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What is Whiplash?

Whiplash is a term that is used to describe an injury to the muscles, tendons and other soft tissues of the neck. Any impact that causes the head to suddenly accelerate or decelerate can cause symptoms of whiplash.

 

Rear collision motor vehicle crashes are the most common cause of whiplash injuries. Whiplash injuries can also occur in other situations where the body is exposed to sudden starts and stops such as contact sports like football, rugby or soccer. Neck sprain or neck strain are other terms that are used to describe whiplash injuries.

Did you know?

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The Symptoms of Whiplash Injury

The symptoms of Whiplash Injury often include pain, decreased mobility of the neck, tenderness, headaches and problems of concentration and memory.

Pain

Whiplash injury is a painful injury. As a result of the impact that caused the injury, there may be bruising or tearing of the soft tissues in the neck region, contributing to symptoms of pain. The pain of whiplash might be localised in the neck, or may also extend to the shoulders, and upper arms. Many individuals who have sustained whiplash injuries also report pain in the lower back region.

Decreased Mobility of the Neck

The uninjured neck has considerable mobility in several directions. The neck can move up and down (flexion-extension), side to side (lateral flexion) and can rotate (rotation). These movements are often restricted following a whiplash injury. There is a natural tendency for muscles to contract when the neck is painful. This contraction is the body’s way of trying to protect itself against further injury.

Tenderness of the Injured Area

Whiplash injury is considered to be an ‘overload’ injury. As a function of the excessive forces that impacted on the neck in the motor vehicle crash, elongation, bruising or tearing of the soft tissue can occur. In turn, the soft-tissue injuries can lead to inflammation and edema (e.g., swelling).  Inflamed and swollen tissues are more ‘tender’ in that they are more sensitive to touch. Following a whiplash injury, areas of tenderness can include regions of the neck, shoulders and upper arms.

Headaches

Whiplash injury can also cause headaches. Headaches of whiplash injury may differ from tension or migraine headaches. Whiplash headaches, are more likely to occur at the top or the back of the head as opposed to regions around the eyes or the side of the head. Whiplash headaches can be intermittent or constant.

Memory and Concentration Problems

Individuals who have sustained whiplash injuries sometimes report problems with memory and concentration. If the head was struck during the crash that caused the whiplash injury, it is possible that the memory or concentration problems might be due to concussion. If the head was not struck, the memory and concentration problems are most likely due to the distracting effects of pain or anxiety.

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The Treatment of Whiplash Injury

A number of treatments have been developed to manage the symptoms of whiplash injury.  Some of the more common treatments described below include:

  • Advice to remain active
  • Education
  • Medication
  • Physiotherapy
  • Treatment of Mental Health Problems

It is important to note that, although there are many different treatment options available for the management of whiplash injury, not all have been shown to be effective. It is also important to note that even though a certain treatment might have been shown to be effective, it might not be the right treatment for you.

It is best to have an in-depth discussion with your GP or physiotherapist to determine the best treatments for the symptoms you are experiencing. The treatment descriptions below are provided solely for the purpose of information, not as treatment recommendations.

At the bottom of this page, you can also access a Whiplash Treatment Options Resource and a Whiplash Self Help Guide. Recover Researcher developed these resources to assist you in your discussions with your healthcare provider about the treatment of whiplash.

Advice to Remain Active

Many GP’s and physiotherapists will recommend to their patients that they try to remain as active as possible during the recovery period.  While such advice might not appear to be much of a treatment, the advice is nevertheless a critical element in ensuring optimum recovery.

When people are injured and are experiencing pain and discomfort, there is a tendency to reduce one’s participation in important activities of daily life. As a result of pain or discomfort, individuals might reduce their participation in family or home activities, in recreational activities and individuals might also discontinue their occupational activities.

Reducing activity sometimes feels like the right thing to do because it is associated with a reduction in pain.  But there lies the trap.  Activity reduction is probably the worst thing to do in the management of a whiplash injury.  While activity reduction might reduce pain and discomfort in the short term, in the long term, activity reduction will likely lead to more severe pain, and more severe disability.

Muscles need to move to remain healthy.  Individuals who discontinue the important activities of their daily lives, or individuals who spend excessive time resting or lying down will actually recover more slowly.  Slowing down a little bit makes sense during the initial days of recovery, but lying down or bed rest should be avoided.  Remaining active is the best formula for optimal recovery.

Education

It is becoming increasingly clear that education is an important element of the management of whiplash injury. A GP or a physiotherapist might choose to spend some time explaining to a patient exactly what whiplash is and describe the pros and cons of different treatments.

