Whiplash (Neck Strain)
The neck consists of intervertebral joints, discs, ligaments, tendons, cervical muscles and nerve roots. The adult spinal column comprises of 33 irregular bones (the vertebrae). The cervical region is comprised of 7 vertebrae. The first vertebra is referred to as C1, the atlas, and the second vertebra C2, the axis. Each vertebra consists of a spinous process projecting posteriorly (to the back) and two transverse processes which project laterally (to the side). The muscle attaches on to these processes. The upper 24 vertebrae articulate with each other through facet joints, which are small gliding joints. These joints allow movement. Between each vertebra there is an intervertebral disc. These discs aid movement and act as shock absorbers, and help prevent wear and tear of the vertebrae. Each disc comprises of a soft, gel-like centre and a harder fibrocartilage outer case.
Whip lash occurs as a result of a sudden flexion or extension of the neck. As a sportsinjury this is usually the result of a person being struck from behind during a contact sport. In a road traffic accident, whip lash occurs when a car hits another vehicle or larger object, such as a tree, suddenly. The weight and momentum of the impact forces the driver or passenger’s head/neck to be thrown forwards and backwards. This causes damage to the intervertebral joints, discs, ligaments, tendons, cervical muscles and nerve roots to become damaged.
Whip lash can occasionally be caused by a trip or fall, as the neck is jolted forwards and back.
Pain and stiffness often occurs in the cervical region. Pain can radiate and numbness can be felt down the arm (due to pressure on or damage to the nerves).
There is reduced range of movement (difficulty turning the head).
There might be a decreased sensation in the skin, muscle weakness or paralysis below the level of the injury.
Headaches can be a symptom.
Pain and stiffness can occur in the lower and upper back.
Poor concentration, tiredness, irritability can happen in the days following an accident.
Seek medical advice if blurred vision, dizziness, pain in the jaw, strange sensations of the skin linger.
Symptoms of whiplash do not always occur immediately. It can take several hours, and be worse the day after an accident.
There are 3 types of whiplash (neck strain):
Grade 1, a mild strain: There is usually less than 5% of the muscle fibres are damaged. There is minimal inflammation and slight tenderness on touching the affected area. Despite some discomfort, normal activity can be continued.
Grade 2, a moderate strain: There is more damage to the muscle fibres, but not complete rupture. The muscle stays complete. The pain is more severe, and a lump might be felt where the muscle fibres have become damaged and have become bunched up. In this strain there are obvious signs of swelling and movement is impaired.
Grade 3, a severe strain: In this instance there is total rupture; over 95% of the muscle fibres have been damaged. A dip in the skin is felt on palpating the area. This is where the muscle fibres have separated. There is a total loss of use. Medical treatment needs to be sought.
Until the injured patient has been x-rayed, the worst case scenario should be assumed (a spinal or cervical break). The patient should be placed on a stretcher, with the head and body being moved simultaneously, to avoid any further damage. If possible the neck should be supported, by a splint or collar.
Anyone who has suffered whiplash should be x-rayed, to rule out possible fractures or breaks to the cervical (neck) region.
Once whiplash, neck strain, has been diagnosed, then the following treatment can be applied.
Rest, in the acute (immediate) phase, the first 48-72 hours. After this time joint mobility exercises can be introduced. It is important to keep the neck mobile. It is important these exercises are initially gentle and increased gradually to avoid further damage.
A physiotherapist, doctor or osteopath can advise on joint mobility exercises and strengthening and flexibility exercises.
A collar can be worn in the early stages, however early joint mobility is encouraged to prevent stiffness.
Ice, can be applied every 10-15 minutes, every 2-3 hours in the acute and sub- acute stage (frequency can be reduced according to recovery, and can be continued for as long as deemed necessary. In the sub-acute stage (3days – 3 weeks) heat therapy can be applied.
NSAIDS (anti-inflammatories) and paracetamol can be taken to aid pain relief. Medical advice should be sought, in case of possible side effects.
Muscle relaxants, such as diazepam are occasionally prescribed for a several days if the muscles become very tight.
A physiotherapist, doctor, osteopath or sports massage therapist can advise on postural advice.
Massage can help aid recovery, and improve neck mobility. It should not be administered during the acute stage. If there is any underlying medical condition, such as a heart condition, it is important to seek medical advice before receiving massage.
A firm supporting pillow can help.
It is best to avoid rough contact sports until complete recovery, or medically fit to do so. It is advisable to seek medical advice before resuming contact sports, to prevent any further injury from occurring.
Published: March 2, 2012Author: Sophia Cross, BA (Hons) MA