Whiplash Injury/ Neck Sprain

What is Whiplash?

Whiplash is a neck injury caused by a sudden, forceful, back-and-forth movement of the neck at speed, resulting in the neck bending beyond its normal range of movement. The injury usually involves the bones and soft tissues in your neck. The whiplash may occur due to a road traffic incident, falling off your bike or off a step or a sporting injury e.g. a rugby tackle.

The majority of whiplash injuries are not thought to be serious, and usually recover well with Physiotherapy, however if left untreated it can lead to long-term pain, discomfort and reduced function.

Anatomy of the Neck

The neck is incredibly complex; it consists of 7 cervical vertebrae (C1-C7), C1 is closest to the skull, while C7 is at the base of the neck. In between each vertebrae are tough, fibrous, shock-absorbing pads called the intervertebral discs. Your cervical spine (neck) also houses the upper portion of the spinal cord through the spinal canal, as well as having an elaborate system of nerves, over 30 muscles, and numerous ligaments and tendons. This means that there are a lot of parts that can be damaged from a whiplash injury.

Your neck naturally compresses, extends, and twists, and acts as a shock absorber for the brain, to ensure minimal damage to the brain from any sudden movement.
The cervical spine allows your head to move in nearly every direction; 90° of forward flexion, 90° of backward extension, approx. 180° of rotation side to side, and almost 120° of tilt to either shoulder. Unfortunately, this flexibility makes the neck very susceptible to injury.

The neck also has to support the weight of your head (approx. 5kg); when this weight whips forwards and back at speed, the force that goes through the cervical spine is considerable.

What Causes Whiplash Injury?

Most whiplash injuries result from a collision that produces sudden, acceleration or deceleration forces. Commonly it is an injury often sustained from car accidents, but they also occur frequently in sports, particularly contact sports, and from trips and falls.

The sudden, excessive, forwards and backwards motion during a whiplash injury, causes the soft tissues (muscles, ligaments, and tendons) in the front and back of your neck to be overstretched, and can sometimes cause small tears. Plus, the abnormal compression and shearing forces put on your cervical spine can potentially damage intervertebral discs, facet joints, and even cause fractures to the vertebral bones. This trauma results in significant pain, stiffness and inflammation.

The sharper and stronger the movement, the greater the force on your neck. That’s why whiplash injuries can range from minor to severe. However, even weak levels of force can still cause moderate or severe whiplash.

At its worst, whiplash can cause a break (known as a fracture) in the vertebrae in your neck, creating a risk of damage to your spinal cord and its network of peripheral nerves.

Some events that can cause whiplash include:

• Car accidents/collisions
• Physical abuse, such as being struck on the head or shaken
• Contact sports, such as rugby, boxing, and some martial arts
• Horseback riding – falling from a horse
• Cycling collisions or falls
• Roller Coasters

It can be more serious in older adults (over age 65) due to age-related muscle and bone deterioration and weakening, making them more susceptible to significant muscle and bone injuries of any kind.

What are the Symptoms of Whiplash/ Neck Sprain?

Sometimes the pain from whiplash/neck strain is felt immediately. In other cases, symptoms can take several hours or days to appear, so it’s important to pay attention to any physical changes for a few days after any crash, fall or traumatic event.

Signs and symptoms of whiplash may include some or all of the below:

• Neck pain and stiffness
• Increased pain with neck movement
• Loss of movement in the neck
• Headaches – often starting at the base of the skull
• Tenderness or pain in the muscles around the neck, shoulders, upper back or arms
• Tingling or numbness in the arms or hands
• Fatigue
• Dizziness

Some people also experience:

• Problems with vision – blurred or double vision
• Tinnitus – ringing in the ears
• Pain in the jaw
• Pain when swallowing
• Difficulty Sleeping
• Irritability, Anxiety or Depression
• Difficulty concentrating or problems with memory

The symptoms of whiplash may look like other neck conditions and medical problems; therefore it is very important to see an experienced healthcare professional to get an accurate diagnosis. If you have any of the above symptoms or are concerned that you have a whiplash injury then please get in touch with us at Complete, to book an appointment.

Please note that injuries or accidents that cause whiplash can also result in concussion. Since concussions can be serious, you need to seek urgent medical care if you have a severe headache that worsens or persists, you have trouble talking, problems with balance or coordination, or are confused, dizzy, nauseous, excessively sleepy, or have been unconscious.

How do we Diagnose Whiplash?

At Complete all of our Physiotherapists are highly skilled diagnosticians, and will be able to give you a clear diagnosis and explanation of your condition following your initial assessment. They will take you through a full subjective interview followed by a comprehensive physical and neurological examination, to evaluate the cause and extent of your symptoms.

