Whiplash

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Whiplash Cervical Spine Injury
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Definition
Whiplash is a nonmedical term used to describe
neck pain following an injury to the soft tissues
of the neck (speci?cally liga- ments, tendons,
and muscles). It is caused by an abnormal motion
or force applied to the neck that causes movement
beyond the neck's normal range of motion. It is
usually caused by a ?exion-extension motion of
the neck that pulls and strains the neck muscles
and ligaments. Whiplash happens in motor vehicle
accidents, sporting activities, accidental falls,
and assault. Synonyms for whiplash include
acceleration ?exion-extension neck injury and
soft tissue cervical hyperextension injury. A
doctor may use the more speci?c terms of cervical
sprain, cervical strain, or hyperextension
injury. Fortunately, whiplash is typically not a
life threatening injury, but it can lead to a
prolonged period of partial disability. While
most people involved in minor motor vehicle
accidents recover quickly without any chronic
symptoms, some continue to experience symptoms
for years after the injury. This wide variation
in symptoms after relatively minor injuries has
led some to suggest that, in many cases, whiplash
is not so much a real physiologic injury, but
that symptoms are more created as a result of
potential economic gain. Many clinical studies
have investigated this issue. Unfortunately,
while there will always be people willing to
attempt to mislead the system for personal gain,
whiplash is a real condition with real symptoms.
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Prevalation
More than one million whiplash injuries occur
each year due to car crashes. This is an estimate
because not all cases of whiplash are reported.
In a given year, an estimated 3.8 people per 1000
experience whiplash symptoms.8 Freeman and
co-investigators estimated that 6.2 of the US
population have late whiplash syndrome.9 The
majority of cases occur in patients in their late
fourth decade. Unless a cervical strain has
occurred with additional brain or spinal cord
trauma mortality is rare.8 Whiplash can occur
at speeds of ?fteen miles per hour or less it is
the sudden jolt, as one car hits another, that
causes ones head to be abruptly thrown back and
sideways. The more sudden the motion, the more
bones, discs, muscles and tendons in ones neck
and upper back will be damaged. Spinal cord
injuries are responsible for about 6,000 deaths
in the U.S. each year and 5,000 whiplash injuries
per year result in quadriplegia.7 After 12
months, only 1 in 5 patients remain symptomatic,
only 11.5 of individuals were able to return to
work a year after the injury, and only 35.4 were
able to get back to work at a similar level of
performance after 20 years. Estimated indirect
costs to industry are 66,626 per year, depending
on the level and severity. Lastly, the total cost
per year was 40.5 billion in 2008, a 317
increase over 1998
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Causes

• The most frequent cause of whiplash is a car
  accident. 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 15 miles per hour can
  produce enough energy to cause whiplash in
  occupants, even when they wear seat belts.
• Other common causes of whiplash include contact
  sport injuries and blows to the head from a
  falling object or being assaulted.
• Strains of the neck from sudden changes in
  direction, for example, roller coasters, minor
  bicycle accidents, or slips and falls can all
  cause whiplash.
• Repetitive stress injuries or chronic strain
  involving the neck (such as using the neck to
  hold the telephone) are common, non-acute causes.
• Child abuse, particularly the shaking of a child,
  can also result in this injury as well as in more
  serious injuries to the child's brain or spinal
  cord.

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Risk factors
Trauma and sports injuries are more common in
young adults. Rates of whiplash are higher in
persons using a seatbelt with shoulder restraint
than with no restraint, but seatbelts often
prevent more serious injuries. Poor
posture. Poorly-?tted head restraints. Women
sustain higher rates of whiplash, probably
because their neck muscles are less well
developed than men's. Narrowing of the cervical
spinal canal due to acquired or congenital
disorders predisposes to spinal cord damage with
these types of injuries.
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Symptoms

• The symptoms of whiplash generally include some
  degree of neck pain and muscle sti?ness.
  Depending on the severity of the injury, signs
  and symptoms may also include
• Tenderness along the back of the neck and
  shoulders
• Neck swelling
• Muscle spasms in the posterior cervical spine
  (back of the neck), anterior cervical spine
  (front of the neck), or in the trapezius muscles
  (back of the shoulders)
• Di?culty ?exing, extending, or rotating the head
• Headache, di?culty concentrating, sleep
  disturbances, and/or fatigue Jaw tightness or
  di?culty chewing
• Severe cases of whiplash may also cause vision
  disturbance, tinnitus (ringing in the ears), and
  other signs of nerve irritation

