Whiplash Disorders

As one of the most frequent conditions seen in our clinics, whiplash or whiplash associated disorders (WAD) typically occur following a road traffic collision. The neck and upper back regions are most injured due to the mechanism of injury, which involves the neck being subjected to rapid acceleration which strains the soft tissues including muscles, ligaments and tendons. The neck complex goes through a contrecoup movement which throws it back and forth multiple times, explaining the severity of issues that are usually reported.  

• Pain in both or either side of the neck and upper back, mid back and/or the lower back.  

• Neck and lower back stiffness – usually first thing in the morning and when in static positions such as desk-based work and driving.  

• Pain in both or either wrists – typically due to gripping the steering wheel tight or bracing yourself on the dashboard with your arms. 

• Headaches – usually because of the tension in the neck muscles which can irritate the cranial and facial nerves which branch from the upper neck.  

• In some instances, shoulder pain on the outside of the upper arm – again typically from bracing or gripping the steering wheel. 

• Discomfort across the chest and waist from the seatbelt.  

• Radiating pain down the arm into the hands and fingers – this usually arises from irritation of the neck nerves which supply the arm and hand. (PLEASE NOTE – if you experience permanent numbness in the arm and hand, becoming floppy with little to no control and power, we recommend that you attend A&E immediately as this can be a sign of significant nerve damage which may require further investigation.) 

Whiplash injuries are categorised using the Quebec Task Force Classification which is outlined below:

• Grade I  — neck pain and associated symptoms in the absence of objective physical signs.

• Grade II — neck pain and associated symptoms in the presence of objective physical signs and without evidence of neurological involvement.

• Grade III — neck pain and associated symptoms with evidence of neurological involvement including decreased or absent reflexes, decreased or limited sensation, or muscular weakness.

• Grade IV — neck pain and associated symptoms with evidence of fracture or dislocation.

(Cote et al., 2016)

Resulting from the rapid acceleration and stretch these structures go through, the symptoms occur because of microscopic tears and inflammation. The body reacts by dilating blood vessel in the area which sends more fresh, oxygenated blood to the damaged areas to help with healing. The affected muscles also go into a spasm which means they become sore and over-active which limits movement and function to varied levels based on severity. Due to this spasm, the muscles in the neck are typically reported as feeling ‘tight’ and ‘sore’. The ‘tight’ sensation is because these muscles want to avoid being lengthened and stretched from the recent microtrauma which happens at cellular level and explains the soreness.  

Stiffness in the neck is common first thing in the morning because when you’re static whilst sleeping, these muscles can increase in tone which is why it is important to keep the neck moving as much as possible throughout the day. Also, because of this acute spasm, the muscles in the neck can also feel sore towards the end of the day because they are more active than normal, meaning they can fatigue quicker as they work hard to support your head.

These are all normal symptoms to be expected which you may not feel within the first 24 hours as they typically develop 48-72 hours post-accident. It is usually the case for whiplash injuries to get worse over the first couple of weeks before symptoms begin to settle. Again, a normal presentation. The symptoms should start to settle over the first 3-6 weeks which is a typical timeline for the acute phase to last.  

Your Physiotherapist will invite you to explain the history of your injury and symptoms. This will be followed by a comprehensive physical assessment so that an accurate and timely diagnosis can be given.

In the acute stage of WAD, the management is focused on promoting your bodies’ healing whilst maintaining function and movement. The professional guidelines by NICE recommend that during the first 4-6 weeks the optimal management is as follows: 

• Keep yourself moving little and often  

• After 72 hours, use heat (hot water bottle, wheat sack, shower/baths) to assist with reducing inflammation  

• Don’t be concerned about taking pain relief to reduce discomfort and keep you functioning – speak to a pharmaceutically trained professional if you need any advice on this.  

• Perform the recommended exercises regularly.  

Please find the patient resources section of our website where we have created a series of recommended exercise programmes for whiplash. We advise consulting with your Physiotherapist prior to trying any of these exercises.

As your pain begins to settle whilst you maintain movement and function with the above recommendations, the next aim – if there is any movement limitation, is to achieve full range of motion in the affected areas. Your Physiotherapist can help support this goal with hands on soft tissue mobilisation & manual therapy coupled with exercise progressions and further self-management advice.

We will also provide you with education on your injury to help you understand your symptoms and how your recovery plan will help. Self-management and home exercises form a crucial part of your rehabilitation because it is important for you to have things to do daily to support your recovery and return to full function.

Upon achieving full movement and function, our Physios will progress your individualised exercise plan to increase the strength of the neck and upper back muscles. This is an important part of your rehabilitation as this will develop robustness to ensure you manage well during typical positions and movements you perform in everyday life. If your muscles are strong, they can work at a lower level to help support your head and neck. This individualised strengthening program will form the basis of your ongoing self-care plan to ensure your symptoms remain well managed and that the previously damaged structures become strong and resilient.

Côté, P., Wong, J.J., Sutton, D., Shearer, H.M., Mior, S., Randhawa, K., Ameis, A., Carroll, L.J., Nordin, M., Yu, H. & Lindsay, G.M. (2016). Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Spine Journal, 25(7), 2000-2022.

National Institute of Health and Care Excellence. (2018). Neck pain – whiplash injury. Retrieved from https://cks.nice.org.uk/neck-pain-whiplash-injury#!scenario [Accessed 7/7/2020].