Because your neck is a complex structure with lots of moving parts, your Physio will need to spend time doing a thorough physical examination, in order to figure out exactly which areas have been affected.

Your physical assessment will likely include:

• Checking range of motion in your neck, upper back and shoulders.
• Gently palpating the areas affected in your neck, shoulders or back, to feel for pain and tenderness.
• Assessing your reflexes, strength and sensation in your limbs – this will assess your nerves.
• Looking at other areas of your spine and peripheral joints that might also be contributing or causing your symptoms.
• Observe specific movements and actions to assess any movement impairments or functional limitations

Whiplash Associated Disorders (WAD) is often graded using the Quebec Task Force classification system which separates them into five different categories:

• Grade 0 – No neck pain, stiffness, or any physical signs are noticed.
• Grade 1: Neck complaints of pain, stiffness or tenderness only but no physical signs are noted by the examining clinician.
• Grade 2: Neck complaints and the examining clinician finds Musculoskeletal signs such as decreased range of movement and point tenderness in the neck.
• Grade 3: Neck complaints plus neurological signs such as decreased deep tendon reflexes, weakness and sensory deficits.
• Grade 4: Neck complaints and fracture or dislocation, or injury to the spinal cord.

Depending on your symptoms and what your physiotherapist finds during the physical exam, they may also suggest diagnostic imaging/scans.

• X-ray. – This will look at your bones to determine whether there are any vertebral fractures.
• MRI or CT scan – Can assess the condition of the cervical spine’s soft tissues (intervertebral discs, muscles, ligaments).

At Complete Physio we have a unique team of physiotherapists who are experts in the treatment and management of whiplash. You are not required to have a GP referral.

How do we treat Whiplash?

There are a number of treatment options that your physiotherapist will discuss with you, and together you will work out a treatment plan based on the source of your symptoms, and your own, personal goals.

Your treatment will likely include some or all of the following:

1. Pain Relief & Protection

Managing your neck pain will likely be the first step in your treatment. Various tools can be used such as medications, ice or heat packs, neck taping techniques, soft tissue massage and acupuncture.

Neck Brace and Taping

A neck brace or a soft collar are rarely advised these days if you are suffering with neck pain, unless you have broken your neck. We often encourage an early range of movement exercises.

Sports taping can be applied to offload muscles and nerves, and help reduce pain.

Soft Tissue Massage

Massage is incredibly useful to help reduce muscle spasms, tension and improve the range of movement of your neck. It also has relaxation benefits.

Acupuncture or Dry Needling

Acupuncture has been used for thousands of years to help with pain and muscle spasm Acupunture is supported by scientific evidence for the treatment of whiplash and neck pain and can be a very effective treatment option.

Medication

Medications are often prescribed to help with the treatment of whiplash. The most common kinds of medications providers prescribe include painkillers, nonsteroidal anti-inflammatory drugs, muscle relaxers and nerve blocks. You should always seek professional medical advice before taking any medication.

2. Regaining Normal Range of Movement and Strength

As your neck pain settles, your physiotherapist will focus on treatments and exercises to ensure you regain your normal neck movement, muscle length, strength, and endurance.

Neck Stretches

You will be given stretching exercises to improve joint range and muscle length. Your physio will also likely do some gentle ‘hands on’ joint mobilisations to work on any localised joint stiffness in the spine.

Your physiotherapist will also assess your movement pattern and posture, and correct any abnormalities.

Strength and Endurance

You will commence a strengthening programme that specifically focuses on neck stability, and targets the deep neck muscles that dynamically control and stabilise your neck. You will also work on global muscle strength, around your upper back, shoulders and arms.

Restoring Full Function

Depending on your occupation, or chosen sport or activities, your physiotherapist will tailor your rehabilitation to work on specific tasks or functional movements, to allow you to return to your desired activities safely.

Spinal injections and Surgery For Whiplash

In very rare cases, an injury from whiplash requires injection therapy or surgery. Spinal injections involve injecting a small amount of steroid (also known as cortisone or corticosteroid) using X-ray guidance (known as fluoroscopy guidance) into the joints and/or soft tissues. Injections are reserved for those cases where the pain is not improving. Surgery is usually only required if there are torn ligaments or fractured vertebrae. Spine surgery will stabilise the affected areas of your spine, preventing nerve damage and further pain.

At Complete Physio we have long standing relationships with some of the most senior and experienced spinal surgeons in the country, and so if a surgical opinion is required, then we will make sure that you are given the best possible care.

Throughout your treatment at Complete, your Physiotherapist will ensure you feel supported, and involved in your recovery process. We will regularly reassess you, to evaluate your progress and we are committed to helping you reach your rehab goals.

If you would like to speak to one of our expert Physiotherapists or to book an appointment please call 020 7482 3875 or email info@complete-physio.co.uk