What Is Whiplash?

If you’ve recently been involved in a car accident, or perhaps suffered a nasty blow while playing sports, you might think that the pain you’re feeling in your neck is whiplash. Whiplash can be debilitating, somewhat elusive, and certainly the last thing you need following a traumatic incident. But what exactly is ‘whiplash’?

Whiplash is an injury involving the neck and head which occurs as a result of the sudden, powerful movement in a back-and-forth motion. You might experience pain and stiffness in the neck, head, and back, as well as headaches and fatigue. With pain relief medication and appropriate physical exercise, whiplash will most likely be behind you in a couple of weeks, but you should always consult your healthcare provider following a suspected neck injury, just to be on the safe side.

Whether you’re a victim seeking answers, or are simply curious to learn more, here you’ll find out everything you need to know about whiplash.

What is whiplash?

‘Whiplash’ is a general term for a neck injury caused by rapid, forceful movement of the head in a back-and-forth or side-to-side motion. This ‘whipping’ action can damage muscles, ligaments, discs, and other tissues in the neck, causing headaches, stiffness and pain. People most often experience whiplash following a rear-end traffic collision, but it’s also common after sports accidents, falls, and other events involving physical trauma.

Causes of whiplash

Whiplash injuries typically occur following a collision that involves sudden acceleration and deceleration of the head relative to the body. This abrupt motion can damage muscles, tendons and ligaments in the neck, as well as the bones, discs and joints that make up the upper region of the spine (i.e. the cervical spine). Whiplash is very common, and there are a number of causes to be aware of. 

Road traffic accidents are by far the most common cause of whiplash. In fact, more than 1,500 claims for whiplash-related compensation are made to insurers each day in the UK, costing the insurance industry over £2 billion a year.

A whiplash injury might also occur due to:

• Sports - Most sports can report incidences of whiplash. An increased risk of whiplash is associated with physical contact sports such as rugby and American football and combat sports like boxing or martial arts, where there is a greater chance of rapid changes in velocity.
• Falls - Everyday falling accidents, such as falling down the stairs, can cause the head to suddenly jolt backwards as the body lands on the floor. Falling backwards is more likely to induce whiplash, for instance, if you slip on a patch of ice as you are walking down the street.
• Physical trauma - Being punched or shaken vigorously might also induce whiplash. Whiplash is actually a symptom of ‘shaken baby syndrome’, where a parent/caregiver has shaken a baby, most likely out of frustration because the baby will not stop crying.

Mechanics of whiplash

There are three distinct phases of whiplash that contribute to causing injury. Recent research suggests that whiplash is caused by hyperextension of the lower cervical vertebrae compared to the upper, which happens due to a kinetic cascade of the cervical vertebrae.^1,2

During a rear-end collision, the lower torso (i.e. the pelvis) accelerates forward first, with acceleration of the upper torso lagging momentarily behind due to the way your body is positioned within a car seat, and the resistance provided by the seat-back. Together, this produces a small rotational movement in the pelvis, and an initial flexing of the cervical vertebrae forwards. 

As the upper torso catches up with the pelvis, the lower vertebrae of the cervical spine extend, gradually followed by the upper vertebrae, leading to momentary straightening of the neck. Shortly after however, the neck once again becomes lordotic (curved), as it cannot withstand the powerful forward motion of the head. During this stage, opposing forces are acting within the cervical vertebrae - a flexion (bending) force occurs in the upper region, while an extension moment acts in the lower region. Together, these forces produce significant shear forces throughout the cervical spine, leading to straining of the soft tissues and vertebrae in the neck.

During the final stage of injury, both ends of the cervical spine align and the neck is extended. Overall, the reflexive action of the neck is actually attempting to correct these sudden changes in the spine, but this is exactly the problem and cause of injury. As the spine attempts to self-correct, too much force is applied to the soft tissue and spinal joints in the neck, leading to damage. This also causes the base of the skull to thrust forward as it follows the upper cervical vertebrae, leading to other medical symptoms and damage to the head. 

Symptoms

Symptoms of whiplash usually appear within 24 hours of injuryt, but can have a delayed appearance in the few days following trauma. Symptoms might look or feel similar to those of other medical conditions, so it’s important to visit your healthcare provider if you think that you might have whiplash. 

Symptoms typically involve the neck and head and most often include one or more of the following:

• Neck pain and stiffness - Individuals with whiplash may experience particular difficulty moving the neck and loss of range of motion. The pain might also get worse when you try to move.
• Shoulder and back pain - Pain that radiates from the neck down into the shoulders and rest of the spine.
• Headaches - Momentum causes the brain to continue moving internally while the rest of the head arrests, leading to impact on the skull. This leads to headaches, often starting at the base of the skull.
• Dizziness and fatigue - This might initially present as confusion, loss of balance, and sleeplessness.

