Whiplash

Whiplash is a term used to describe a neck injury caused by a sudden movement of the head forwards, backwards or sideways.

Introduction

Whiplash is a term used to describe a neck injury caused by a sudden movement of the head forwards, backwards or sideways.

It often occurs after a sudden impact such as a road traffic accident. The vigorous movement of the head damages the ligaments and tendons in the neck.

Tendons are tough, fibrous bands that connect muscles to bone. Ligaments are the fibrous connective tissues that link two bones together at a joint.

Common symptoms of whiplash include:

  • neck pain and stiffness
  • tenderness over the neck muscles
  • reduced and painful neck movements
  • headaches

After an accident, the symptoms of whiplash often take a while (6-12 hours) to develop.

The neck pain and stiffness is often worse on the day after the injury and may get worse for several days afterwards.

Read more about the symptoms of whiplash.

Causes of whiplash

Road accidents are the main cause of whiplash, but it can also occur following:

  • a sudden blow to the head – for example, during contact sports such as boxing or rugby
  • a slip or fall where the head is suddenly and violently jolted backwards
  • being struck on the head by a heavy or solid object

Read more about the causes of whiplash.

Diagnosing whiplash

Whiplash can usually be diagnosed from a description of your symptoms. Tests and scans are not usually required.

Visit your doctor if you have recently had a road accident or a sudden impact to your head and are experiencing pain and stiffness in your neck.

Your doctor will ask about your symptoms and details of how the injury happened. They may also examine your neck for signs of muscle spasms, tenderness and to assess the range of movement in your neck.

X-rays and scans, such as computerised tomography (CT) or magnetic resonance imaging (MRI), will usually only be recommended if a fracture or other problem is suspected.

Treating whiplash

Whiplash is often a self-limiting condition, meaning it eventually gets better on its own or after some basic treatment.

If you have whiplash, it is better to move your neck rather than keep it still using a neck brace or collar. Your neck may be painful, but keeping it mobile from an early stage will improve its functionality and speed up your recovery.

Painkillers, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be used to help relieve the pain.

Whiplash that lasts for six months or more is sometimes known as chronic whiplash or late whiplash syndrome.

Your treatment plan should be based on your symptoms. If you have severe pain, your doctor can prescribe a stronger painkiller, such as [codeine] or recommend physiotherapy.

Read more about how whiplash is treated.

Complications

In many cases, whiplash will eventually get better without any lasting damage. However, in a small number of cases, the pain can last for six months or longer (chronic whiplash).

If you experience prolonged pain, you may find it difficult to carry out daily activities and enjoy your leisure time. It may also cause problems at work and could lead to [anxiety] and depression.

Visit your doctor if you have chronic neck pain that is causing problems with work and carrying out normal, everyday activities.

Read more about the complications of whiplash.

Symptoms

Whiplash causes pain, stiffness and loss of movement in the neck. You may also experience headaches, muscle spasms and pain in your arms or shoulders.

If you have whiplash, the ligaments in your neck will be overstretched. This is known as a sprain.

Hyperextension and hyperflexion are where the tendons and ligaments of the neck are forcefully extended or flexed beyond their normal limits.

Although the ligament is not broken, a sprain can often take a long time (sometimes several months) to heal. After an accident, the symptoms of whiplash often take a while (6-12 hours) to develop.

Any inflammation and bruising that occurs in neck muscles will not usually be evident at the time of the accident.

Neck pain and stiffness is often worse on the day after the injury and may continue to get worse for several days afterwards.

Whiplash is usually short lived and self-limiting, but in a small percentage of people symptoms persist beyond six months when the condition becomes chronic.

Common symptoms of whiplash include:

Less common symptoms of whiplash can include:

  • lower back pain
  • pain, numbness or pins and needles (paraesthesia) in your arms and hands
  • muscle spasms
  • dizziness
  • tiredness
  • blurred vision
  • vertigo – the sensation that you are moving or spinning while standing still

Following a whiplash injury, the symptoms of dizziness, headaches and blurred vision should only last a short period of time. You should visit your doctor if any of these persist.

Sometimes, whiplash can also cause memory loss, poor concentration and irritability.

Chronic whiplash

Symptoms associated with chronic (long-term) whiplash are:

  • neck pain and stiffness
  • persistent headache
  • dizziness
  • pins and needles (paraesthesia) in the arms and hands
  • psychological and emotional symptoms, such as anxiety and depression

Read more about how chronic whiplash is treated.

Causes

Whiplash occurs when your head is suddenly jerked or jolted, causing it to move violently backwards, forwards, or sideways.

The force of the motion makes your neck move beyond its normal range of movement, overstretching the ligaments, tendons and muscles.