One of the benefits of education is that it can help reduce anxiety. The experience of severe pain and symptoms of stiffness and headaches can be alarming. The injured person might think, ‘there must be something seriously wrong with my neck’, ‘if it hurts this much, there must be a lot of damage’, ‘when I move, it hurts more, so I should probably not move’. Thoughts like these will create anxiety or fear. In turn, anxiety and fear will lead the person to discontinue even more of their activities.

The GP or physiotherapist might wish to educate the injured person about why he or she is experiencing a lot of pain, to explain that the symptoms of whiplash will recover over time, and to explain the importance of remaining as active as possible.

The GP or physiotherapist might also wish to educate the injured person about the relation between pain and injury severity.  We often assume that if the pain is severe, this must mean that the injury is severe. But with whiplash injury that is not the case. The pain of whiplash can be very severe, but that does not mean that severe or irreparable damage has been done to the neck. The majority of whiplash injuries are not considered ‘medically serious’; the pain might be initially severe, but the pain dissipates over time.

Physiotherapy

Physiotherapy is another commonly used approach to treating whiplash injury.  A physiotherapist might use a variety of treatment techniques to manage the symptoms of whiplash. Initially, the physiotherapist might use modalities such as manual therapy or ice to reduce the swelling and inflammation of the injured areas.  The physiotherapist will also provide the injured person with exercises to improve or maintain the movement in their neck as well as strength and control of the muscles in their neck and upper body.  This in turn will help increase the person’s tolerance for participation in household, recreational and occupational activities.

As the injured person begins to be more physically active, it sometimes happens that their pain and discomfort might increase. This increase in pain is usually caused by engaging muscles that have remained inactive or immobile for extended periods of time. The pain associated with increasing activity is temporary and will usually subside in a day or two.

Medication

The two most frequently prescribed medications for whiplash injury are anti-inflammatories and analgesics.  Following a whiplash injury, the soft-tissues of the neck and shoulders can become inflamed. Inflammation often leads to increased stiffness and pain. Anti-inflammatories reduce swelling of the injured soft tissues, and reduce pain as well. Inflammation is typically only present in the first few weeks following injury so anti-inflammatories tend not be used for long term pain management.

There are two main types of analgesics that might be prescribed for pain caused by whiplash injury. There are non-steroidal analgesics such as aspirin or paracetamol (Panadol), and there are opiate analgesics such as codeine. Analgesics can be useful treatments to manage the pain of whiplash injury in the short term, but long-term use is typically not recommended. Long-term use of paracetamol can cause stress on liver function.  Long-term use of opiate analgesics can lead to gastro-intestinal problems, and of even more concern, these medications can lead to problems of addiction.

Treatment of Mental Well Being

Some individuals with whiplash injuries might develop symptoms of a mental health problem. The most common mental health problems associated with whiplash injury include depression, anxiety and post-traumatic stress symptoms. If an injured person is experiencing troubling symptoms of depression, anxiety or post-traumatic symptoms, the GP might consider prescribing medication such as an anti-depressant or anti-anxiety medication. Since the presence of symptoms of a mental health problem can slow the rate of recovery following whiplash injury, these medications can play an important role in the successful management of whiplash injury.

If you have developed symptoms of a mental health problem following your whiplash injury, your GP might also consider a referral to a mental health professional such as a psychologist or a social worker. Psychologists and social workers can provide counselling or psychotherapy that can be useful in managing some of the mental health consequences of whiplash injury. Your GP can familiarize you with the mental health services that are available in your community.

Other Treatment Approaches

There are many other types of treatments that have been used in the management of whiplash injury. Some of these include manipulation, dry needling, electrical nerve stimulation, traction, ultrasound among many others.

It is difficult to make strong statements about the utility of these treatments since so little research has examined whether they are effective. Injured individuals who are slow to recover might reach a level of desperation where they are willing to try anything. It is important to remember that unless a treatment has been shown to be effective in a clinical trial, there is always the possibility that the treatment might not be helpful, or could actually worsen the condition.  Before starting any treatment for your whiplash injury, it is best to discuss with a GP or medical specialist the treatment options that are most appropriate for your condition.

Treatment Options

Recover researchers have developed a Whiplash treatment options resource. The resource is designed to assist you in your discussions with your healthcare provider about the treatment of Whiplash

Whiplash Self Help Guide

Leading clinical researchers from the University of Queensland and Griffith University developed the Whiplash Injury Recovery Self Help Guide. This booklet aims to help people who have a whiplash injury on the road to recovery. It provides information about whiplash associated disorders, an exercise program which may assist in recovery and advice on how to manage your daily life to prevent unnecessary strain on your neck and aid recovery. The booklet is a self-help resource to aid recovery and to supplement any care provided by a health care practitioner.

The Motor Accident Insurance Commission (MAIC) has published this booklet for your information only. It is not intended for use as a substitute for the advice of a health professional.

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