Definition
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The term "whiplash," used to describe an injury
mechanism of sudden hyperextension (backward
motion) followed by hyperflexion (forward motion) of
the neck.
Hyperextension – is a result of acceleration. The lower
part of the body accelerates forwards and the unstable
neck cannot control the movement of the head which
moves the neck into sudden extension as a result of
the weight of the head.
 Hyperflexion – is a result of deceleration. The neck
continues to move forwards causing hyperflexion until
the chin bumps the chest.
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Patho-physiology
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While the time associated with a specific collision will vary, the following provides an
example of the occupant and seat interaction sequence for a collision lasting
approximately 300 milliseconds.
0 ms: Rear car structure is impacted and begins to move forward and/or crushes
Occupant remains stationary
No occupant forces
100 ms: Vehicle seat accelerates and pushes into occupant’s torso (i.e. central portion
of the body in contact with seat)
The torso loads the seat and is accelerated forward (seat will deflect rearward)
Head remains stationary due to inertia
150 ms: Torso is accelerated by the vehicle seat and may start to ramp up the seat
Lower neck is pulled forward by the accelerated torso/seat
The head rotates and extends rapidly rearward hyper-extending the neck
175 ms: Head is still moving backwards
Vehicle seat begins to spring forward
The torso continues to be accelerated forward
The head rotation rearward is increased and is fully extended
300 ms: Head and torso are accelerated forward
Neck is “whipped” forward rotating and hyper-flexing the neck forward
The head accelerates due to neck motion and moves ahead of the seat back
Causes and Risk factors
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Common causes :
 MVA / Sport injuries e.g. diving & contact sports(rugby)
 Degeneration in the articular complex.
Risk factors:
Whiplash pain/symptoms persisting beyond 6 months
(43% failed to recover on average)
 Significant ligament, disc, nerve, or joint capsule injury.
-Passive instability—the ligaments of the neck are
loosened, making it more susceptible to whiplash pain
-Dynamic instability—the nervous system disruption
causes a disturbance in the body’s natural muscular
response to common, everyday forces.
 Delay in initiating treatment
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Causes and Risk factors cont.
Occupant age over 65
 Occupant in a small car
 Alcohol intoxication at time of MVA
 Pre-existing degenerative changes
 Prior whiplash injury
 Prior cervical spine fusion
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Signs and Symptoms
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Acute
 Pain during rest especially if structures are placed on
stretch as a result of oedema.
 Pain through entire ROM.
 Muscles are painful during stretch and contraction.
 Ligaments are painful when placed on stretch, except the
interspinal ligament which is painful during extension.
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Pain and tenderness on palpation over structures.
Referred pain as a result of :
- irritation of a nerve-root
- active myofascial trigger points
- sclerotome referral (deep burning
pain in the bone itself)
Signs and Symptoms cont.
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Tenderness on palpation over spinous processes.
Neck muscle spasm with decreased cervical
lordosis.
Headaches, especially occipital, temporal, frontal
and retro-orbital, experienced as a deep pressure
with pounding, nausea, vomiting, and photophobia.
Normal ROM restricted as a result of pain and
muscle spasm.
Dysphagia as a result of oesophagus and
pharyngeal trauma with hoarseness during the acute
phase.
Sympathetic signs: intermittent weak vision,
headache, dizziness, Horner’s Syndrome etc
Oedema
Signs and Symptoms cont.
Other:
 anterior chest pain:
presents with angina, worsens with exercise and/or
coughing & sneezing
Associated symptoms:
 Thoracic outlet syndrome with intermittent
compression on the brachial plexus
 - TMJ injury as a result of hyperextension
Psychosis symptomatic of chronic pain:
 Depression
 Anxiety
 PTSD
Possible Pathological Changes
Ant.,Post. and interspinal ligament injury
 Disc herniation in severe cases
 Fracture of the spineous process and
vertebral bodies
 Tear of the neck muscles
 Oesophageal haemorrhage
 Concussion
 Vertebral Artery Damage
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Medical management
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Acute
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Total bed-rest may be required for the first 2-3 days
Supportive, soft neck-support may be worn both day and night, only when
the patient is in an upright position
The above mentioned encourages healing of the soft tissue
Ice for the first 24 hours
Heat is contra-indicated in the first 48 hours since it might cause
haemorrhage of the soft tissue. It may be used afterwards, especially damp
heat
Anti- inflammatory medication and muscle relaxants are prescribed
Careful, active non-weight bearing exercises may commence, except
rotation and lateral flexion
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Sub-Acute
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Muscle spasm and pain are less and the symptoms become more specific.
Wean from neck support. Still use it in a vehicle or when neck feels tired
Ultra sound and damp heat/ice
Mobilisations-short of pain
Cautious isometric exercises for instability
Increase active exercises and introduce flexion and extension exercises
into the programme. Commence with PNF- patterns if patient’s pain will
allow it.
Cautiously commence with distal neural mobilisations
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Chronic
Treat according to signs and symptoms
 Pain at end of range; 6-8 weeks after injury
 Totally wean from neck-support
 Isometric exercises are progressed into standing
 Evaluate for muscle imbalance and treat accordingly
 Mobilise by stretching at the end of the range of movement(IV*),
also make use of the combined movements and neural
mobilisation techniques for final rehabilitation
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Continue with treatment until treatment reaches a plateau.
The patient must then only come in for follow-up visits.
Treatment
Analgesics
 Anti- depressants
 Surgery
 Psychiatric Treatment
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Illustrations/ X-rays
Article
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http://www.medicinenet.com/whiplash/ar
ticle.htm
References
http://www.necksolutions.com/whiplashneck-pain.html
 http://www.spinehealth.com/conditions/neck-pain/factorsaffecting-whiplash-injury
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