Less common but still reported symptoms can include:

• Tinnitus (i.e. ringing in the ears)
• Blurred vision
• Memory loss
• Concentration difficulties
• Irritability

Diagnosis and treatment of whiplash

Seeking medical help

If you think there’s a possibility that you’ve got whiplash, it's important that you go and see your doctor. The vast majority of mild to moderate cases of whiplash are very treatable at home, but there could be additional damage to the structures of the body that require more specific treatment.

Diagnosing whiplash

Firstly, your doctor will likely want to perform a physical examination so that they can assess your range of motion, and check areas of tenderness for signs of more severe damage. During this initial consultation, they will ask you questions about the trauma that caused the injury, and take your medical history in order to gain a better understanding of your situation, and to rule out any previous medical conditions.

They might also order a range of imaging tests. A ‘whiplash’ injury isn’t particularly detectable in image testing, but they can help your doctor to rule out any other local injuries that you might have sustained from the trauma, and help them get a better picture of your particular situation. 

Some of the imaging tests might include:

• X-ray imaging - Most often used only when there is thought to be the possibility of a neck fracture, to create an image of the tissues and bones in your neck and head. Fracture is the greatest concern when dealing with neck trauma, but is quite unlikely in most cases.
• Magnetic resonance imaging (MRI) - Considered more versatile than X-ray imaging, MRIs prove better for evaluating soft tissues like ligaments, tendons, and the spinal cord.
• Computed tomography (CT) scan - Similar to x-ray imaging, CT scans are used to view bone and joint fractures, as well as blood clots and internal bleeding. However, they can provide a far more detailed image than an X-ray, with the added benefit of being computerised and 3-D.

Treatment

There is no definitive catch-all treatment for whiplash, so most efforts tend to focus on pain relief and restoring your full range of movement, as well as preventing further complications. 

• Medication - Over-the-counter painkillers, like paracetamol and ibuprofen, can provide much-needed relief from neck pain. You might also benefit from muscle relaxants and anti-inflammatory medication that help to loosen tight muscles. For more severe injuries, your doctor might recommend stronger prescription painkillers.
• Physical Therapy -  Doctors typically recommend that you perform a series of gentle stretching and movement exercises, such as rotating and bending your neck in all directions, tilting your head from side to side, and rolling your shoulders. The ultimate goal is to gradually rebuild strength in your neck muscles without causing additional strain.
• Alternative Aftercare - If your symptoms persist beyond a few weeks, or if the pain you experience shows no sign of improvement, you might want to consider alternative treatment methods. This could include targeted massage, chiropractic care, and electrical nerve stimulation.

Prognosis

Whiplash can be painful and can certainly get in the way of your everyday life. Thankfully, symptoms can subside in as little as a few days, and the majority of people will make a full recovery within 3 months. That being said, some people can experience persistent pain that lasts for several months or even longer, but to sustain long-term complications from whiplash is rare.

Preventing whiplash

Though there is no sure-fire way of preventing whiplash, measures can be taken to reduce the risk.

Since rear-end car accidents are the primary cause of whiplash, it’s important to be aware of the things you can do to lower the chances of it happening to you. Above all, the best way to avoid whiplash is to make sure that you adopt an appropriate seating position while driving, and the same goes for your passengers. The head restraint of your seat should be positioned directly behind your head so that its top edge is level with the top of your head and should be positioned no more than 3 inches away from the back of your head. Additionally, always make sure that everyone in the vehicle is wearing their seatbelt - it’s there for a reason! 

The very nature of some sports makes the risk of whiplash somewhat inevitable. You can, however, lower the risk by making sure that you wear appropriate protective equipment and employ proper techniques in your game. It can also be helpful to perform a warm-up routine involving neck stretching exercises, facilitating better flexibility and decreased likelihood of soft tissue strains.  

Summary

In summary, whiplash is an injury affecting the neck and head, caused by an event that produces forceful movement of the head relative to the neck, often described as a ‘whipping’ motion. There are many situations from which whiplash can arise, including injuries in sports and personal accidents like falling, but the most common cause is rear-end traffic collisions. Symptoms usually involve pain in the neck and head, as well as limitation in your range of movement, and might also include headaches, dizziness and fatigue. 

Whiplash is quite easily treatable at home, but you should always seek advice from medical professionals if you suspect that you have whiplash. Once your doctor has performed a physical examination and perhaps ordered additional testing should they feel it is needed, they will likely suggest painkillers and physical therapy to help you get back on your feet.

In the end, though whiplash can be painful and certainly frustrating, the overwhelming majority of cases are resolved with no lasting damage. Making yourself aware of preventative measures is really your best bet at making sure you avoid whiplash in the future.