Whiplash (Neck Strain)

What is whiplash?

Whiplash is a condition that happens when sudden movement changes force your neck (cervical spine) and upper spine to move in ways that cause injury. This causes a form of neck sprain.

Whiplash refers to a single concept but can have a wide range of effects. Experts refer to conditions that happen due to whiplash as “whiplash-associated disorders.” Whiplash can also happen with sudden movement changes in any direction.

Because it involves a neck injury, first responders and medical personnel will often treat whiplash as an emergency condition. Healthcare providers will also approach it with extreme caution until they can confirm, treat and stabilize a dangerous injury, or rule out that kind of injury.

Who does whiplash affect?

Whiplash can affect anyone at any age, but is more likely to cause serious or lasting injuries in two groups: older adults and women and people assigned female at birth (AFAB). It’s more serious in older adults (over age 65) because they’re typically more prone to muscle and bone injuries of any kind. That’s usually due to age-related muscle and bone deterioration and weakening.

Women and people AFAB are more likely to have whiplash-type injuries in car crashes, which may be due to several factors:

• Height. Experts suspect that’s because women and people AFAB have a shorter average height compared to men and people assigned male at birth (AMAB).
• Spine structure differences. Women and people AFAB also have a different spinal column structure than men and people AMAB. That affects the distance between each vertebra (the interlocking bones that make up your spine).
• Muscle differences. Women and people AFAB usually have less muscle tissue, which can act as a shock absorber to reduce the effects of sudden impact forces. That means they have less available muscle to help absorb movement forces.
• Vehicle construction. Modern vehicle construction may contribute to the risk of injury for women and people AFAB. Head restraints (better known as headrests) are there to stop your head from moving backward too far in a collision. Because women and people AFAB have a shorter average height, seat back and headrest height may affect them differently.

How common is whiplash?

Whiplash is fairly common, affecting millions of people worldwide each year.

How does whiplash affect my body?

Whiplash happens because of how one law of physics, the law of inertia, affects the human body. Think about what it’s like to be in a moving car when the driver suddenly steps on the brakes. Inertia is why your body keeps moving forward even though the car is stopping. Inertia is also why you press back into your seat if the driver suddenly steps on the gas and goes from a complete stop to rapid acceleration.

Just like you’re a passenger in the car in the above analogy, your brain is a passenger in your skull. Sharp, sudden movements can cause your brain to smack against the inside of your skull, causing injury to your brain. That’s why your neck is like a shock absorber for your head, naturally compressing, extending or twisting to minimize the effect of sudden movements on your brain.

Whiplash happens when inertia causes your head, neck and body to move at different speeds. That forces your neck to compress or extend too quickly or in ways that push the muscles, ligaments and bones of your spine beyond what they can tolerate.

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. Experts don’t fully understand why this happens, but research is ongoing. At its worst, whiplash can break the vertebrae in your neck, creating a risk of damage to your spinal cord and its network of connected nerves.

What are the symptoms of whiplash?

The symptoms of whiplash depend on how severe the whiplash was and how severely your neck hyperextended or compressed. The greater the extension or compression, the greater the injury.

A key part of whiplash symptoms is the timing. Some symptoms of whiplash may begin immediately after a crash, while others take at least 12 hours to appear. Sometimes, it may take a full day or even a few days for all the symptoms to show up.

Because whiplash can have various effects, experts created a grading system for the severity of whiplash-associated disorders. Known as the Quebec Classification of Whiplash-Associated Disorders, this grading system (with more details about each grade immediately below) is as follows:

• Grade 0: No injury.
• Grade 1: Pain only.
• Grade 2: Pain plus signs of injury.
• Grade 3: Pain plus signs of injury and neurological effects.
• Grade 4: Severe pain and signs of serious or dangerous neurological effects.

Grade 0

At this level, a person with whiplash doesn’t feel any pain or show any signs or symptoms of injury.

Grade 1

This level of whiplash is the first one where a person feels pain. They’ll also show:

• Stiffness when moving.
• Tenderness to being touched around the injury.

Grade 2

This is the first level where a person shows pain and other symptoms from Grade 1, plus physical signs of an injury. The pain also can also have different effects from Grade 1. The symptoms of Grade 2 whiplash include.

• Pain that radiates to nearby areas like your head, face, shoulder and back.
• Muscle spasms that make it hard to move or turn your head and neck.
• Physical signs of injury, including bruising, swelling and sensitivity to being touched around the injury.

Grade 3

Grade 3 whiplash involves neurological symptoms. These happen because swelling or inflammation disrupts nerve signals traveling through the injured area on the way to or from your brain.

These symptoms include:

• Muscle weakness.
• Numbness (including loss of ability to feel hot, cold or pain) in your neck, upper back, shoulders or upper arms.
• Burning, tingling or “pins and needles” feeling (paresthesia) in your neck, upper back, shoulders or upper arms.
• Headaches.
• Vision problems (these happen because of disruptions in reflexes that allow your eyes to automatically remain stable even when you move your head and neck).
• Hoarseness or loss of voice (dysphonia) and trouble swallowing (dysphagia).
• Dizziness or vertigo (this is known as cervical vertigo).

