• Skip to main content
  • Skip to primary sidebar
  • Skip to footer
  • General Ortho
  • Procedures
  • Spine
  • Upper Limb
  • Lower Limb
  • Pain
  • Trauma
  • Tumors
  • Newsletter/Updates
  • About Us
  • Contact Us

Bone and Spine

Orthopedic health, conditions and treatment

Whiplash Injury of Cervical Spine [Strain and Sprain]

By Dr Arun Pal Singh

In this article
    • Causes of Whiplash Injury
    • Risk Factors
    • Mechanism of Whiplash Injury
    • Classification of Whiplash Injuries
    • Presentation of Whiplash Injuries
    • Differential Diagnosis
    • Lab Studies
    • Imaging
      • X-rays
      • CT Scanning
      • MRI
      • CT Myelography
    • Treatment of Whiplash Injuries
    • Prognosis
    • References

The term whiplash injury is used for a neck injury caused by a sudden movement of the head forwards, backwards or sideways. It is a term that describes mechanism of injury as well as the injury per se. It covers both ligament injuries [sprain] and other muscles, tendons, and soft tissue injuries [strain].

The injury is also called Whiplash Associated Disorders.

Traffic accidents esp the rear-end vehicle collisions. are the most common cause of an acute whiplash injury. The injury occurs because of sudden or excessive neck movements like hyperextension, hyperflexion, or rotation.

The injury may also be caused by sports injuries, falls or assaults.

Most of the injuries happen in C5 and C6 cervical vertebrae.

Cervical acceleration-deceleration injury is the term used for injury due to motor vehicle accidents.

In spite of the history of the severity of accidents that precedes, the injury could be missed because the presentation is often not in proportion to the severity of the crash.

Cervical sprain and strain can also be associated with traumatic brain injury.

The neck is the most common site of injury, though the whiplash injury may also cause injury to the thoracic spine.

Causes of Whiplash Injury

  • Rear end collision in a motor vehicle
  • Roller coaster rides [without neck restraint] at an amusement park
  • Skiing accidents
  • Airplane travel [sudden jerks]
  • Direct injury to head or neck
  • Violent shaking of the neck
  • Sports injury

Risk Factors

  • Using a seat belt with shoulder restraint [than with no restraint]
  • Poor posture
  • Poorly-fitted head restraints.

Whiplash injury is more common in women than in men.

Mechanism of Whiplash Injury

Whiplash injury is caused by overload injury resulting in elongation or tear of muscles or ligaments, often resulting in swelling, bleeding of tissues, and inflammation.

The classic whiplash injury is described in the case where the patient’s vehicle has been struck from behind.

The vehicle suddenly accelerates forward immediately followed by the trunk and shoulders. This leads in forced neck extension as the head is still static. The relative movement of the cervical vertebrae causes S-curve formation which precedes the extension.

Mechanism of Whiplash Injury
MEchanism of Whiplash Injury, Image Credit: Research Gate

Following this, the head swiftly moves forward and the neck into flexion.

There could be a different set of injuries depending on different factors

  • A frontal impact will cause lower cervical spine region injury [c2-c7]
  • If head is in slight rotation, the head might be forced into the further rotation and injure facet joints processes, intervertebral discs, and the alar ligaments.
  • An impact from left side stresses both sternocleidomastoid muscles and splenius capitis muscle of the side opposite to the impact.

 

An impact when head is turned can lead to injury in multiple planes.

whiplash-injury
Image Credit: Spine Universe

Another mechanism of whiplash injury is a rapid deceleration of existing neck motion as it occurs when the vehicle strikes into the back of another vehicle.

The rapid deceleration causes sudden flexion of the neck followed by hyperextension.

The head is thrown forward causing flexion of the spine. Hyperextension may occur in the subsequent recoil.

Classification of Whiplash Injuries

  • Grade 0
    • No complaints or physical signs.
  • Grade 1
    • Neck complaints but no physical signs.
  • Grade 2
    • Neck complaints and musculoskeletal signs.
  • Grade 3
    • Neck complaints and neurological signs.
  • Grade 4
    • Neck complaints and fracture/dislocation
      • Mostly C2 or C6 or C7 levels

Presentation of Whiplash Injuries

The symptoms may include

  • Pain in neck
  • Pain in jaw
  • Stiffness of neck
  • Tightness in paraspinal muscles
  • Pain in shoulder and interscapular area
  • Tender neck
  • Headache
  • Dizziness
  • Vertigo
  • The blurring of vision
  • Numbness/ weakness/paraesthesia in the upper limb
  • Sphincter disturbance
  • Difficulty in swallowing.
  • Insomnia
  • Anxiety or depression.

