Getting in a car accident can be scary. I remember my first accident when I was sixteen. I was driving on an icy road called “Wildcat Canyon” and I took a turn too quickly spun around in a few circles and then got stuck on the side of the road. I was only sixteen and so I didn’t receive any medical care for this incident, but I probably should have.

Whiplash goes by many names. It can be called “Cervical hyperextension/ hyperflexion injury” or “Cervical acceleration/ deceleration syndrome” (CAD). It explains how the injury occurred instead of explaining the associated symptoms. 83% of individuals involved in a motor vehicle accident (MVA) will suffer a whiplash injury (1) and have: neck pain, headaches, arm pain, pain shooting down the arm, numbness, tingling in the arms, muscle weakness in the neck or arms, jaw pain, visual disturbances, vertigo/dizziness, low back pain, tinnitus, difficulty sleeping, hypersensitivity to light or noise, fatigue, impaired cognitive function, diminished concentration, irritability, and memory loss. Thankfully chiropractic care can help resolve all these symptoms. Even with exceptional medical care 50% of those injured report ongoing neck pain one year after the accident (2, 101-105) and 40% of whiplash cases can have pain for 2-3 years after. (21,24-26) It is important to determine if you are likely to be a long-term pain sufferer through the Quebec task force Whiplash Associated Disorder (WAD) scale. (28, 29).

The primary factor in injury is the speed of impact. Beyond this are other factors that can contribute to long term injury are called “extrinsic” factors (i.e., collision environment), or “intrinsic” factors (i.e., occupant characteristics).

Extrinsic Factors
Direction of impact- Since a car is primarily made to drive forwards a rear end injury will cause more bodily injury than an impact from other directions (3,4).

Vehicle mass- The most bodily damage occurs when a small car is hit by a larger car. The mass of the large car is transferred into the smaller car.

Vehicle damage- Vehicle damage is poorly correlated to whiplash (5,6). While speeds above 15mph are needed to damage most newer cars, five miles or less can cause significant whiplash (7).

Restraints- Seat belts have decreased the number of fatalities and have increased the number of injuries (8). By holding the body and not the head they increase neck damage. (9). This can be even worse if the head restraints are not properly positioned. (4)

Intrinsic factors (related to the occupants)

Head position- Whiplash is more severe when the head is rotated. This usually affects the side away from where the head was rotated worse (4).

Awareness- If you are surprised by impact and have not braced yourself you will experience a slower recovery (4,10)

Braking- Whiplash is dependent on acceleration (having the foot off the brake) and deceleration (having the foot on the brake). Breaking can increase the whiplash injury to occupants in motion. (11).

Age- The older you are the more likely it is for your injuries to be severe. (12,20,21,111)

Gender- Females are more prone to prolonged injury than males (2,12,14,15,20).

Prior neck pain- Occupants with prior neck pain are three times as likely to have whiplash symptoms following an accident. (17,20)

Symptom onset- The sooner symptoms show up after the accident the more likely they are to last (2, 20, 21,111). Patients whose pain level is above a 5/10 also are slower to recover. (20)

Health status – Other conditions when the whiplash injury occurs makes damage worse. This can include congenital or developmental anomalies of the spine, rheumatologic disease, osteoporosis, bone disease, scoliosis and prior trauma. (30) Other risk factors associated with a poor outcome include; depression (14), post-traumatic stress symptoms (21), poor psychological coping mechanisms, negative beliefs about recovery (112), less than post-secondary education (20, 2), lower household income (1), unemployment (1), cigarette smoking (1), and delayed treatment (15).

Anatomy of whiplash injuries

Any tissue in the neck can be damaged during an accident. The symptoms associated with this damage will usually show up gradually in the hours or days following an accident. Pain may arise from damage to ligaments, muscles, tendons, discs, nerves, or bone. The most common complaints following a whiplash injury include cervical pain (94%), headache (72%), and shoulder pain (49%).

The muscles most often involved are the trapezius, longus capitus, longus coli, sternocleidomastoid, suboccipitals, splenius capitus/cervices

The joints that are affected are the atlanto-occipital joint, the facet joints, and of the fibrocartilaginous disc joints.

The ligaments that can be involved are the ligamentum flavum, anterior/posterior longitudinal ligaments, and ligaments of the joint capsule.

Causes of whiplash injuries

Whiplash is caused by the acceleration and deceleration of the neck during the accident. This creates shearing forces in the spine and can cause tears in the ligaments and muscles of the neck.

