Definition

Whiplash is an injury to the soft tissues of the neck from a sudden jerking or "whipping" of the head. This type of motion strains the muscles and ligaments of the neck beyond their normal range of motion.

See also: Neck pain

Considerations

When a vehicle stops suddenly in a crash or is hit from behind, the seat belt will keep a person's body from being thrown forward. But the head may snap forward, then backward, causing a whiplash injury.

Causes

In addition to car accidents, whiplash can be caused by roller coasters and other amusement park rides, sports injuries, or being punched or shaken. (Whiplash is one of the hallmarks of shaken baby syndrome.)

Symptoms

You may feel pain and stiffness in your neck for the first few days after a whiplash injury. You may feel better early on, but the pain and stiffness may come back several days later. This symptom can last for months or years.

The discomfort you feel may involve surrounding muscle groups in your head, chest, shoulders, and arms.

First Aid

Steps to take care of your whiplash injury include:

Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).
Apply heat or ice to the painful area. One good method is to use ice for the first 48 - 72 hours, then use heat after that. Heat may be applied with hot showers, hot compresses, or a heating pad. Be careful not to fall asleep with a heating pad or ice bag on. This can give you burns or frostbite.
Reduce or stop your normal physical activity for the first few days. This helps calm your symptoms and reduce swelling (inflammation).
Perform slow range-of-motion exercises -- up and down, side to side, and from ear to ear -- to gently stretch the neck muscles.
Have a partner gently massage the sore or painful areas.
Try sleeping on a firm mattress without a pillow or with a special neck pillow.
Use a soft neck collar for a short period of time to relieve discomfort. (Using a soft neck collar for a long time can make the neck muscles weaker and prolong your neck pain.)

You may want to reduce your activity only for the first couple of days. Then slowly resume your usual activities.

Do not perform activities that involve heavy lifting or twisting of your back or neck for the first 6 weeks after the pain begins. After 2 - 3 weeks, slowly begin exercising again. A physical therapist can help you decide when to begin stretching and strengthening exercises and how to do them.

Other steps that may help your neck pain improve are:

Use relaxation techniques and regular exercise to prevent stress and tension in the neck muscles.
Learn stretching exercises for your neck and upper body. Stretch every day, especially before and after exercising. A physical therapist can help you learn how to stretch correctly.
Use good posture, especially if you sit at a desk all day. Keep your back supported. Adjust your computer monitor to eye level. This prevents you from having to look up or down.
If you work at a computer, stretch your neck every hour or so.
Use a headset when on the telephone, especially if answering or using the phone is a main part of your job.
When reading or typing from documents at your desk, place them in a holder at eye level.
When you sleep, make sure your pillow supports your head and neck comfortablhy. You may need a special neck pillow. Make sure your mattress is firm enough.
Use seat belts and bike helmets to prevent injuries while riding in a car or on a bike.

Call immediately for emergency medical assistance if

Call your doctor if:

Neck pain and stiffness come back after they had cleared up
Neck pain is severe
The pain spreads to your shoulders or arms
You have numbness, tingling, or weakness in your arms or legs
You have problems with your bladder or bowels

Prevention

Headrests in your car can reduce the severity of neck pain from a car accident. Make sure that the headrest is positioned properly for your height.

If you do get whiplash, learn proper stretching exercises once your neck has healed. This reduces the chance that neck pain or stiffness will come back.

References

Hudgins TH, Shahban L, Alleva JT. Cervial sprain or strain. In: Frontera, WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 5.

Ronthal M. Arm and neck pain. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann; 2008:chap 32.

Verhagen AP, Scholten-Peeters GG, van Wingaarden S, de Bie R, Bierma-Zeinstra SMA. Conservative treatments for whiplash. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD003338.

Devereaux M. Neck Pain. Med Clin North Am. 2009;93:273-284.

Reviewed By

Review Date: 06/04/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief Sports Medicine and Shoulder Service, UCSF Dept. of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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