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Most whiplash injuries result from a collision that includes sudden acceleration or deceleration. Many whiplash injuries occur when you are involved in a rear-end automobile collision. They also happen as a result of a sports injury, particularly during contact sports.

Whiplash, also called neck sprain or neck strain, is injury to the neck. Whiplash is characterized by a collection of symptoms that occur following damage to the neck. In whiplash, the intervertebral joints (located between vertebrae), discs, and ligaments, cervical muscles, and nerve roots may become damaged.

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Symptoms of whiplash may be delayed for 24 hours or more after the initial trauma. However, people who experience whiplash may develop one or more of the following symptoms, usually within the first few days after the injury:

In most cases, injuries are to soft tissues such as the discs, muscles and ligaments, and cannot be seen on standard X-rays. Specialized imaging tests, such as CT scans or magnetic resonance imaging (MRI), may be required to diagnose damage to the discs, muscles or ligaments that could be causing the symptoms of whiplash.

No single treatment has been scientifically proven as effective for whiplash, but pain relief medications such as ibuprofen (Motrin, Advil) or naproxen (Aleve, Naprosyn), along with gentle exercises, physical therapy, traction, massage, heat, ice, injections and ultrasound, all have been helpful for certain patients.

In the past, whiplash injuries were often treated with immobilization in a cervical collar. However, the current trend is to encourage early movement instead of immobilization. Ice is often recommended for the first 24 hours, followed by gentle, active movement.

Neck strain is often just called whiplash. Although it's usually associated with car accidents, any impact or blow that causes your head to jerk forward or backward can cause neck strain. The sudden force stretches and tears the muscles and tendons in your neck.

Some people with whiplash experience chronic (long-term) pain or headaches for years after the event that caused the initial injury. Doctors may be able to trace this pain to damaged neck joints, discs, and ligaments. But chronic pain following a whiplash injury typically has no medical explanation.

Very few people have any long-term complications from whiplash. Usually, recovery time is anywhere from a few days to several weeks. According to the National Institute of Neurological Disorders and Stroke, most people recover fully within 3 months.

Whiplash is the most common injury associated with motor vehicle accidents, affecting up to 83% of patients involved in collisions, and is a common cause of chronic disability [2, 3]. The overall economic burden of whiplash injury, including medical care, disability, and sick leave, is estimated at $3.9 billion annually in the US [4]. If litigation is included, the costs are greater than $29 billion [5]. The incidence of WAD is widely variable in the literature. In the US, it is estimated at 4 per 1,000 persons [6].

The most recent literature suggests that whiplash injury may occur as a result of hyperextension of the lower cervical vertebrae in relation to a relative flexion of the upper cervical vertebrae, which produces an S-shape of the cervical spine at the time of impact [7]. This differs from the normal physiology where motion of the cervical spine begins with the upper vertebrae. This theory suggests an abnormal physiologic basis for the development of whiplash injuries.

The most common radiographic findings associated with whiplash injury are preexisting degenerative disease or slight loss of the normal lordotic curve of the cervical spine [4]. Flexion-extension X-rays at the time of injury may also reveal a kyphotic angle. It is postulated that this is due to hypermobility at a level adjacent to a level of hypomobility, secondary to muscle spasm [9].

A prospective study of 39 patients with grade two to three whiplash injury who underwent MRI within a mean of 11 days from injury and a follow-up MRI after two years found that 33% (13 patients) had medullary or dural impingement by cervical discs [12]. At two year follow-up, all patients with medullary impingement (seven patients) had persistent or increased symptoms and three patients with no or slight changes on MRI had persistent symptoms.

Rosenfeld et al. followed 97 patients exposed to whiplash trauma over a three year period prospectively. The patients were randomized either to an early intervention using frequent active cervical rotation or to a standard intervention of initial rest, recommended soft collar, and gradual self-mobilization. Patients who received active intervention had significantly reduced pain intensity and sick leave at 6 months and 3 years respectively [14]. In addition, patients receiving early active intervention had a total cervical range of motion similar to that of matched uninjured controls at 3 year follow-up.

A prospective uncontrolled study of patients with Type I and Type II whiplash followed patients through a multimodal treatment program including exercise, group therapy, and occupational therapy. Vendrig et al. found that at 6 month follow-up, 65% of subjects reported complete return to work, 92% reported partial or complete return to work, and 81% reported no medical or paramedical treatments over 6 months [16].

