Whiplash: mechanism and uncomplicated management
Whiplash is a neck injury from rapid hyperextension (head thrown backwards) then hyperflexion (thrown forwards) that strains the neck ligaments, the tough fibrous bands holding the neck bones together.
Remember
Once serious injury has been excluded, uncomplicated whiplash is managed by gentle neck movement, normal activities and simple painkillers; collars and long periods of rest do not help.
Memory aid
think of a whip: the neck snaps back and then forward
Picture the crack of a whip: the neck goes back first, then forward, and the stretched ligaments take the strain.
Whiplash is a hyperextension then hyperflexion injury of the cervical spine (the neck part of the spine). Hyperextension means the head is thrown backwards beyond its normal range, and hyperflexion means it is then thrown forwards. Rapid deceleration is a common cause, for example in a car crash: the body is stopped suddenly but the head keeps moving.
The damage falls mainly on the ligaments (the tough fibrous bands that hold the neck bones together) and on other soft tissues. Pain and stiffness in the neck may take several hours to appear. Headaches or shoulder and arm pain can follow, and spinal cord injury is a recognised possibility.
In uncomplicated cases, once a serious injury such as a fracture or neurological injury has been excluded, whiplash usually settles by itself. Recovery is usually within 2 to 3 months, although some people have symptoms for longer.
The advice is gentle neck movement, normal activities as far as pain allows, and simple painkillers such as paracetamol or ibuprofen. Gentle movement speeds recovery, whereas a collar or long periods of rest do not help.
Red flags are warning features such as tingling, weakness of the arms or legs, or difficulty walking, and they need urgent assessment. If symptoms are not improving at follow-up, the next steps are review in primary care, then physiotherapy, a pain specialist or psychological support if symptoms persist.
Key facts
- Mechanism
- hyperextension then hyperflexion of the neck, often from rapid deceleration.
- Tissues injured
- the neck ligaments and other soft tissues.
- Symptoms
- neck pain and stiffness, which may take several hours to appear.
- Usual course
- whiplash usually settles by itself, usually within 2 to 3 months, although some people have symptoms for longer.
- Advice in uncomplicated cases
- gentle neck movement, normal activities as far as pain allows, and paracetamol or ibuprofen once serious injury has been excluded.
- Not helpful
- collars, braces and long periods of rest do not help recovery.
- Red flags
- tingling, weakness, difficulty walking or severe pain despite simple painkillers need urgent assessment.
Exam traps
- A collar, even a soft one, is not advised for uncomplicated whiplash, because keeping the neck still (immobilising it) can delay recovery.
- Prolonged bed rest does not help uncomplicated whiplash: it reduces movement and does not speed recovery, whereas staying active does.
- In uncomplicated whiplash, a stronger painkiller such as codeine is not the first choice, because simple painkillers such as paracetamol or ibuprofen are tried first, and a stronger drug is considered if these do not work.
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