Whiplash (cervical strain or neck strain) is an injury involving the soft tissues of the neck region. The most common cause of whiplash is a rear-end automobile accident. Whiplash occurs when the head is jerked forward and then backward in a violent motion, much like cracking a whip.
What symptoms are associated with whiplash?
Most people will not experience neck pain immediately after the accident or injury. However, 1-3 days later, symptoms appear. Along with neck pain, the patient will have limited neck range of motion, cervical stiffness, dizziness, headache, sleep disturbance, trouble concentrating, paresthesias (abnormal sensations of prickling, tingling, and/or burning), and problems swallowing. Many people who suffer a cervical strain have bruising of the myofascial tissues (muscles and ligaments).
What causes whiplash?
The cervical spine is supported by soft tissues (muscles and ligaments), as well as intervertebral discs (quarter-sized cushioning components). Excessive neck motion causes soft tissue stretching and mild tearing. Pre-existing musculoskeletal conditions and advancing age may increase the severity of whiplash.
How is whiplash diagnosed?
After an injury or major trauma, the doctor will inquire about the accident, take a medical history, and conduct a thorough physical examination. To rule out fracture of the spine, x-rays are done. To assess soft tissue structures, such as intervertebral discs, muscles, and ligaments, a magnetic resonance imaging (MRI) scan and/or computed tomography (CT) scan are often included in the workup.
How common is cervical strain?
It is estimated that around one million people are treated for whiplash each year in the United States alone.
How is whiplash treated?
The treatment of a cervical strain depends on the patient’s symptoms, what injuries are involved, the health of the patient, and the severity of the pain. Options include:
- Cervical collar – A soft, cervical support collar is usually recommended for 2-3 weeks. This supports the cervical spine and prevents further spine injury.
- Physical therapy – The therapist will initially use heat therapy to relieve muscle pain and tension. Other pain relief measures include electrical stimulation, massage, and ultrasound. Strengthening and flexibility exercises are used to restore strength and cervical spine function.
- Medications – For pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed, including naproxen, ibuprofen, and ketoprofen. Muscle relaxants are used to relieve muscle spasms and tension. Examples include Baclofen and Flexeril. For severe pain, narcotic painkillers are given short-term.
- Cervical epidural steroid injection (ESI) – The doctor can inject a corticosteroid agent, with or without an anesthetic, into the space around the spinal cord. This decrease nerve root inflammation and irritation to relieve pain. In a recent medical study of 70 people with neck pain related to disc pathology, 92% reported successful relief of symptoms with ESI.
- Trigger point injections (TPIs) – The doctor can inject the tense, spasming muscles of the upper neck and shoulder region. Agents used in these injections include bupivacaine and lidocaine (anesthetics), prednisolone and dexamethasone (corticosteroids), and botulinum toxin A (Botox). TPIs will deactivate painful myofascial trigger points. In a large systematic review of studies, TPIs were found to be superior to placebo for relief of myofascial pain.
- Medial branch block – The doctor can use fluoroscopy (real-time x-ray) to insert a needle near the affected cervical nerve root. An anesthetic or neurolytic agent is injected onto the nerve to block pain signal pathways. Radiofrequency ablation can be used to deaden the nerve root to offer long-term pain relief. A review of randomized clinical trials found this procedure to have a 92% efficacy rate.
- Chiropractic care – The pain management specialist may refer you for chiropractic care. The chiropractor can perform spinal manipulation and adjustments, which are maneuvers to provide pain relief.
- Acupuncture – The practitioner can insert fine, tiny needles into the skin and muscles of the upper shoulder and neck region. With this Chinese therapy, the body releases endorphins, which are natural pain relievers. Acupuncture is also used to stimulate healing and restore body energy. In a study of 27 patients with whiplash injury, acupuncture was found to have positive results.