A traumatic neck injury, whiplash is caused by a sudden movement of the head forwards, backwards or sideways. It often occurs in road traffic accidents.
Introduction
Symptoms of whiplash
Causes of whiplash
Diagnosing whiplash
Treating whiplash
Complications of whiplash
Introduction
The vigorous movement of the head damages the ligaments and tendons in the neck. Tendons are tough, fibrous bands that connect muscles to bone. Ligaments are the fibrous connective tissues that link two bones together at a joint.
Neck sprain
During whiplash, the ligaments in the neck are sprained. A sprain occurs when a ligament is overstretched. Although the ligament is not broken, a strain can often take a long time (sometimes several months) to heal.
Whiplash typically causes pain, stiffness and a loss of movement in the neck. Headaches, muscle spasms and pain in the shoulders or arms are also possible symptoms.
How common is whiplash?
Whiplash is a common injury that often occurs following road accidents, when a collision (usually from behind) jolts the head backwards before it then “whips” forwards.
Motor vehicle accidents do not have to be severe for a person to develop whiplash, with neck pain and associated injuries often developing following low-speed collisions.
Whiplash tends to affect women more than men because their neck muscles are often weaker.
In rare cases, whiplash can also sometimes occur following a violent blow to the head – for example, after a fall or during contact sports such as boxing and rugby.
Outlook
The outlook for whiplash will vary depending on how severely the neck has been sprained.
The recovery time may take a few weeks if the neck ligaments and tendons are only slightly damaged. However, in severe cases, whiplash and whiplash-associated injuries can last for several months or even years.
One study found that the average recovery time for a whiplash injury without any other associated symptoms was 32 days, and that out of 2,627 participants 12% had not recovered six months later (chronic whiplash).
Symptoms of whiplash
Whiplash can be categorised as:
- acute whiplash – where there is sudden hyperextension, hyperflexion or rotation of the neck that causes neck pain and other symptoms
- chronic whiplash – where symptoms persist for more than six months after an acute whiplash injury and are characterised by a number of specific symptoms (see below)
Hyperextension and hyperflexion are where the tendons and ligaments of the neck are forcefully extended or flexed beyond their normal limits.
Following an accident, the symptoms of whiplash often take a while to develop. Any inflammation (swelling) and bruising that occurs in the neck muscles will not usually be evident at the time of the accident.
It may take 6-12 hours for the symptoms of whiplash to become apparent, and the neck pain and stiffness is often worse on the day after the injury. The pain may continue to worsen for several days afterwards.
The common symptoms of whiplash include:
- neck pain and stiffness
- neck swelling
- tenderness along the back of the neck
- reduced movement in the neck or loss of movement
- headaches
Other symptoms of whiplash can include:
- lower back pain
- pain, numbness or paraesthesia (pins and needles) in the arms and hands
- muscle spasms
- dizziness
- tiredness
- difficulty swallowing (dysphagia)
- blurred vision
- vertigo – the sensation that you are moving or spinning while standing still
- tinnitus – the perception of noise in one ear, both ears or inside the head
Following a whiplash injury, the symptoms of dizziness, headaches, blurred vision and problems with swallowing should only last a short while. Visit your GP if any of these persist.
Sometimes, whiplash can also cause:
- memory loss
- poor concentration
- irritability
Chronic whiplash
The symptoms that are associated with chronic (long-term) whiplash are:
- neck pain and stiffness
- persistent headache
- dizziness
- paraesthesia in the upper limbs (arms) and hands
- psychological and emotional symptoms, such as anxiety and depression
See Whiplash – Treatment for more information and advice about the treatments that are suggested for chronic whiplash.
Driving
Avoid driving if you have neck pain and stiffness that prevents you from turning your head quickly. See the Directgov website for the medical rules for drivers.
Causes of whiplash
Whiplash occurs when there is a sudden jerk or jolt to your head that causes it to move violently away from your body. The force of the movement makes your neck move beyond its normal range of movement, so that the ligaments, tendons and muscles in your neck are overstretched.
Motor vehicle accidents
Car and motorcycle accidents are a common cause of whiplash because they often involve a sudden stopping force or a collision that makes your head move violently away from your body.
As whiplash can occur when your head is thrown forwards, backwards or sideways, the condition can develop following collisions from the front, back or side. Collisions that occur at low speed can also cause whiplash.
Other causes
As well as road accidents causing whiplash, it can also occur from:
- a sudden blow to the head – for example, during contact sports such as boxing or rugby
- a slip or fall where the head is suddenly and violently jolted backwards
- being struck on the head by a heavy or solid object
Whiplash injuries in children can sometimes be a sign of child abuse. If a child is shaken violently, it can cause their head to jolt backwards, forwards and sideways, resulting in sprained ligaments and tendons in their neck.
Diagnosing whiplash
Tests and scans are not usually required to diagnose whiplash. The condition can usually be diagnosed from a description of your symptoms.
Visit your GP if you have recently had a road accident or a sudden impact to your head and you are experiencing pain and stiffness in your neck.
When making a diagnosis, your GP will ask you about your symptoms and details of how the injury happened.
Physical examination
Your GP may carry out a physical examination of your neck to check for signs of muscle spasms, tenderness and whether there is any pain when you move your limbs.
They may also decide to assess the range of movement in your neck if they think that your injuries are relatively minor and that moving your neck will not cause any further damage.
An X-ray, computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan will only usually be recommended if another problem, such as a spinal injury, is suspected.
Treating whiplash
Whiplash is often a self-limiting condition, which means that it will eventually get better following some basic or minimal treatment. Short-lived whiplash is sometimes referred to as an acute whiplash injury.