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Diagnosis
After an accident the patient may be taken to the
hospital or a doctor's o?ce to be examined. The
doctor will examine the patient to determine if
they have any injuries that require treatment.
Based on the symptoms and examination ?ndings the
doctor may place a collar on the neck for
additional support. The doctor may also obtain
x-rays of the neck to check for more serious
injury. The most important ?rst step is to make
sure there is no major injury to the neck, head
or the rest of the body requiring immediate
treatment. If the x-rays are normal but the
patient continues to have neck pain, the doctor
may keep the cervical collar in place and see the
patient back in the o?ce in about a week for an
additional examination. At that time the doctor
may obtain new x-rays to see if there have been
any changes. If the doctor is still concerned
about soft tissue injuries, he or she may obtain
either x-rays with the head leaning forward and
backwards (dynamic x-rays) or obtain an MRI
(magnetic resonance imaging study). These dynamic
x-rays or MRI scans are better able to detect
injuries to the soft tissues of the neck,
especially instability, that may not been seen
with normal x-rays of the neck.
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Self-Care at Home

• See a doctor to diagnose whiplash. For minor
  injures or strains of the neck, without serious
  signs and symptoms as listed above, or without
  evidence of any neurologic problems, home care
  may be appropriate. If there is any question
  about the severity or treatment of a neck injury,
  see a doctor.
• Home care for whiplash includes decreasing the
  painful symptoms of the strain. The symptoms of
  whiplash can be treated
• with the following home remedies
• Cold packs or ice can be applied to the neck to
  minimize swelling and pain. Apply ice/cold to the
  neck area for 15-20 minutes. Repeat every hour,
  as needed, for the ?rst 48-72 hours after the
  injury.
• If there is no pre-existing condition or
  contraindication to their use, over-the-counter
  pain medications can be used (consult a doctor)
• acetaminophen (Tylenol)
• ibuprofen (Advil, Motrin) o naprosyn (Alleve)
• aspirin
• Limit motion of the head and neck until pain and
  muscle tightness are gone. Limit strenuous
  activities such as sports or heavy lifting.

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Treatment

• The medical treatment for whiplash depends on the
  severity of the injury. Severe neck injuries
  associated with bone or spinal cord damage may
  require surgical intervention. Less severe
  injuries are often limited to soft tissue
  injuries (muscles, ligaments, tendons) and
  treatment is directed at symptom relief.
• Your doctor may prescribe a treatment plan
  including
• Pain medications (over-the-counter or
  prescription)
• Narcotic pain medication may be necessary with
  severe whiplash
• Nonsteroidal anti-in?ammatory medications
  (NSAIDs) should be part of the treatment if the
  patient is able to take them
• Muscle relaxers
• Benzodiazapine medications such as diazepam
  (Valium) may help muscle tightness and spasm
• Other muscle relaxer drugs may also be used
• A cervical collar may be used for the ?rst few
  days, but use should be limited to the time
  period prescribed
• Cold packs or ice can be applied to the neck to
  minimize swelling and pain. Apply ice/cold to the
  neck area for 15-20 minutes. Repeat every hour,
  as needed, for the ?rst 48-72 hours after the
  injury.
• Limit motion of the head and neck until pain and
  muscle tightness are gone. Limit strenuous
  activities such as sports or heavy lifting.
• Physical therapy with range of motion exercises,
  muscle strengthening,ultrasound, or electrical
  stimulation may be pre- scribed.
• Non-traditional medical treatments such as
  chiropractic, massage, or acupuncture may be
  helpful for some patients in the treatment of
  whiplash. Consult your doctor.

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Alternative medicine
Many nontraditional therapies have been employed
to treat whiplash pain, including ACUPUNCTURE.
By inserting ultra?ne needles through speci?c
locations on your skin, acupuncturists can
relieve many di?er- ent types of pain. But
research studies have been unable to de?nitively
show that acupuncture can help relieve persistent
neck pain caused by strains.
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Alternative medicine

• CHIROPRACTIC CARE. Many people seek chiropractic
  care for neck pain, and it has been shown in
  certain types of neck pain to
• work just as well as, but no better than,
  physical therapy. Pairing spinal manipulation
  with exercise provides more bene?t. However,
  chiropractic manipulation of the neck has been
  associated, in very rare instances, with
  potentially life-threatening injuries.
• MASSAGE. Kneading the tight muscles in your neck
  may be helpful if you continue to have muscle
  spasms for more than a week or two. Relax the
  muscles in your neck ?rst by taking a hot shower
  or bath, or by using a moist towel warmed in the
  microwave.
• TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION
  (TENS). TENS is a device that applies a mild
  electric current to the skin. This nonharmful
  current can help to decrease some types of pain,
  possibly by interfering with the transmission of
  pain signals or by releasing endorphins, the
  body's natural painkillers. TENS can help relieve
  chronic neck pain, but only when combined with
  exercise.

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Prevention

• Prevention is the most e?ective way to avoid
  whiplash.
• Always using seatbelts and drive motor vehicles
  with airbags. Proper adjustment of the car seat
  headrest can also help keep
• the neck from snapping backwards.
• Always use the proper safety equipment when
  participating in sports.
• Follow amusement park or carnival safety
  instructions on high-velocity rides, such as
  roller coasters. Report suspected child abuse to
  authorities.
• Monitor children's activities to prevent falls or
  serious injuries.