Whiplash Injury: Symptoms, Diagnosis, Treatment, and Prevention

Have you ever accidentally hit an obstacle while riding a bicycle and experienced neck and shoulder pain for several days afterwards? Did you know that activities that prioritize health and fun, such as cycling, boxing, and trampolining, pose a hidden risk of neck injury?

Do not take neck stiffness and pain lightly. When the cervical spine receives a strong impact, sudden acceleration, or deceleration, it may cause whiplash injury. Patients may experience mild neck and shoulder pain, and later may develop numbness or even nerve damage, such as limb weakness, muscle atrophy, loss of sensation, severe vertebral fractures, or herniated discs causing paralysis.  In this article, we will discuss in more detail the common questions about whiplash injury for adults and juveniles, including the symptoms, diagnosis, treatment, and prevention.

How does it happen?

Whiplash injury is a common type of neck injury that can occur due to a sudden and forceful back-and-forth(jolt) movement of the neck. This can happen in:

1. A car accident
2. During sports activities, such as receiving a blow during boxing
3. Accidentally hit an obstacle while riding a bike
4. Falling off a bicycle and hitting the head while riding.
5. Gymnastics can occur during sudden, forceful head and neck movements, such as those during falls or high-velocity routines.
6. To be hit on the back of the head by someone
7. or other types of accidents that involve a sudden jolt to the head and neck area.

Quoting from Quebec Task force OTF, the definition of Whiplash-associated disorder is  "a variety of clinical manifestations following an acceleration-deceleration injury commonly resulting from a road traffic collision."

What are the symptoms of Whiplash Injury?

The symptoms of whiplash injury can vary in severity, and they may not appear until several hours or even days after the injury occurs. Common symptoms of whiplash injury include:

• Symptoms related to neck injury (Whiplash-specific symptoms):
  • Neck pain and stiffness
  • Shoulder pain or upper back pain
  • Tingling or numbness in the arms or hands
  • Jaw pain
• Other Symptoms are potentially related to a brain concussion: 
  • Dizziness or vertigo
  • Speech function compromised: mumbling
  • Difficult to focus
  • Fatigue
  • Difficulty concentrating
  • Memory problems
  • Ringing in the ears
  • Headaches, especially at the base of the skull

How to diagnose Whiplash Injury?

If you suspect that you or your child has a whiplash injury, it's essential to seek medical attention as soon as possible. A healthcare professional will typically perform a physical examination and ask about the symptoms and circumstances of the injury. They may also order imaging tests, such as X-rays or an MRI, to rule out other underlying conditions.

In addition, a healthcare professional may use a grading system to categorize the severity of the whiplash injury. This grading system is based on the severity of the symptoms and the range of motion in the neck.

What are the Treatment options for Whiplash Injury?

The treatment of whiplash injury may vary depending on the severity of the damage and the individual case. Whiplash treatment aims to control pain, restore the normal range of motion in your neck and get you back to normal activities.  Common treatments for whiplash injury include:

• Heat or Cold
• Rest:  This would be helpful for a day or two after injury, but too much rest is not encouraged.  We will cover this in the later part.
• Pain relief medication, such as over-the-counter pain relievers or prescription medications
• Injections of local anaesthetics or steroids to reduce inflammation and pain
• Physiotherapy exercises to improve the range of motion and strengthen the neck muscles
• Transcutaneous electrical nerve stimulation (TENS)
• Shockwave therapy: Shockwave therapy (is limited to muscles only, and cannot be used on joints that may affect nerves)
• Surgery: In some instances, surgery may be necessary to repair damaged tissues or spinal discs.

Shall I REST or Keep Active after an injury?

Sometimes we would learn that it is essential to stay immobilized after an accident, while sometimes, we hear the other way around, so which one is true?  The answer is both are.  It's important to note that rest and immobilization should only be done for a short period of time, as prolonged immobilization can lead to muscle weakness and stiffness. Physical therapy exercises are essential to the recovery process and can help improve range of motion and prevent scar tissue formation.

If the injury is mild ( Your doctor will tell you, so don't attempt to determine this by yourself), and there is no nerve compression.  Conducting active mobilisation is advised, meaning doing more physiotherapy and exercise. It is hoped that exercising the neck can maintain its elasticity and range of motion. Research has shown that the more exercise one does, the faster the recovery rate. Wearing a neck brace may seem like better protection for injured necks, but it stiffens the neck and slows the recovery process for patients with non-structural neck injuries. However, it is essential to note that self-exercise can be challenging to master without exacerbating the condition, so it is ideal to undergo rehabilitation under the guidance of professionals.

In addition, maintaining good posture and regular exercise can help improve the strength and flexibility of the neck muscles, reducing the risk of injury.

When is surgery recommended for whiplash injury?

Surgery plays a limited role in treating whiplash injuries and is only considered in certain specific situations or when the recovery process is poor. For example, when MRI reveals that the intervertebral disc of the cervical spine is damaged, causing instability, nerve compression, or persistent neck pain, and the pain is not just in the small joints, cervical disc fusion surgery may be recommended. If there is no obvious structural damage shown on the MRI scan, the pain could be stemming from the cervical facet joint injury. The confirmatory test is conducted by X-ray guided cervical facet joint injection test. If the joint pain remains with prolonged conservative treatment, radiofrequency neurotomy of cervical facet joints can alleviate the pain further.

Prevention of Whiplash Injury

There are several steps that you can take to prevent whiplash injury, including:

• Wearing a seatbelt while driving or riding in a car
• Adjusting the headrest in your car to the appropriate height
• Using proper techniques when playing contact sports, such as football or soccer
• Wearing protective gear, such as helmets and shoulder pads, when playing contact sports
• Avoiding activities that put undue strain on the neck, such as heavy lifting or repetitive motions

In conclusion, whiplash injury is a common type of neck injury that a sudden and forceful back-and-forth movement of the neck can cause. If you suspect that you or your child has a whiplash injury, it's essential to seek medical attention as soon as possible. Treatment options may include medication, rest and immobilization, physical therapy, and surgery in severe cases. To prevent whiplash injury, take appropriate safety measures, such as wearing a seatbelt and using proper techniques when playing sports, and maintain good posture and regular exercise.