If the injury occurred in a traumatic context, X-rays of the neck may be necessary to rule out a fracture. 

Here are some criteria that warrant an X-ray of the neck:

• Falling from a height of more than one meter or down five steps
• Receiving a load that crushes the head (for example, diving into a pool)
• A car accident at more than 100 km/h, being ejected from a car, or the car rolling over
• An accident in a motorized recreational vehicle (snowmobile, quad, motocross, Ski-Doo, etc.)
• Being on a bicycle and colliding with a car

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When should you consult a physiotherapist for a cervical sprain?

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 be responsible for your pain.

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You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

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What are the physiotherapy treatments for a cervical sprain?

As with all traumatic injuries, we must allow the body to perform its natural healing process.

« Inflammation is a normal and necessary process for proper healing. There is therefore no miracle way to speed up healing. »

However, it is very important to make sure to eliminate any factors that could slow down healing. Here are some examples of things that could slow down healing:

• Improper dosage of exercises and daily activities
• Poor biomechanics of your movements
• Stiffness in the joints, muscles, and nerves
• Worries or fears related to the injury or pain.

« For this reason, your physiotherapist can help you optimize the healing of the injury. They will be able to guide you in the best possible direction to ensure that the injury heals effectively. »

Think of healing from a traumatic injury like taking care of a plant. Pulling on the plant won't make it grow faster. However, you can make sure it gets enough water, sunlight, and fertilizer. We want to put the plant in a good environment to heal. It's the same for a traumatic injury.

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Your physiotherapist will perform an assessment to determine the type and severity of the injury. To do this, they will evaluate the following elements:

• 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

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What to do at home for a cervical sprain?

Temporarily stop doing the movements that cause pain, and then gradually start doing them again.

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Here are some other tips that may help at home:

• Move your neck in the movements that don't cause any pain at all
• Support your shoulders and shoulder blades
  
  • With a cushion under your armpit
  • With the armrests of a chair or sofa
  • By putting your hand in your pants pocket
• 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.
• Make sure your neck is well supported while sleeping at night with a pillow that fills the hollow of your neck. Sleeping on your stomach should be avoided if you have stiffness or pain in the morning or during the night.
• Do a cardio activity like walking, stationary cycling, or swimming if it doesn't cause any pain. Cardio activity improves blood circulation and speeds up healing.

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

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Sources

• Delfini R, Dorizzi A, Facchinetti G, Faccioli F, Galzio R, Vangelista T. Delayed post-traumatic cervical instability. Surgical neurology. 1999 Jun 1;51(6):588-95.
• Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, Laupacis A, Schull M, McKnight RD, Verbeek R, Brison R. The Canadian C-spine rule for radiography in alert and stable trauma patients. Jama. 2001 Oct 17;286(15):1841-8.
• Stiell IG, Clement CM, McKnight RD, Brison R, Schull MJ, Rowe BH, Worthington JR, Eisenhauer MA, Cass D, Greenberg G, MacPhail I. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. New England Journal of Medicine. 2003 Dec 25;349(26):2510-8.

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