Whiplash-associated Disorder

Whiplash-associated Disorder

By Ted Findlay, MD, DO, CCFP

Introduction

The cervical vertebrae are the topmost seven bones of the spinal column. Important nerves exit between each of these vertebrae. The vertebral arteries run through small holes in the boney processes that are at the sides of these vertebrae.

Whiplash is the term commonly used after abnormal flexion/extension forces are applied to the cervical spine such as may occur in a motor vehicle accident, sports, or even amusement park rides. Neck associated disorder refers to neck pain that occurs in the absence of these forces. It is a common experience. Most of us will have at least one episode of neck associated disorder in our lifetime. Having had at least one episode makes it more likely that we will have another one at some time in the future.

Signs and symptoms

Neck-related pain can be either localized or referred. Localized pain is at the one spot. Referred pain can be felt near or far away from the injury. Pain referred from neck related muscles may produce pain anywhere in the head (headache), upper back, or arms. If the nerves that exit between the neck vertebrae are involved, there may be pain or weakness into the arms, hands, and fingers in predictable patterns.

You may feel pain or stiffness in the neck right after an injury, or it may appear and become worse over the following few days.

Causes

When hit from behind by surprise, there can be hyperextension (backwards bending) of the neck that is not limited until hitting the headrest. In reaction, the head and body is often thrown forward. This can lead to a hyperflexion (bending) injury. These abnormal movements can lead to injury of the ligaments that normally stabilize the neck and limit abnormal movement. These ligament injuries may be mild or severe. There is also the risk of fracture of the vertebral bodies, although this is much less commonly seen.
Risk factors for Neck Associated Disorder include age, family history, sedentary, and repetitive work. Degenerative joint changes are often seen on X-ray and do not always explain the reasons for someone's neck pain. They are often seen also in persons with no neck pain.

Diagnostic tests

Right after an injury the need for further studies such as X-ray or computed tomography (CT) scan will be made by a doctor based upon the history, physical findings, and presence or absence of other injuries. These tests are in general not productive in the cases of minor injury in the absence of midline pain, or signs or symptoms going into the upper extremities.

Treatment approach

Call 911 in an emergency

If you think that someone may have broken their neck, do not move the person unless there is an urgent threat to their life or advanced airway care or cardiopulmonary resuscitation (CPR) is needed. Call 911 right away for emergency help. If the person must be moved, support the head and neck so that it is in a straight line with the body and move the entire person as a unit.

Hot and cold packs

Self-treatment in the first few days includes the use of topical cold packs such as ice or gels applied for not longer than 15 to 20 minutes at a time. After 48 or 72 hours, hot packs may feel better or be switched back and forth with the cold.

Over-the-counter medicines

Over the counter medicines such as acetaminophen or ibuprophen can be helpful, if you are sure that these medicines are safe in your particular case. Your doctor may prescribe other anti-inflammatory or pain medicines.

Cervical collars and therapy

Soft cervical collars are sometimes used in the short term, but many therapists are concerned about muscle weakness that may result from longer term use. They are sometimes recommended at night to protect the neck from movements in sleep. Many people will see a manual physiotherapist, chiropractor, osteopathic doctor, or other manual therapy specialist. The evidence for effectiveness of these treatments is limited. Other treatments include exercises, laser therapy, and acupuncture.

Injections

For chronic neck pain, doctors some times recommend injections that may include anti-inflammatory cortisone injections to the cervical joints, nerve blocks, or denervation (ablation). All of these treatments are temporary in nature. Injection to the ligaments to improve stability is sometimes performed. The evidence for this is not strong. Surgical treatment for disc or joint related nerve radiculopathy is only needed every so often.
There is an association between neck manipulation and stroke. The risks are small and similar to the risks of patients receiving family doctor care.

Prevention

  • The use of seatbelts and a properly adjusted headrest as per the manufacturer's instructions are the most important preventive strategies for whiplash.
  • Never dive into a shallow pool or unknown lake, river, or other body of water.
  • Always wear the correct protective equipment for the sport you are playing or competing in.

Web sites

Web MD
www.webmd.com

Pain.com
www.pain.com

American Pain Foundation
www.painfoundation.org

TRIP Database (Resources for Evidence Based Medicine)
www.tripdatabase.com

SpineUniverse
www.spineuniverse.com

Michigan Head-pain and Neurological Institute
www.mhni.com

National Institute of Neurological Disorders and Stroke
www.ninds.nih.gov