The examination includes evaluation of spine and head injury if any.

Spinal cord injury should be excluded. If present, the level of spinal injury should be determined.

Risk factors for serious injury are

  • History of neck surgery
  • Presence of osteoporosis
  • Risk factors for osteoporosis
    • Premature menopause
    • Patient on systemic steroids

Persistent radicular pain after cervical trauma requires further investigation to rule out nerve root involvement.

Differential Diagnosis

  • Vertebral fractures
  • Cervical disc herniation

Lab Studies

Laboratory investigations are mostly normal.

Imaging

X-rays

Anteroposterior, lateral and anteroposterior odontoid peg views are standard x-ray projections done for whiplash injury.

Guidelines for selecting a patient for radiography are as per Canadian C-spine rule.

Canadian C-Spine Rule

CT Scanning

CT is superior to plain radiography and is indicated immediately when

  • The patient had a Glasgow coma scale <13
  • The patient has been intubated or is being scanned for multi-region trauma.

CT is also done in cases where x-rays are suspicious or abnormal or are normal in the presence of strong clinical suspicion.

CT is also done in cases of children<10 years as odontoid view x-ray is not done in these cases.

MRI

MRI is better for detecting soft tissue injuries such as an intervertebral disc, posterior longitudinal ligament, and interspinous ligament injury etc.

MRI should be done in patients with indicated for patients with neurological even in the presence of normal radiographs.

MRI can distinguish hematoma from edema, which can have prognostic importance.

CT Myelography

CT myelo is not routinely done. This is indicated if MRI is not available or contraindicated or the patient is not able to tolerate MRI.

Treatment of Whiplash Injuries

Often, mild injuries have a self-limiting course.

The goal of the treatment is the restoration of the function by increasing the strength, endurance, and flexibility.

The acute management of the injury is done by

  • Drugs for pain
    • NSAIDs
    • Opioids
  • Neck support
    • Cervical Collar
    • Braces
  • Local heat or cold therapy
  • Traction
  • Ultrasound massage
  • Exercises

Most cases resolve in a few days. But other neck strains may take weeks or longer to heal.

The rest should not be extended unnecessarily as early movement is more effective in reducing pain.

The neck exercises include

  • Strength and endurance exercises
  • Stretching exercises
  • Exercises for deep neck muscle strengthening

Surgical treatment may be required in serious injuries leading

  • Cervical radiculopathy
  • Cervical spine instability
  • Kyphotic deformity

Percutaneous radiofrequency neurotomy provides good results in cases of pain originating from facet joint.

Prognosis

The consequences of whiplash range from mild pain for a few days to severe disability.

Following factors may indicate poorer prognosis

  • Prolonged inactivity
  • Non-compliant with the exercise regime
  • Psychological issues like depression

References

  • Siegmund GP, Winkelstein BA, Ivancic PC, Svensson MY, Vasavada A. The anatomy and biomechanics of acute and chronic whiplash injury. Traffic Inj Prev. 2009 Apr. 10 (2):101-12.
  • Kumar S, Ferrari R, Narayan Y. Looking away from whiplash: effect of head rotation in rear impacts. Spine. 2005 Apr 1. 30(7):760-8.
  • Kasch H, Stengaard-Pedersen K, Arendt-Nielsen L, et al. Headache, neck pain, and neck mobility after acute whiplash injury: a prospective study. Spine. 2001 Jun 1. 26(11):1246-51.
  • Giannoudis PV, Mehta SS, Tsiridis E. Incidence and outcome of whiplash injury after multiple trauma. Spine. 2007 Apr 1. 32(7):776-81.
  • Soderlund A, Lindberg P. Long-term functional and psychological problems in whiplash-associated disorders. Int J Rehabil Res. 1999 Jun. 22(2):77-84
  • Hendriks EJ, Scholten-Peeters GG, van der Windt DA, et al. Prognostic factors for poor recovery in acute whiplash patients. Pain. 2005 Apr. 114(3):408-16.

