Each year more than two million Americans experience a whiplash injury (a.k.a. whiplash-associated disorder) to their neck. Numerous studies have shown that the most common cause of whiplash is a 6 to 12 mph rear-end automobile collision where the individual has a sudden, hyper-extension (backward movement) and flexion (forward movement) of the neck. The violent, unexpected motion forces the neuromuscular structure of the cervical region to exceed its normal movement parameters. Collisions at higher speeds have a commensurately higher incidence of severe damage to the cervical spine region.
Whiplash-associated disorder can also be caused by a front-end or side-impact automobile collision, contact sport-related accident, e.g., being struck from behind, diving/swimming pool accident, amusement park ride, or physical abuse (e.g., shaken baby syndrome). The pain the individual feels can be mild to severe and acute (short term) or chronic (long term). It is generally agreed that as many as 40% of patients with acute, whiplash-associated neck pain will develop chronic neck pain.
Soft Tissue Injury
In the majority of cases, the whiplash injury damages the soft tissue of the neck resulting in a sprain or strain of the neck muscles or ligaments. In the past, damage to the soft tissues was nearly impossible to visualize. Even with the aid of various advanced imaging technologies (MRI, CT-scan, standard x-ray with contrast, etc.) visualization remains difficult. There are times when patients will experience soft tissue injury, with pain, yet the imaging studies are completely normal. This means that the key factor in soft tissue diagnosis is the knowledge and experience of the spine specialist.
The symptoms of a soft tissue neck injury include neck pain, arm and hand pain, stiffness, back pain, shoulder pain, ringing in the ears, dizziness, neck-related (cervicogenic) headache, paresthesia (burning, tingling or prickling sensation), or injury to the discs, facet joints of the low back or sacroiliac joints. Some people may also experience cognitive deficits such as memory loss and impaired concentration as well as sleep disorders or psychological conditions, e.g., nervousness, depression or irritability. It is important to keep in mind that while the symptoms of a whiplash-associated disorder usually appear within 24 hours, in some cases the symptoms may not manifest themselves until days or even weeks after the accident.
If a soft-tissue injury is confirmed, there are a number of passive treatment alternatives that may be recommended including bed rest, hot and cold compresses, pain relieving medications such as non-steroidal anti-inflammatory drugs, and muscle relaxants. The decision as to which medication(s) is prescribed will depend on the type and severity of pain being experienced, the individual’s pain tolerance, and their general medical condition. Spine specialists now prefer that the patient pursue their daily activities in as normal a manner as possible. In the past, whiplash patients were advised to wear a cervical collar to limit neck movement. This type of immobilization is no longer considered an effective therapy as prolonged collar wear can cause weakness in the neck muscles.
Most patients with mild to moderate whiplash will have pain relief within a few days to two weeks, with a prognosis of full recovery in 10 to 12 weeks. For those individual’s whose neck pain becomes chronic (more than 12 weeks) or worsens the spine specialist may recommend, in addition to pain medication, some form active intervention including physical medicine, e.g., physical therapy, traction, range of motion exercises, etc. In the rare case of prolonged, debilitating soft-tissue pain the patient may be prescribed anti-inflammatory cortisone injections, opioid analgesics and/or anti-depressants. Surgery is not considered to be a treatment option for a soft-tissue whiplash-associated disorder.
Cervical Spine Injury
The pain symptoms of a cervical spine injury due to whiplash-associated disorder are similar to that of a soft tissue injury. If the spine specialist’s examination and imaging studies reveals damage to the facet joints, intervertebral discs, nerve roots and/or vertebrae of the cervical spine a more aggressive treatment regimen is usually undertaken. This approach may include physical medicine, anti-inflammatory pain medications, injections of cortisone into facet joints, facet joint radiofrequency neurotomy, facet joint laser ablation, therapeutic nerve blocks (steroid plus analgesic), and/or anterior cervical discectomy or laminectomy with fusion.
End Note: Although whiplash injuries occur with ever-greater frequency, the diagnosis of a whiplash-associated disorder is a challenging undertaking. The success of whiplash treatment will be a function of the thoroughness and accuracy of the spine specialist’s diagnosis.
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