The use of cervical radiofrequency neurotomy (CRFN), a neuroablative procedure used to interrupt nociceptive pathways, has been supported by several studies in patients with chronic WAD. Prushansky et al. conducted a prospective study of 40 patients with chronic whiplash injury-associated disorders who underwent CRFN treatment. The authors found an improvement in 70% of patients based on a number of parameters including Neck Disability Index and cervical range of motion [18].

Put simply, the ligaments and tendons in the neck are sprained during a whiplash injury because they have been overstretched. Even though the neck has not been broken, it may sometimes take several months for everything to heal.

A whiplash injury typically takes 12-24 hours to develop. At the time of the incident, any swelling or bruising to the neck muscles will not be apparent straight away. In most cases, the discomfort, pain, and stiffness is much worse on the following day, and may continue to worsen as each day goes by.

Painkillers, such as Tylenol (paracetamol), may reduce whiplash injury pain. Some doctors may advise patients to take painkillers regularly, and not just when the pain is severe. It is important not to exceed the dose.

Soft foam collars used to be popular for whiplash injury treatment. However, immobilizing the neck for long periods may undermine recovery, because muscle bulk and strength is reduced. If a cervical collar is needed, it should usually be worn for no more than 3 hours at a time.

Most cases of whiplash are caused by car accidents where the person has been rear-ended. Other potential whiplash causes, while comparatively rare, can include assault, bungee jumping, rollercoaster, football, falls while skiing or during equestrian events, and other high-impact activities where extreme acceleration-deceleration forces might be applied to the cervical spine.

The most common symptom of whiplash is neck pain, which can range anywhere from mild to pins-and-needles tingling to excruciating. Other symptoms can include neck stiffness or reduced range of motion, neck instability, shoulder and/or upper back pain, or headache. There could also be tingling, weakness, or numbness that radiates into the shoulder and/or down the arm.

Whiplash symptoms can be numerous, complicated, long-lasting, and hard to diagnose, which is why they are commonly known as whiplash-associated disorders. Concurrent injuries may also be symptomatic, such as a stinger, concussion, radiculopathy (pinched nerve with radiating pain into the arm), or shoulder injury.

The process of a whiplash injury sustained in a car accident can vary depending on many factors, including the angle of the collision. Usually the collision happens from behind, resulting in a whiplash injury that can be considered to occur in five general phases:

While the severity of the car crash usually correlates to the severity of the whiplash injury, there are exceptions. Sometimes a sturdy car does not crunch up and thus shows no significant outside damage, but the forces that were not absorbed by the car exterior were instead transferred through the seat and thus caused worse whiplash. Also, whiplash injuries have been recorded in incidents where the speed at impact was less than 10 miles per hour. 1 Bogduk N, Yoganandan N. Biomechanics of the cervical spine Part 3: minor injuries. Clinical Biomechanics. 2001; 16(4) 267-275.

Predictors of outcome following whiplash injury are limited to socio-demographic and symptomatic factors, which are not readily amenable to secondary and tertiary intervention. This prospective study investigated the predictive capacity of early measures of physical and psychological impairment on pain and disability 6 months following whiplash injury. Motor function (ROM; kinaesthetic sense; activity of the superficial neck flexors (EMG) during cranio-cervical flexion), quantitative sensory testing (pressure, thermal pain thresholds, brachial plexus provocation test), sympathetic vasoconstrictor responses and psychological distress (GHQ-28, TSK, IES) were measured in 76 acute whiplash participants. The outcome measure was Neck Disability Index scores at 6 months. Stepwise regression analysis was used to predict the final NDI score. Logistic regression analyses predicted membership to one of the three groups based on final NDI scores (30 moderate/severe pain and disability). Higher initial NDI score (1.007-1.12), older age (1.03-1.23), cold hyperalgesia (1.05-1.58), and acute post-traumatic stress (1.03-1.2) predicted membership to the moderate/severe group. Additional variables associated with higher NDI scores at 6 months on stepwise regression analysis were: ROM loss and diminished sympathetic reactivity. Higher initial NDI score (1.03-1.28), greater psychological distress (GHQ-28) (1.04-1.28) and decreased ROM (1.03-1.25) predicted subjects with persistent milder symptoms from those who fully recovered. These results demonstrate that both physical and psychological factors play a role in recovery or non-recovery from whiplash injury. This may assist in the development of more relevant treatment methods for acute whiplash. 9af72c28ce