 

Save

Spread the Knowledge
  • 7
    Shares
  •  
    7
    Shares
  •  
  • 7
  •  
  •  
  •  

Filed Under: Spine

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

Reader Interactions

Comments

  1. bob provencal says

    December 12, 2010 at 2:42 pm

    I was involved in an auto acciodent back in aug 20th 2010 I continue to have severe pain at the base of my skull, I have had thearpy and the pain clinic. I went to see a neurosurgen and he is sending me for an epidural injection at c6-7 WEhat will this do

  2. Dr Arun Pal Singh says

    December 15, 2010 at 11:20 am

    @bob provencal,

    I was not provided enough information to answer this question properly.

    Epidural injections are part of treatment. You need to ask your doctor as to what would they be doing in your case.

  3. Dr Arun Pal Singh says

    December 21, 2010 at 7:20 pm

    @bob provencal,

    Did you ask your neurosurgeon? What has been diagnosed as the problem.

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Primary Sidebar

Range of Motion of Cervical Spine

Range of Motion of Cervical Spine

Cervical spine movements are complex and result of individual vertebral motion. There are six movements possible in the normal range of motion of the cervical spine. These are Flexion A movement by which chin attempts to touch the chest. Extension A movement in the opposite direction of flexion Lateral Flexion This movement allows you to […]

Pencil Cup Deformity in Psoriatic Arthritis

Psoriatic Arthritis Presentation & Treatment

Psoriatic arthritis is a chronic inflammatory, seronegative arthritis that develops in about 5% of the people who have psoriasis. Psoriasis is an autoimmune disorder that mainly affects skin leading to a characteristic rash. About half of the patients of psoriatic arthritis have often human leukocyte antigen HLA B27 associated spondyloarthropathy. Psoriatic arthritis is considered as […]

Brachial Plexus Injury

Brachial Plexus Injury – Causes, Presentation and Treatment

Brachial plexus injuries can occur in neonates following birth trauma [Erb’s paralysis and Klumpke’s paralysis], compression of brachial plexus by surrounding structures [thoracic outlet syndrome] and due to inflammation of the nerve [Turner parsonage syndrome or brachial neuritis] and direct or indirect injury by trauma [called traumatic brachial plexus injury]. Traumatic brachial plexus is the […]

ADI and PADI in atlantoaxial instability

Atlantoaxial Instability Causes and Treatment

Atlantoaxial instability implies excessive movement between the first cervical vertebra or atlas, and second cervical vertebra or axis. Atlantoaxial joint is formed between these two vertebrae This joint is a kind of transition zone and the instability may occur because of bony or ligamentous instability. The instability can be asymptomatic or cause neck pain and […]

IDSA guidelines for treatment of vertebral osteomyelitis

IDSA 2015 Clinical Practice Guidelines for Native Vertebral Osteomyelitis in Adults

The guidelines are published by the Infectious Disease Society of America. These guidelines include evidence and opinion-based recommendations for the diagnosis and management of patients with native vertebral osteomyelitis treated with antimicrobial therapy, with or without surgical intervention. Native vertebral osteomyelitis in adults is often the result of hematogenous seeding of the adjacent disc space […]

Stages of disc herniation

Spinal Disc Herniation

Spinal disc herniation is a condition in which a tear in the annulus fibrosus (Outer firmer ring) of an intervertebral disc allows the soft, central portion (nucleus pulposus) to bulge out. Due to that adjacent neural structures may get compressed and produce symptoms of radiculopathy. Following diagram would make it easier to comprehend how a […]

Terry Thomas Sign In Wrsit

Scapholunate Instability [Scapholunate Ligament Injury]

Scapholunate instability is a spectrum of wrist instabilities that have occult scapholunate interosseous ligaments sprains on one side and scapholunate advanced collapse on the other side. Often the term is used interchangeably with scapholunate dissociation but in a strict sense, the scapholunate dissociation is one of the types of scapholunate instability. To summarize, acute disruption […]

Browse Articles

Footer

Pages

  • About
    • Policies
    • Contact Us

Featured Article

Osteochondroma and Multiple Hereditary Exostoses

Osteochondroma is a cartilage-capped bony projection on the external surface of a bone and is considered a non-neoplastic anomaly similar to … [Read More...] about Osteochondroma and Multiple Hereditary Exostoses

Search Articles

© Copyright: BoneAndSpine.com