Whiplash

Whiplash: Neck Sprain or Strain

If you have ever been in a car crash and experienced pain in your neck, you have most likely had whiplash. Whiplash, also called neck sprain/strain, is an injury to the structures of the neck. This type of injury is often the result of rear-end car crashes. Whiplash can include injury to the intervertebral joints, discs, ligaments, cervical muscles and nerve roots. The most common structure injured in whiplash is the cervical facet joint.

Each year, over 2 million North Americans are injured and suffer from whiplash. Whiplash can be caused by:

• Motor vehicle accident. The most frequent cause of whiplash is a motor vehicle accident (MVA). The speed of the cars involved in the accident or the amount of physical damage to the car may not relate to the intensity of neck injury; speeds as low as 8 miles per hour can produce enough energy to cause whiplash in occupants.
• Sports injury
• Fall
• Being struck by a falling object
• An assault

Whiplash, although not technically a medical term, is very real and can be very painful. It is called whiplash because your neck really can whip back and forth—first backward (hyperextension) and then forward (hyperflexion). In reality, the specific biomechanics of this injury are far more complex than this, but these details are beyond the scope of this discussion.

The key symptom of whiplash is neck or upper back pain. If you have whiplash you might feel:

• Neck Pain
• Shoulder pain
• Upper back pain
• Tightness or spasms of the neck or upper back muscles
• Burning or tingling
• You may also experience other symptoms, such as:
• Numbness and/or tingling
• Headaches
• Dizziness
• Nausea
• Blurred vision
• Ringing in the ears or blurred vision
• Difficulty concentrating or remembering
• Irritability, sleep disturbances, fatigue

Pain can start immediately, or it can develop days, weeks, and sometimes even months after the accident. Some people only have a little pain, but some experience a lot. Traditionally, it was believed that most people with whiplash recover fully. We now know that a significant number of whiplash injuries fail to improve without further intervention.

Anatomy of Whiplash

In a whiplash injury, it is possible to injure the joints, discs, vertebrae (bones), ligaments, nerve roots, and even the spinal cord. However, in 80% of patients, the source of pain can be isolated to one of three main structures:

• Joints (~55%)
• C2-3 to C7-T1 facet joints (also called the z-joints or zygapophysial joints)
• C1-2 joint (also termed the “atlanto-axial joint”)
• Discs (~20%)
• Nerve roots (~5%)

Diagnosis

It is critical to understand one major concept: from the clinical assessment alone, it is very difficult for your physician to be 100% certain which particular structure in your cervical spine is injured. To make an accurate diagnosis, your doctor needs a combination of tools and sophisticated technology. After reviewing your x-rays and MRI, listening to your history and performing a proper physical exam, your physician may form a strong suspicion that you are suffering from a specific spine pain disorder.

Treatment

• Physical therapy: Passive (i.e. ice, heat, massage) and active therapies (exercise) is typically prescribed. Your physical therapy program is designed for you and your needs. PT typically involves:
  • Stretching exercises
  • Strengthening exercises
  • Scapular (shoulder blade) stability training. The shoulder girdle provides a platform or base for your cervical spine. Proper rehabilitation starts with a good foundation
• Medications may help alleviate inflammation and severe pain.
  • Anti-inflammatory medications help reduce swelling and pain
  • Narcotic painkillers are prescribed to alleviate acute pain (only if absolutely necessary)

Interventional Pain Treatment Options

Although whiplash pain and symptoms usually resolve in 6 to 8 weeks, if pain persists or worsens, interventional pain treatments are considered. Cervical medial branch nerve block steroid injection treats facet joint-related pain. Cervical facet joints may be sprained or damaged in much the same way other joints are injured in a high velocity “stop and go” movement.

Cervical epidural steroid injections treat pain secondary to a disc disorder / pinched nerve.

Your physician may perform electromyography (EMG), nerve conduction study (NCT), and MRI to confirm the cause of pain. Electromyography measures electrical activity in muscles. A nerve conduction test (NCT) to studies nerve function.

If pain returns after a cervical medial branch block, then a radiofrequency ablation of these nerves can be considered for longer term relief.