Easing the Pain from Whiplash

Dr. Larry Levine, Alaska Spine Institute

When you hear the word whiplash, most people immediately think of a car accident. While a large percentage of those suffering from whiplash do get it from a car accident, it’s also a common sports injury and can occur when someone receives a blow to the head, slips or falls, or is hit by a falling object.

The term whiplash actually dates back to 1928, and while some have tried to change the term to more medical synonyms (acceleration flexion-extension or soft tissue cervical hyperextension), whiplash continues to be the most recognizable term for this type of injury.

What is Whiplash?
Also called neck sprain or neck strain, a whiplash is a soft tissue injury to the neck. It can include injury to intervertebral joints, discs, ligaments, cervical muscles and nerve roots, too. Whiplash is caused by an accidental motion or force being applied to your neck that results in movement beyond the neck’s normal range of motion. About 20 percent of people involved in a rear end motor vehicle accident will complain of neck symptoms and about 25 percent of these will have chronic pain.

One of the interesting things about a whiplash injury is that neck pain can be present immediately following the accident. In other cases, pain may be delayed for several days. In general, the sooner the patient feels the pain after the initial injury, the greater the chance of more serious damage.

Symptoms of whiplash include neck stiffness and pain, headache, dizziness, abnormal sensations, such as a burning or prickling (paresthesias) and shoulder or back pain. In severe cases, patients can experience cognitive, bodily, or psychological conditions usually secondary to the pain as a result of whiplash. This may include memory loss, an inability to concentrate, nervousness, irritability, sleep disturbances, fatigue or depression
Neck pain is definitely not an injury to take lightly or to decide to self-treat. Most doctors recommend bracing the neck immediately after the injury and seeing a doctor as soon as possible.

With a neck injury, X-rays are usually taken to determine the extent of the injury and to make sure there are no fractures or signs of other serious problems. Other tests will be performed including testing the patient’s physical strength, the ability to sense a touch to the skin in different areas of the body and reflexes at the joints of the arms and legs. Doctors also will look for any external signs of trauma such as bruises or cuts. Depending on the findings, further testing may be indicated.

Magnetic Resonant Imaging (MRI) a specialized scan to help better look at the nerves, discs and joints of the neck may be obtained. Electrodiagnostic studies that look at the function of nerves and muscles may help identify the location and severity of nerve injuries. A specialized x-ray known as DMX can look at the neck while it is moving to identify abnormal movement from ligamentous injuries that are difficult to see in any other way.

One would think that the speed of a car in the accident would relate to the intensity of a neck injury, but that’s not always the case. A passenger in a car going as low as 15 miles per hour at the time of impact, whether they are wearing a seat belt or not, can receive a serious whiplash injury.

With a minor whiplash, patients are instructed to minimize movements of the head and neck and to ice the neck frequently. Acetaminophen or ibuprofen can be taken to ease the pain. In more serious whiplash injuries, a mixture of therapies may be recommended. Immobilizing the neck with a soft collar, neck massage, ice, and oral pain relievers usually do the trick. About 72 hours after the injury, it can be a good idea to try heat therapy to restore flexibility and to avoid neck strain activity for a week, followed by slow increases in activity over the next few weeks.

Continued neck pain, headaches, increased fatigue, shoulder or arm pain, back pain, blurred vision, dizziness or difficulty in sleeping may be indicators of a bigger problem. More serious symptoms seem to be present for people who had a more rotated or inclined head position at the time of impact injury.

Because whiplash injuries can be very different, there isn’t a “one-size-fits-all” solution. A variety of approaches – from acupuncture and massage to steroid injections and nerve blocks can be effective. Accupuncture may provide pain relief and this method is recommended more for patients who respond well to modalities. Massage and/or rolfing also can relieve muscle spasms and tightness and help restore mobility.

Visiting a chiropractor can be helpful, especially in the 12 weeks following a whiplash injury. A good chiropractor sees a lot of whiplash cases and can be successful in helping a patient regain range of motion in sub-acute and chronic cases.

Many of the patients seen at Alaska Spine Institute benefit from a combination of treatments. If further testing is required to best direct care, it can usually be obtained in the Alaska Spine Institute on the day of your first appointment.

Physical therapy is an important component to whiplash care. Professionals, who have a strong educational background in how to treat whiplash, should design the exercise routine and supervise each workout. Some patients enthusiastically stick to a regimented physical therapy program and see great results. Others need to be realistic in how willing or able they are to commit to the workout regimen. In general, physical therapy is one of the best ways to regain lost range of motion and to find relief from the stiffness that plagues whiplash sufferers. This approach also works for a wide range of injuries, from acute to sub-acute and chronic whiplash injuries.

In resistant cases injections to the affected joints or nerves can be done often offering significant relief from neck and shoulder pain as well as headache pain. Epidural steroid injections or selective nerve root block injections can help to relieve whiplash cases that involve pinched nerves, irritated nerves (chemical radiculitis) or herniated discs. In the most severe cases, this treatment can help a patient to avoid surgery and to ease the soreness and stiffness.

Electrical treatments such as use of a TENS unit (transcutaneous electrical nerve stimulation) or e-stim can provide pain relief by helping to relax muscles that are tight or in spasm. This can be an excellent option for patients who want to stay away from medications. The treatment works in two main ways. First, it can provide a stimulation that your body interprets as a tingling or buzzing instead of pain. Second, it can artificially make the muscle contract breaking up the spasm cycle.

For whiplash patients who have a herniated disc that doesn’t respond to more conservative treatment or for those with bony arthritis or instability, surgery may be the last resort. It is a good solution for very specific cases and in some instances is the only viable solution. Doctors usually will try other methods before recommending surgery. Patients should make sure they have tried other solutions or are sure that a proper prognosis has been made. Find a skilled surgeon who has lots of experience in whiplash treatment, and who will stick with you through the recovery and physical therapy required following surgery.

Avoiding Whiplash Injury
Simple ways to avoid whiplash injuries include always wearing your seat belt in the car. Also, adjust the headrest in the car to the proper height when driving. The middle of the headrest should be even with the upper tips of your ears. While this won’t prevent whiplash, it may keep the injury to a minimum, and the headrest will reduce the risk of more serious injury or death during a car accident. The effect of air bags on whiplash prevention is still being studied. When playing sports, use the required protective gear and avoid high contact sports that can result in a high impact blow to the upper body.

While no absolutely reliable way exists to predict an individual’s prognosis, the long-term outlook for someone suffering from whiplash is good. The majority of neck and head pain subsides within a few days or weeks. In most cases recovery time is rarely longer than three months. For those patients experiencing lingering neck pain and headaches, you are, unfortunately, in the approximately 25 percent of people who will suffer chronic pain. Official statistics show that whiplash patients have a 40 percent chance of experiencing some symptoms after three months, and an 18 percent chance after two years. If you do suffer from whiplash, qualified help is available locally and a variety of approaches can ease the pain. Even in the chronic cases of whiplash, there are treatment options at The Alaska Spine Institute to help ease and manage the pain.