One of the most common injuries associated with a car accident, whiplash is often brushed off as something that heals easily and is not a lasting problem. While this is true in some cases, the damage done to your body during a car accident, especially during the motion involved in whiplash, can have effects beyond what you initially realize. Whiplash occurs when the force of an accident causes your head to move backward and forward very fast, straining and even tearing the tissues in your neck. But in a severe enough case, or one not met with appropriate whiplash treatment, the nerves can become damaged as well and lead to lasting neurological issues.
What Is Whiplash?
Whiplash is both a movement that occurs in the body as well as the type of condition that is caused by this movement. It is characterized by a rapid back and forth motion of the neck, similar to the cracking of a whip. While this can occur in other scenarios, like a fall or sports injury, car accidents lend themselves to whiplash, making it the most common injury. Whiplash is also heavily associated with rear-end car accidents specifically.
A whiplash injury usually occurs in five phases:
- The car is hit (often from behind), causing the seat to push against the driver or passenger’s back. This loads the spine with forces that compress the cervical spine upward and toward the head.
- The torso continues to accelerate forward because of the seat’s impact, while the head does not. This causes the neck’s natural C-shape to temporarily become an S-shape. The combination of these forces can cause damage to intervertebral discs, facet joints, and other structures in the neck.
- The head then slams backward into the accelerating seat. This is when soft tissues at the front of the neck are likely to be injured, as the neck is rapidly extending backward.
- The head bounces off the seat and accelerates forward.
- When a seatbelt is worn, it restrains the body, preventing more serious car accident injury. However, the neck also rapidly flexes when the head whips forward. Soft tissues at the back of the neck may be injured here.
These steps take place in a matter of seconds and can vary in speed and severity based on things like speed, positioning, and the type of cars involved. However, even speeds below 10 miles per hour have been shown to result in whiplash.
A set of guidelines known as the Croft Guidelines are used specifically to classify whiplash injuries. These include a Type of Collision, which specifies whether there was a primary rear, side, or frontal impact. The severity of the injury is then graded on a scale of one to five:
- Grade I: Minimal, with no neurological findings and no limitation of motion. No known injury to the ligaments.
- Grade II: Slight limitations of motion, but no neurological findings or ligament injury.
- Grade III: Moderate, with some limited motions and ligament injury. Neurological findings may or may not be present.
- Grade IV: Moderate to severe ligament injury and motion limitations, with neurological findings present. Fracture or disc issues are also present.
- Grade V: Severe, with surgical management required.
The Croft Guidelines also identify a stage of injury:
- Stage I: Acute injury in the inflammatory phase; 0 to 72 hours from injury.
- Stage II: Sub-acute injury in the repair phase; 72 hours to 14 weeks from injury.
- Stage III: Remodeling phase, from 14 weeks to 12 months post-injury.
- Stage IV: Chronic, with permanent symptoms.
The combination of stage and grade is often used to determine the proper treatment for whiplash and can help us understand if neurological problems are present or likely.
Whiplash Symptoms and Diagnosis
Almost all cases of whiplash are characterized by neck pain and stiffness in the neck. This pain can be very mild or extremely painful and sometimes has a “pins and needles” tingling quality associated with it. Stiffness can also vary, with some cases being only a mild twinge during movement and others leaving the patient unable to turn their head at all. These symptoms may spread to the shoulders, back, or upper arms in some cases.
Other common symptoms of whiplash are headache, nausea, and prolonged numbness in the neck or arms. These can result from the whiplash itself or from something known as a whiplash-associated disorder, like a concussion that occurred due to the sudden movement.
Whiplash is usually diagnosed through a combination of symptoms, a physical examination, and a discussion of the car accident or other inciting event. Diagnostic imaging may be used to rule out other issues and will sometimes show damage to tissue, but it is not necessary in all cases of whiplash.
Whiplash and the Brain
The same motion that causes whiplash is also very likely to cause a concussion. While people think of concussions as a result of something hitting the head, they can occur even when there is no impact. The sudden movement during whiplash can cause the brain to move within the skull, making contact with the hard bone and causing this mild traumatic brain injury. The symptoms of a concussion are often treated as whiplash instead of as an independent injury, even though they are distinct.
Common signs of a concussion that can be associated with whiplash include:
- Numbness and tingling in the upper extremities
In rarer cases, people have experienced brain dysfunction and weakness in the lower extremities. There may also be trouble with sensory or cognitive processing. Individuals who have experienced a neurological issue after whiplash may report:
- Increased sensitivity to light or sound
- Scattered or disorganized communication skills
- Slow or impaired reaction times
- Psychosocial issues
- Reduced IQ
These are all signs of a brain injury related to the motion of whiplash, rather than the injury to neck tissues known as whiplash. However, the relationship between the two is very strong- one study found that in 1200 MRI scans of patients who reported neck pain, nearly a quarter of the cases had a related brain injury. It is likely that the number is higher as doctors do not always diagnose both issues when they occur.
Unfortunately, improperly treated neurological damage can have lasting effects. While both concussions and whiplash are typically resolved with mild intervention, it is important they are addressed in tandem.
Preventing Chronic Whiplash Symptoms
In general, someone with a mild to moderate whiplash injury is expected to recover within 3 months if they are receiving proper treatment. However, some cases lead to long-term pain and neurological symptoms. This can happen in untreated cases and those that are very severe, but other risk factors like an older age or being a female also make chronic whiplash more likely. The best way to prevent this outcome is to take proper steps after an accident to treat whiplash and any associated conditions.
It is important to know that while whiplash happens during the collision itself, you may not experience symptoms for hours or even days after the event. Adrenaline and shock may prevent you from feeling the pain caused by whiplash. It is best to seek treatment immediately to begin treatment or as soon as you feel any symptoms.
Mild cases of whiplash can be managed with a doctor’s supervision and basic home care like rest, a mixture of ice and heat therapy, and anti-inflammatory medication like ibuprofen. While avoiding strenuous movement is good, it is also important to stay somewhat active and help the neck adjust to movement. This is why neck braces and cervical collars are no longer recommended.
When a case of whiplash requires more intervention, common therapies may include:
- Prescription pain medication like muscle relaxants and opioids to help manage pain enough for further treatment.
- Physical therapy to focus on improving strength and flexibility in the neck and relieve pressure on the spine.
- Chiropractic care to ensure the spine is properly aligned and increase range of motion.
- Injections to target a specific area, reduce nerve and tissue inflammation, or provide pain relief.
Other therapies may include acupuncture, massage therapy, and ultrasound therapy. The goal of any treatment program will be to heal any damaged tissue and keep the neck healthy so that it can regain freedom of movement and reduce or eliminate pain.
At AICA Orthopedics, every care plan is created with a patient’s unique needs and goals in mind. Our staff includes a mix of specialists, from chiropractors to neurologists, who can look at your injury holistically and determine the right types of care for your unique situation. Whether you need light physical therapy to address mild whiplash or may require surgery to manage your injury, AICA Orthopedic has a specialist who can work with you to meet your goals. We specialize in caring for car accident victims and will always pay special attention to the way injuries interact and look for ways to prevent long-term pain and damage. Contact us today for your first appointment!