Grade 4

This is the highest level of whiplash-associated disorders. These usually involve all of the above symptoms, especially neurological ones, but they’re more severe. When neurological symptoms are more severe, that can indicate at least one neck vertebra has a fracture or is out of alignment or shifting out of place, putting pressure on your spinal cord or nearby nerves.

What causes whiplash?

Whiplash happens when your movement speed or the direction you’re traveling suddenly changes. Some of the most common events or activities that can lead to whiplash include:

• Motor vehicle crashes (these are the most common cause of whiplash).
• Contact sports (such as football, hockey, rugby, etc.).
• Roller coasters.

While the above are the most common possible causes, whiplash can happen in many other ways. Even simple slips and falls can cause whiplash under the right circumstances

How is whiplash diagnosed?

Whiplash is a diagnosis of exclusion. That means healthcare providers make the diagnosis after ruling out more serious conditions that need immediate treatment or other possible causes. Ruling out those other conditions involves a combination of diagnostic tests, imaging scans, physical and neurological examinations, and more. Healthcare providers also ask you questions about your symptoms and any events that could have caused the whiplash, especially car crashes.

What tests will be done to diagnose whiplash?

There are several possible tests, most of them imaging scans, that can help a provider rule out other conditions or issues and diagnose whiplash, including:

• X-rays.
• Computerized tomography (CT) scans.
• Magnetic resonance imaging (MRI) scans.

How is whiplash treated, and is there a cure?

Whiplash is treatable, but there’s no way to cure it directly. Instead, the goal of treatment is to allow whiplash to heal as much as possible on its own while supporting that healing process and minimizing symptoms. Some people may also need care for chronic issues that happen because of whiplash.

What medications or treatments are used?

Some treatments for whiplash are most helpful right after an injury, while others are best if used to treat the long-term effects and chronic problems from a whiplash injury. Some can do both. The most common treatments for whiplash (with more about them below) include:

• Immobilization.
• Medications.
• Cold application for the first seven to 10 days. Heat application is recommended after that.
• Exercise/physical therapy.
• Transcutaneous electrical nerve stimulation (TENS) therapy.
• Radiofrequency nerve ablation.
• Spine surgery.

Immobilization

Because whiplash can affect your spine and spinal cord, it’s common for people with possible neck and spine injuries to receive some forms of protective care immediately. An example is a cervical collar (C-collar), which emergency medical personnel can put on a person’s neck at the scene of a car crash.

A C-collar has a rigid frame that holds your head and neck in alignment, so your vertebrae don’t press on or damage your spinal cord. That also helps keep your neck muscles from bearing the weight of your head, which might be very painful if your neck muscles are injured.

There are also other forms of immobilization. Your healthcare provider is the best person to tell you about the available forms and which form they recommend.

Medications

Medications are a major part of whiplash treatment, helping address many of the symptoms. Because there are many symptoms, many different types of medication can help. The most common kinds of medications providers prescribe to treat whiplash include:

• Painkillers. These range from over-the-counter drugs like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, etc. Stronger painkillers, such as opioids, are also possible for moderate to severe pain. However, healthcare providers prescribe these very cautiously because of the risk of long-term dependence or addiction to these drugs.
• Anti-inflammatory drugs. These medications reduce swelling from inflamed tissue. Swelling from whiplash can lead to other symptoms if it presses on nerves and keeps signals from going to or coming from your brain.
• Muscle relaxers. Sprained muscles can often spasm uncontrollably, causing severe pain and preventing healing from an injury. Muscle relaxers cause muscles to relax, preventing spasms and giving those muscles a chance to heal.
• Nerve blocks. Blocking nerve signals can offer relief to people dealing with severe or chronic pain from whiplash.

Many other kinds of medications are also possible. Your healthcare provider is the best person to tell you about the available medication options they recommend.

Applying cold and heat

Experts recommend using cold packs during the first seven to 10 days to decrease swelling and inflammation. After that, gentle warmth and heating can help improve blood flow to an injured area, which helps promote the healing of damaged tissues.

Exercise or physical therapy

Recovering from whiplash can often involve physical therapy. This form of treatment uses guided exercises to strengthen injured areas after they heal. That can help you regain more function in the affected area and can also help ease related symptoms like pain.

Transcutaneous electrical nerve stimulation (TENS) therapy

Transcutaneous electrical nerve stimulation, or TENS for short, is a therapy that delivers a mild electrical current through your skin to surface nerve endings. Your nerves use electrical signals to communicate, so using an outside electrical current at low levels can help with pain in those areas. Using a TENS unit to ease the pain is much like using white noise to help you block out other sounds while you sleep.

Radiofrequency (RF) nerve ablation

One way to treat chronic pain is to stop the nerves in the affected area from sending pain signals. This is especially helpful when an injury leads to nerve damage, making the affected nerves send pain signals more than they should. This treatment uses RF energy to heat the targeted nerves and intentionally damage them, so they stop sending pain signals. This can reduce pain for weeks or months.

