Introduction

Whiplash is an injury in the area of the cervical spine. It is caused by sudden, jerky bending and overextension of the head due to an unexpected force. Whiplash is also called whiplash phenomenon, or acceleration trauma of the cervical spine. 

Most often, whiplash is caused by a car accident with rear-end collision (rear-end collision). However, whiplash can also be caused by sports accidents, falls or other violent impacts on the cervical spine.

The majority of those affected can be treated successfully with specific exercises and medication. After a few weeks, they hardly show any symptoms. However, some patients experience a less pleasant course and develop chronic neck pain that can accompany them for years.

Typical Symptoms

The typical signs and symptoms of whiplash usually develop within days after the neck injury. Patients often complain about the following symptoms:

• Pain and stiffness in the neck
• Increased neck pain with movement
• Range of motion in the neck is significantly reduced
• Headache, in the area of the back of the head
• Pain also in the shoulders and upper back area
• Tingling and/or numbness in the arms
• Fatigue and difficulty concentrating
• Dizziness

Some patients also report other symptoms:

• Blurred vision
• Tinnitus complaints
• Sleep disturbances
• Increased irritability
• Memory problems

Factors influencing pain chronification

Most people with whiplash can be successfully treated with specific exercises and medication, so that they have hardly any symptoms after a few weeks. However, some patients experience a less pleasant course and develop chronic neck pain, which can accompany them for years.

It is difficult to predict how a patient will recover from whiplash. However, it seems that patients with rapid onset of severe symptoms often have a less favorable outcome and are more likely to suffer from chronic pain later on.

Disadvantageous signs for a later pain chronification can be:

• Rapid onset of severe neck pain
• Significant restriction of the range of motion in the cervical spine
• Pain radiating into the arms

In addition, the following risk factors are associated with a worse course of a whiplash injury:

• A previous, recovered whiplash injury
• Increased age
• Pre-existing back pain
• High-speed accident

Diagnosis

The focus is on a precise anamnesis and a systematic physical examination. Imaging / radiological methods can occasionally play a role in the diagnostic process. However, it is important to understand that X-ray examinations, computer tomographies and also MRI examinations usually do not provide direct evidence for the possible presence of whiplash.

Conservative treatment

Most patients who suffer a whiplash injury experience an improvement in their symptoms in the first weeks and months after the triggering event. During the first days and weeks after a whiplash injury, pain management and the restoration of normal mobility are at the centre of all therapeutic efforts. The aim is to enable patients to return to their usual activities as soon as possible. The healing process is positively influenced by the selective use of medication and suitable neck exercises. In addition, physical measures such as heat or cold applications as well as electrical treatment with TENS can be helpful.

What to do in case of chronic course?

Unfortunately, some patients with whiplash are affected by a chronic course. These patients often suffer from persistent severe neck pain and have a poor quality of life. After six months at the latest, it should be determined whether irritation of the facet joints of the cervical spine (small vertebral joints) is the cause of the persistent whiplash symptoms. For this purpose, ultrasound- or X-ray-controlled test injections are recommended as part of a routine procedure. If the typical neck pain disappears as a result of a test injection, treatment with radiofrequency can often provide lasting relief from pain or even painlessness.

References

Tegenthoff M. et al., Beschleunigungstrauma der Halswirbelsäule, S1-Leitlinie, 2020, in: Deutsche Gesellschaft für Neurologie (Hrsg.), Leitlinien für Diagnostik und Therapie in der Neurologie. Online: www.dgn.org/leitlinien

Manchikanti, L., Singh, V., Rivera, J., & Pampati, V. (2002). Prevalence of cervical facet joint pain in chronic neck pain. Pain Physician, 5(3), 243-249.