Common symptoms of whiplash injuries

The neck pain experienced is usually a constant dull pain that intensifies or becomes sharp with movement. The pain is usually felt where the neck meets the shoulder and can be felt in the front of the neck or down the arm. Rest is important in order to relieve pain initially but can lead to stiffness. Sometimes muscle pain will show up days after the accident indicating a more complicated injury (18).

The neck pain is accompanied by headaches at the base of the skull or as a band across the forehead. These types of headaches can also predispose someone to migraines and tension headaches. (99) When the upper cervical facet capsules are injured the altered proprioceptive input can result in varying degrees of vertigo (36-38). Dizziness, vertigo, or disequilibrium can occur in 80% of whiplash patients. (36,39-41)

When to go to the ER

If you are having trouble swallowing or hoarseness this can indicate a possible retro tracheal or retropharyngeal hematoma. Seek immediate investigation.

Cervical instability is another reason to go to the emergency room. It involves a feeling of instability in the neck, a lack of control in the neck or arms, or incapacitating pain, a neck that gets stuck, and difficulty moving in a smooth fashion. These symptoms will improve while laying down and will increase when standing or sitting. (46-48)

Whiplash can cause damage to the spinal cord. This presents as pain, paresthesia, numbness, or weakness in the arms and legs, including clumsiness, hyperreflexia, pathologic reflexes, and possible urinary incontinence.

How to evaluate whiplash injuries

The primary injuries include poorly localized pain, swelling, and loss of range of motion of the neck. Pain when your head is being moved passively suggests damage to the ligaments, pain while moving your neck actively suggests muscular involvement, especially with looking up. (27) Early on there is often tenderness along the spine and there can be muscle spasms. Assessment is focused on finding myofascial pain, chronic overloading, altered intersegmental mobility leading to hypermobility

A common pattern in whiplash is under activation of deep neck flexors and overactivation of the sternocleidomastoid and upper trapezius. (43-45) Most patients who are in acute pain don’t tolerate examination and treatment procedures (46).

Upper cervical chiropractic for whiplash injuries

Each treatment plan is unique to the individual and so these are merely suggestions on possible tools to use in order to heal whiplash. The earlier treatment is administered the better the outcomes are. (55) Treatment of chronic whiplash demonstrates limited success after the first three to six months. (21,24-26,56-58) During this time trigger point therapy of the cervical erectors, sternocleidomastoid, subocciptals, semispinalis capitus, and upper trapezius. Myofascial release can be used on the scalenes, trapezius, levator, pectoral, SCM, and other paracervical muscles. (97)

In the absence of instability, the use of rigid or soft collars is not needed as it leads to deconditioning and is less effective than upper cervical adjustments. (63-69,72-77) Pain is a normal reaction to injury and not returning to activities of daily living may delay recovery. (63,65,67,69,95,96) Patients should be encouraged to resume normal daily activities as soon as possible. (74)

Passive modalities can be used when active exercise isn’t helping. (77-80) NSAIDs may provide short-term benefit. (81) Neck traction can be used when there is pain going down the arm. (46) Nerve mobilization techniques may be necessary to restore normal neurodynamics.

Upper cervical adjustments are a valuable tool for the restoration of normal joint mechanics in whiplash injuries. (83,100) These are gentle and good because hypermobility is common in whiplash patients, particularly increased rotation at C3/4 & C4/5 and increased translation at C5/6. (86) Segmental hypermobility may be better served by a cervical stabilization program along with postural and ergonomic advice. (46)

Incorporation of exercise provides significant benefit. (72,73,88) Exercises should begin with simple range of motion progressing through isometric strengthening and functional activity. (91) Modification should include: limiting prolonged static postures, especially workstations that require “non-neutral” postures, utilizing proper workstation mechanics including; armrests and backrests. Avoid cradling telephone handsets- instead, utilize speakerphones or headsets, avoid heavy headgear (i.e. hard hat, helmets) when possible. Maintain “neutrality” in the cervical spine while sleeping, always avoid sleeping on your belly and consider the use of a cervical pillow.


Exercises to help heal whiplash injuries

To see more videos visit the Dr. Noah Volz YouTube channel.


Whiplash can be healed and this article gives you some suggestions on what to look for to determine you what to do about it. I hope that this information helps you. If you have any additional questions please leave a comment. In addition to this article you can also read the Guide to Chronic Neck Pain eBook.

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