Spine surgery

In rare cases, an injury from whiplash — especially torn ligaments or fractured vertebrae — need surgery. Spine surgery can stabilize the affected areas of your spine, preventing further nerve damage and pain.

Complications/side effects of the treatment

The possible complications and side effects of whiplash treatments vary widely. Your healthcare provider is the best person to tell you about the complications and side effects that you can expect.

How can I take care of myself and manage symptoms of whiplash?

When whiplash is minor, especially in Grade 1 or Grade 2, it’s usually something you can manage on your own. Cold followed by heat, over-the-counter anti-inflammatory or pain medications, and rest are often enough to help you recover. But it’s best to see a healthcare provider if the pain is moderate or doesn’t get better with at-home remedies. Pain that doesn’t get better is a sign of a more serious injury.

You shouldn’t try to take care of whiplash injuries on your own if the event that caused your whiplash also involved you passing out or losing consciousness. You also shouldn’t try to manage it on your own if you show any signs of nerve-related problems.

Passing out, dizziness and vertigo, headaches, tingling, numbness, weakness or trouble swallowing or speaking are all signs that you need to see a healthcare provider as soon as you can, as these are also signs of a concussion or traumatic brain injury, both of which can be dangerous.

How soon after treatment will I feel better?

The time it takes to recover from whiplash depends on the treatments themselves, as well as factors like the cause of your whiplash, personal circumstances, health history and more. Your healthcare provider can tell you more about the likely timeline for you to feel better and recover.

How can I reduce my risk or prevent whiplash?

You can do several things to reduce your risk of developing whiplash. Unfortunately, it happens unpredictably, so there’s no way to prevent it entirely. The best things you can do to reduce your risk include:

• Adjust your vehicle seat. Putting your seat into the right position and using the headrests can reduce the risk of developing whiplash from vehicle-related situations (see your vehicle’s driver’s manual to learn the correct positioning). There are also orthopaedic seat cushions that can help adjust your height or posture so the seat’s safety features, like headrests, have the most benefit.
• Wear your seat belt properly. If your seat belt isn’t worn correctly across your shoulder or it isn’t snug against your body, it might not be able to stop your forward motion before your forward momentum causes a whiplash injury.
• Drive safely. Being cautious with driving can help you avoid situations where the driver behind you can’t stop in time. An example of this is not driving too close to someone in front of you only to slam on the brakes, which might not leave the person behind you enough time to stop.
• Position matters. If you see or hear something that indicates your vehicle is about to be rear-ended and there’s time, place your head against the headrest and face straight ahead. Having your head against a properly placed headrest keeps your head, neck and body from moving at different speeds, which can cause whiplash.
• Play contact sports safely. Avoiding dangerous contact during these sports can help avoid a whiplash injury to another player.
• Talk to a healthcare provider before riding roller coasters at a theme park. A primary care provider can advise you on whether or not you can and should ride roller coasters or participate in other high-movement activities that could lead to injury.

How long does whiplash last?

Most people with whiplash, especially lower grades, can recover within days or a few weeks. More severe whiplash can take several weeks or even months to heal.

Whiplash lasts longest when complications lead to chronic pain or inflammation in and around your spine. The timeline for recovery from chronic complications of whiplash can vary widely, so a healthcare provider is the best source of info on what you can expect in your specific case.

What’s the outlook for whiplash?

Whiplash is often a minor concern, causing pain, soreness or stiffness but no long-term effects. When it’s more severe, whiplash can cause long-term pain and complications. In the most extreme cases, whiplash can cause severe spinal injuries that can be permanently disabling or deadly. However, these are also extremely rare thanks to advancements in safety equipment and engineering, especially in motor vehicles.

When should I seek medical care?

In situations where you have whiplash that lasts more than a few days, or if the pain or other symptoms are disrupting your regular routine and activities, you should see a healthcare provider as soon as you can.

When should I go to the emergency room?

You need emergency medical care if you have any nerve-related symptoms of whiplash. This includes any kind of muscle weakness, numbness or tingling below your neck, as well as headaches or vision problems.

What is the best treatment for whiplash?

The best treatment for whiplash depends on many factors. The severity of your injury, what caused it and your medical history can all play a role. Treating your symptoms and not straining yourself and making the injury worse might be all it takes for minor whiplash.

You should see a healthcare provider sooner rather than later for more severe injuries. The longer you wait, the more likely you’ll develop a chronic complication that could linger for months or even years.

A note from Cleveland Clinic

Whiplash is a common injury that happens when a sudden movement change puts too much force on your head, neck and body. That causes those body parts to move at slightly different speeds and with subtle differences in direction, straining and damaging bones, muscles, ligaments and nerves in your head, neck and upper back.

Most people can recover from whiplash within days or weeks, but chronic problems can last for months or even years. Fortunately, there are many ways to treat this problem. While most work best when used sooner rather than later, there are still ways to treat chronic pain and other issues that happen because of whiplash.