Whiplash injury to the neck is caused by a sudden and uncontrolled backward jerking of the head followed by a forceful forward bend.
The injury typically occurs in a rear-end automobile collision but may be caused by other mechanisms, as well.
Whiplash-associated disorder (WAD)
A syndrome called whiplash-associated disorder (WAD) may develop after whiplash injury, with onset at the injurious event.
The criteria for WAD
The mechanism of injury described above
No cervical fracture, intervertebral disk prolapse or spinal injury
No objective neurological deficits
No imaging findings
The figures reported for the annual incidence of WAD vary greatly, from 28 to 834 per 100 000.
Its incidence is highest among 20- to 24-year-old women.
Most cases of WAD resolve within a few weeks but in 14 to 42% of patients the symptoms persist.
The time of onset of WAD symptoms ranges from a few hours to several days after the incident.
Typical symptoms include neck/shoulder pain (100%), headaches (78-86%), vertigo (41-48%) and numbness/tingling of the upper limbs (38-46%).
The neck is stiff and painful on movement.
Neurological findings are normal.
Nothing abnormal can be seen in cervical x-ray or CT images. MRI findings are also unspecific and unrelated to the nature or severity of symptoms.
The development of WAD is thought to be due to augmented nociceptive processing associated with tissue damage and to the development of sensory hypersensitivity (cf. fibromyalgia, for example Fibromyalgia).
Systemic inflammation process has been suggested to be related to the development of WAD. The blood interleukin-1 beta and tumour necrosis factor alpha concentrations have been found to be increased in people suffering from chronic neck pain.
Risk factors for WAD
Severe neck pain and/or headache immediately after the injury
Low level of education
Female sex
Neck symptoms before injury
Catastrophic thinking and a pessimistic view of recovery
If symptoms following whiplash injury persist, it is important to exclude any treatable causes (fractures, traumatic disk protrusion, unstable cervical spine) and to confirm the diagnosis.
Cervical MRI is often necessary.
In the treatment of WAD, active mobilization and maintenance and improvement of cervical mobility are essential.
Appropriate instruction concerning the nature of the problem and safe mobilization promote recovery.
Psychological support should also be provided if there are signs of a posttraumatic stress reaction, for instance.
Mobilization can be carried out through a home exercise programme; a physiotherapist can help to plan and implement the programme.
Massage, kinesio taping and manipulation of the thoracic spine may be helpful.
Cervical collars, muscle relaxants and botulinum injections should be avoided.
Surgery does not bring benefits.
Chronic pain often constitutes an insurance law problem.
References
Li Q, Shen H, Li M. Magnetic resonance imaging signal changes of alar and transverse ligaments not correlated with whiplash-associated disorders: a meta-analysis of case-control studies. Eur Spine J 2013;22(1):14-20. [PubMed]
Michaleff ZA, Maher CG, Lin CW et al. Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial. Lancet 2014;384(9938):133-41. [PubMed]
Walton DM, Macdermid JC, Giorgianni AA et al. Risk factors for persistent problems following acute whiplash injury: update of a systematic review and meta-analysis. J Orthop Sports Phys Ther 2013;43(2):31-43. [PubMed]
Ferrari R, Russell AS, Carroll LJ et al. A re-examination of the whiplash associated disorders (WAD) as a systemic illness. Ann Rheum Dis 2005;64(9):1337-42. [PubMed]
Styrke J, Stålnacke BM, Bylund PO et al. A 10-year incidence of acute whiplash injuries after road traffic crashes in a defined population in northern Sweden. PM R 2012;4(10):739-47. [PubMed]
Carroll LJ, Holm LW, Hogg-Johnson S et al. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976) 2008;33(4 Suppl):S83-92. [PubMed]
Farrell SF, de Zoete RMJ, Cabot PJ et al. Systemic inflammatory markers in neck pain: A systematic review with meta-analysis. Eur J Pain 2020;24(9):1666-86. [PubMed]