Question: I am a middle aged woman, approximately 8 months ago, I was involved in a motor vehicle accident. I was coming to a stop at a red light and another driver ran into the back of me. Since the accident, I have had headaches, severe neck pain, stiffness, and afraid my neck is not going to get better. My head still feels very “heavy”. Can you tell me if this is related to the accident, I have a friend that said I’m suffering from “whiplash”, is this true?
Dr. Bradway's Answer:
Whiplash neck injuries are the most common complaint following motor vehicle accidents. You might also see this type of injury in sports (e.g., waterskiing, surfing, skiing, snowboarding) or other collision-type sports (e.g., soccer, football). It is estimated that between 40-60% of cases of whiplash lead to chronic neck pain and other cognitive complaints.
Immediate symptoms following a whiplash injury include neck and upper back pain, neck stiffness, dizziness, fear, and headaches. If a person continues to have symptoms one might also begin to have shoulder pain, TMJ pain, visual and hearing problems, loss of memory, fatigue, anxiety, insomnia, and depression. Chronic whiplash injury signs can include reductions in neck muscle strength, endurance, and mobility.
There are no strict clinical guidelines for treating whiplash injuries, unlike other traumatic injuries. X-rays can rule out serious issues, otherwise imaging has not proven to be overly successful in identifying underlying problems. Research evidence indicates that early intervention is essential to full recovery following an accident. The issues for post-trauma is what to do and when. Doing too much activity too soon, can actually extend the recovery process and intensify the spasms and pain. Needless to say there are a number of misconceptions regarding whiplash injuries and the recovery process.
When a person is rear-ended in a car accident, their head is thrown forward and then whips backwards causing a sprain or strain to the cervical ligaments and surrounding muscles. If a moderate to severe muscle and ligament strain occurs, then immobilization is required (e.g., soft neck collar). This can be useful for 3-5 days. Longer use is not recommended as this can extend recovery time as it causes the neck muscles to weaken causing stiffness to get worse. Normally, a person’s head weighs 10% of their body weight, approximately 12-15 lbs. A cervical soft collar can be helpful initially off-loading the neck musculature and providing some rest and relaxation for those muscles.
In addition, I’ve had patients see me following manipulation treatments to relieve their symptoms. Unfortunately, manipulation involves a thrusting movement of the neck which can often cause even more pain and stiffness. I have found that soft tissue work using intramuscular stimulation (dry needling), heat/ice, electrical stimulation, therapeutic soft tissue mobility and mild exercise is more effective than thrust movements initially.
Some whiplash patients are treated with cervical traction soon after the accident. Unfortunately, I have found that cervical traction immediately following an accident does not help. While cervical traction can be very effective when there is a spinal discogenic or nerve impingement problem, it isn’t as effective on moderate to severe cervical soft tissue, ligament or muscle injuries.
I have had patients who began an aggressive strengthening program for the neck early in their recovery, only to encounter intensified spasms and pain. The reason for these negative results is that the neck must first have a significant reduction in pain and cervical range of motion needs to improve before even a mild strengthening program should be initiated. Introducing a vigorous strengthening program too soon can result in increased spasms and pain as the body attempts to protect itself from the exertion.
In a whiplash injury, the provider must listen carefully to the patient during each visit to ensure their treatment program is progressing and not moving in the wrong direction. A good progression for treatment outcomes includes both physical and psycho-social findings. For example, the patient is making improvements with range of motion deficits, pain, postural and muscle weakness. Other important factors that should be considered in treatment planning are fears, stress, anxiety, disturbed sleep, and altered perception of symptoms. Trauma and severity of symptoms can determine treatment progression.
Immediately following a whiplash injury, there is pain and the pain should gradually subside over a 4 week period. As a treatment program continues, the range of motion should increase. Improvement in range of motion is not necessarily linear, progress can vary and there can be good days and bad days. More often, the good days out weigh the bad days and eventually there are no bad days at all, only good days. In the latter stage of recovery from whiplash, strengthening is essential. Without a postural and strengthening program, the individual is subject to recurrent neck pain, headache and poor quality of life. Full recovery from a whiplash injury is not just recovering from the pain but recovering your range of motion, all your strength, feel a significant decrease in pain and improve your cognitive well-being.
If you would like to post a comment below with your own questions, I, along with Dr. Katie Davenport, PT, DPT and Dr. Clay Reedy, PT, DPT, will be more than happy to answer them.