Other cases of whiplash can cause a wide range of troublesome symptoms that are often severe and last for a considerable length of time. Whiplash that lasts for six months or more is sometimes known as chronic whiplash or late whiplash syndrome.
Treatments for both are outlined below.
Acute whiplash
Research has shown that if you have severe pain at the time of your injury, and you later experience a variety of symptoms, your recovery time is likely to be longer and your chances of developing chronic whiplash are greater.
There is no clear-cut evidence about the best way to treat an acute whiplash injury because most of the studies that have been carried out to date have been of poor quality.
Mobilisation
However, most healthcare professionals agree that active interventions, such as neck exercises and keeping the neck mobile, are better than inactive interventions, such as resting the neck and keeping it still by using a neck brace or collar.
Even though you may experience a considerable amount of pain, keeping your neck mobile from an early stage will help to improve its functionality and speed up your recovery.
Resting your neck and keeping it still is likely to prolong your symptoms and delay your recovery. Any pain that you experience when moving your neck is normal and will not cause further damage.
Medication
Analgesics (painkillers), such as paracetamol, can be used to help relieve the pain of an acute whiplash injury.
Paracetamol is usually recommended as the first painkiller to treat mild to moderate pain. For neck pain, regular use of paracetamol is thought to be more effective than only using it when the pain is at its worst. If your pain is severe, your GP will be able to prescribe a stronger painkiller, such as codeine. Codeine can also be used in combination with paracetamol to provide increased pain relief.
Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), can ease pain and reduce inflammation.
Always follow the manufacturer’s recommended dosage instructions when taking painkillers and NSAIDs. Do not take ibuprofen if you have a peptic ulcer (an open sore on the inside lining of the stomach) or if you have had one in the past. Also avoid taking it if you have severe heart failure (where the heart does not pump blood around your body effectively) or severe liver disease.
There are also a number of other health conditions where ibuprofen should only be used with caution.
Physiotherapy
If your whiplash symptoms continue to give you problems for several weeks following your injury, your GP may recommend trying physiotherapy.
Physiotherapy uses a variety of physical methods, such as massage and manipulation, to promote healing and wellbeing. It can often help to restore a person’s range of movement following an injury such as whiplash.
As well as helping to relieve pain and stiffness in your neck using massage and manipulation, your physiotherapist will also be able to advise you about neck exercises that you can do at home.
See Physiotherapy to find out more.
Chronic whiplash
Whiplash that persists for six months or longer is known as chronic whiplash. As with acute whiplash, there is little in the way of concrete evidence to suggest what the best approach for treating chronic whiplash is, and which treatments are most effective.
However, similarly to acute whiplash, if you have chronic whiplash it is recommended that you keep your neck mobile and continue with your normal daily activities.
For chronic whiplash, a treatment plan should be based on your specific set of symptoms and should focus on dealing with the cause of your pain.
Medication
As with acute whiplash, a number of different painkillers may be recommended to provide pain relief. The specific type of painkiller recommended for you will depend on the severity of your pain and how long it usually lasts.
In some cases, paracetamol or ibuprofen taken as and when required will often provide sufficient pain relief. If not, you may need to take them more regularly.
If your pain is more severe or prolonged, your GP will be able to prescribe a stronger painkiller, such as codeine, which can be used on its own or in combination with paracetamol or ibuprofen. When using paracetamol or ibuprofen, always follow the dosage instructions provided by the manufacturer.
Anxiety and depression
Whiplash that lasts for several months or longer can sometimes cause anxiety and depression. If the injury was the result of a motor vehicle accident, sorting out the damage to your vehicle and dealing with compensation claims can often be stressful and time-consuming.
If your symptoms are particularly painful or chronic (long-lasting), you may begin to feel depressed. It is important to try to remain positive and focus on your treatment objectives. However, if you begin to feel depressed, visit your GP who will be able to recommend treatment.
Your GP may refer you to a specialist pain clinic for further assessment and treatment, or they may recommend that you see a psychologist for counselling. Alternatively, they may refer you for a short course of cognitive behavioural therapy (CBT), where a therapist will help you to manage your problems by changing how you think and behave.
Self-care
As well as keeping your neck mobile and using medication to reduce pain, the self-care measures listed below may also help you to manage the pain and stiffness in your neck and prevent them from getting worse.
- Good posture. You should maintain a good, upright posture by keeping your back straight while you are sitting, standing and walking. If you spend a considerable amount of time using a computer, you should ensure that your chair and computer screen are correctly adjusted.
- Supportive pillow. Some people find that a firm, supportive pillow helps when sleeping. You should avoid using more than one pillow.
- Yoga. Doing controlled exercises and stretches will help you to improve your strength and posture. However, there is no evidence to suggest that they help to reduce neck pain.
Complications of whiplash
Chronic whiplash
With time, most cases of whiplash eventually get better without any lasting damage. However, in a small number of cases, the pain caused by whiplash can last for six months or longer. This is known as chronic whiplash.
If you have prolonged pain, you may find it difficult to carry out daily activities and enjoy leisure time. It may also cause problems at work and could lead to anxiety and depression.
See your GP if you have chronic neck pain that is causing problems with work and carrying out normal, everyday activities.
Other injuries
In cases where whiplash occurs as the result of a road traffic accident, you may also have other injuries, such as chest pain or bruising on your chest, caused by the restraining force of your seat belt.
Correctly adjusting the headrests in your car may help to prevent whiplash by stopping your head from moving backwards. It is difficult to prevent your head moving forwards or sideways.
See the Royal Society for the Prevention of Accidents (RoSPA) road safety information for advice about how to adjust your head restraint (pdf).