Motor vehicle accidents

Car and motorcycle accidents are a common cause of whiplash because they often involve a sudden stopping force or collision that makes your head move violently.

As whiplash can occur when your head is thrown forwards, backwards, or sideways, the condition can develop following collisions from the front, back or side. Low speed collisions can also cause whiplash.

Other causes

As well as road accidents, whiplash can also be caused by:

  • a sudden blow to the head – for example, during contact sports, such as boxing or rugby
  • a slip or fall where the head is suddenly and violently jolted backwards
  • being struck on the head by a heavy or solid object

Treatment

In many cases, whiplash will eventually get better on its own or after some basic treatment.

However, sometimes whiplash can cause a number of severe and troublesome symptoms that last for a long time.

Whiplash that lasts for six months or more is sometimes known as chronic whiplash or late whiplash syndrome.

Mobilisation

If you have whiplash, it is important you keep your neck mobile by doing some gentle neck exercises.

Your neck may be painful, but keeping it mobile from an early stage will improve its functionality and speed up your recovery. Any pain you experience when moving your neck is normal and will not cause further damage.

Resting your neck and keeping it still is likely to prolong your symptoms and delay recovery. Therefore, using a neck brace or collar is not recommended.

Painkillers and anti-inflammatories

Analgesics (painkillers) can be used to help relieve the pain of a whiplash injury.

Paracetamol is recommended to treat mild to moderate neck pain. You should use it regularly rather than only when the pain is most severe.

If you have severe neck pain, your doctor will be able to prescribe a stronger painkiller, such as [codeine]. This can be used on its own or in combination with paracetamol to provide increased pain relief.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also be used to help ease pain and reduce inflammation.

Always follow the manufacturer’s recommended dosage instructions when taking painkillers and NSAIDs. Avoid taking ibuprofen if you have a stomach ulcer, or if you have had one in the past. Also avoid taking ibuprofen if you have severe heart failure or liver disease.

Read more about the considerations when using ibuprofen.

Physiotherapy

If your symptoms of whiplash continue for several weeks, physiotherapy may be recommended.

Physiotherapy uses a range of physical techniques, such as massage and manipulation, to help restore function and movement. It can often help restore a person’s range of movement following a whiplash injury.

Your physiotherapist will also be able to show you neck exercises you can do at home.

Chronic whiplash

Symptoms of whiplash can sometimes last six months or longer (chronic whiplash). There is little in the way of scientific evidence to suggest which treatments are most effective for treating long-term whiplash.

However, keeping your neck mobile and using painkillers to provide pain relief are recommended. Your treatment plan should be based on your specific symptoms and focus on dealing with the cause of your pain.

If you have severe neck pain, a stronger painkiller, such as codeine, can be prescribed to either use on its own or with paracetamol or ibuprofen. Again, you should always follow the manufacturer's dosage instructions when using painkillers and anti-inflammatories.

Self care

As well as keeping your neck mobile and using painkillers, the self care measures below may also help you manage the pain and stiffness in your neck and prevent them getting worse.

  • Good posture – always maintain a good, upright posture by keeping your back straight while sitting, standing and walking. If you spend a lot of time using a computer, you should adjust your chair and computer screen correctly.
  • Supportive pillow – some people find a firm, supportive pillow helps when sleeping. Avoid using more than one pillow.
  • Exercises and stretches - controlled exercises, such as those used in activities like yoga, will help improve your strength and posture. However, there is no evidence they help reduce neck pain.

Complications

Most cases of whiplash eventually get better without any lasting damage, but sometimes the pain can be prolonged and severe.

Whiplash that lasts for several months or longer can sometimes cause [anxiety] and depression.

If the injury was the result of a motor vehicle accident, sorting out the damage to your vehicle and dealing with compensation claims can often be stressful and time-consuming.

Severe or prolonged pain can make it difficult to carry out daily activities and enjoy your leisure time. It can also affect your work. Visit your doctor if your neck pain is causing problems with work or everyday activities.

Try to remain positive and focus on your treatment objectives. However, if you do feel depressed, your doctor will be able to recommend appropriate treatment. They may refer you to a specialist [pain clinic] for further assessment and treatment or they may recommend counselling.

Recovering from whiplash

The length of time it will take to recover from whiplash will depend on how severely your neck has been sprained.

It may take a few weeks if the ligaments and tendons in your neck are only slightly damaged. However, in severe cases, whiplash and whiplash-associated injuries can last several months or over a year.

One study found the average recovery time for a whiplash injury without other associated symptoms was 32 days, and that out of 2,627 participants 12% had not recovered six months later (chronic whiplash).

Content supplied by NHS Choices