Whiplash is the rapid bending forward and extension backward of the spine, usually the cervical spine, by an abrupt change in the speed and direction in which you are in is obviously traveling faster that yours. When the collision occurs, your car is projected forward, forcing your head backward. Then you car rapidly decelerates, hits another car ahead of you, or you slam on the brakes to avoid it, and your head is thrown forward. All this may occur within seconds and cause damage to the facets and their coverings, discs, and the muscles around and the ligaments supporting the spine.
The whiplash may also cause the brain to bounce back and forth inside the skull. The brain is a mass of nerve and other cells and blood vessels. It has the consistency of moderately firm butter and is supported by leatherlike sheets (dura) and surrounded by a leatherlike sac filled with spinal fluid. At the base of the brain, delicate nerves, a fraction of an inch in diameter, leave the buttery mass, enter holes in the skull, then can travel to your nose, eyes, ears, and other structures. You can readily understand that as a result of severe whiplash, in which the brain is thrown back and forth inside the dural sac inside the skull, damage to it and the nerves leaving it may occur. A whiplash injury may cause a mild concussion, which can affect thinking and mood. Double vision, ringing in the ears, and headaches are common. If the speed at which this accident occurs is high enough, broken vertebrae, a damaged spinal cord, and severe concussion or even a contusion or bruise of the brain, resulting in bleeding within it, can result. There are usually no broken bones, disc herniations, large blood clots, ripped muscle, or torn skin. The result of a whiplash injury is obviously painful, and the painful aftereffects, for unclear reasons, last varying times in different people.
Acute whiplash pain may cause local or widespread muscle spasm. For those with chronic pain, the facets are the usual culprits, although muscle spasm may still exist. The top three segments of facets, C2-3, C3-4, and C4-5, are responsible for head and upper neck pain. Lower facets may cause mid-to-lower neck, thoracic, and lumbar pain.
Whiplash injury may also cause what we call discogenic pain. Even when not herniated, discs may have a torn covering (annulus) and internal tears within the nucleus. The torn annulus can be seen on MRIs. Not all discs with a torn annulus are painful. The C2-3 and C3-4 discs may cause headache and these and the C4-5 discs may also cause upper neck pain. Like facets, lower discs may cause lower neck, thoracic, or lumbar pain. Discogenic and facet pain may coexist.
Symptoms of Whiplash
Symptoms may occur right after the injury or may be delayed for several days. They include:
- neck pain and stiffness
- pain in the shoulder or between the shoulder blades
- pain, numbness, or tingling (paresthesia) in he arm and/or hand
- less commonly, low-back pain, with possible radiation into the buttocks, groin, hips, and thighs
Treating Cervical Whiplash Pain
Most whiplash-caused head and neck pain goes away in a few weeks to a few months. In the past, whiplash was often treated by immobilising the neck in a cervical collar; today, we encourage early movement rather than keeping the neck rigid. The collar is the best used intermittently for short periods.
In the first twenty-four hours after injury, apply heat and keep moving the neck slowly and gently. No single treatment has proven effective, but exercises, physiotherapy, cervical collars, medication, and injections have all helped some people some of the time.
Key Points about Whiplash
- Whiplash is one of the most controversial conditions in medicine.
- It is most frequently caused by a rear-end auto accident.
- Most whiplash heals in a matter of weeks, but 20 percent to 40 percent persist for years.
- It can lead to chronic neck, back, and head pain.
- Cervical facets and muscle spasm cause the pain.
- Whiplash can also cause discogenic pain.
- Because it is test-negative, others frequently don’t believe that you have it.
- Diagnosis must be done by ruling out all other possibilities.
- It is treated with medication, physiotherapy and injection.