Whiplash

About 1 million people suffer from whiplash injuries each year, usually after being involved in minor fender-benders. Yet for the numerous whiplash cases reported, it can still be difficult for many doctors to diagnose and harder still to pinpoint an effective treatment. Although 90 percent of patients with whiplash injuries get better within a year with little or no treatment, other people appear to suffer lingering pain. That may be why one medical magazine has called it "the enigma of whiplash injury."

How does whiplash occur?

One of the most common traumatic injuries to the neck, whiplash can happen when a vehicle must stop very suddenly, or a stopped car is rear-ended by another. An injury typically occurs when the force of the impact snaps the head of the driver -- or that of a passenger -- violently forward and then back by the impact, causing a moderate to severe strain to the neck region. The bones, disks, muscles, nerves, and tendons of the neck may be injured in whiplash and whiplash-associated disorders (WADs), according to the American Academy of Orthopaedic Surgeons.

You don't have to be driving fast to suffer whiplash. Some whiplash injuries happen when a car travels at speeds as low as 5 mph. Although whiplash is associated with driving, it can also be caused by sudden stops in roller coasters or other amusement park rides, by sports injuries, or by being punched or shaken. When small babies are shaken violently, they can also suffer whiplash injuries or brain damage.

What are the symptoms?

Symptoms may include one or more of the following:

  • pain or stiffness in the neck, jaw, shoulders, back, or arms
  • headaches
  • dizziness
  • blurred vision or ringing in the ears
  • tingling or numbness in the arms, hands or shoulders
  • memory loss or difficulty concentrating
  • nervousness or irritability
  • difficulty sleeping
  • fatigue
  • burning or prickling, particularly around your neck
  • depression
  • vertigo

What if I don't feel anything at first, but start to have symptoms later?

This is typical of whiplash: Symptoms may occur right away but often do not begin to develop for several hours after the incident and then worsen over the next 24 to 48 hours.

How long do the symptoms last?

Most neck and head pain symptoms clear up within a few days or weeks, according to the National Institute of Neurological Disorders and Stroke (NINDS). For others, the recovery can take up to three months. But about 25 percent of people with whiplash report symptoms for up to a year, and about 10 percent of patients report permanent symptoms as a result of their injuries.

How is whiplash diagnosed?

Whiplash is difficult to diagnose since most injuries are to soft tissues -- like muscles and ligaments -- and will not show up on an x-ray. If an x-ray fails to reveal a problem, doctors will sometimes order specialized tests such as computed tomography scans or magnetic resonance imaging (MRI). But more often they will make a diagnosis based on your history and symptoms, and by ruling out other possible ailments.

If you've seen your doctor about your injury and the symptoms persist for more than six weeks, it may be time for you to see a specialist. You should contact your doctor about seeing a specialist, such as a neurologist, who can help diagnose your condition.

What is the treatment for whiplash?

For severe pain, doctors often prescribe anti-inflammatory painkillers or muscle relaxants. You can apply ice to the injured area to reduce pain and swelling for up to 20 minutes every hour during the first 24 hours. After that, heat usually provides more relief than cold, as it loosens and relaxes tight muscles. Some patients also find relief in physical therapy, massage, ultrasound, and chiropractic treatments. Your doctor may suggest a series of exercises as soon as your condition improves.

One thing your doctor probably won't order is a cervical collar. A stiff cervical collar used to be standard treatment for whiplash, but the current trend is to encourage early movement rather than immobilization, according to the American Academy of Orthopaedic Surgeons (AAOS). (Soft surgical collars are sometimes still used on a short-term basis.)

Oddly enough, resting is not the best way to recover from whiplash. Experts suggests that gradually resuming normal activities is the best way to get back on track.

What can I do to help prevent whiplash?

Since the most common cause of the injury is car crashes, experts say safe driving, seatbelts, and properly adjusted headrests are your best protection against whiplash. Seatbelts help keep you from being flung forward, even on a roller coast ride. A low headrest in your car allows your head to pivot backwards over the top during an accident: Be sure to raise or lower your car's headrest until the center of the rest meets the center of the back of your head. The Insurance Institute for Highway Safety (IIHS) recommends that the headrest be at least as high as the head's center of gravity (or about 3 to 5 inches below the top of the head), and that the distance between the back of the head and the headrest be as small as possible.

Up until recently, head restraints were poorly designed and inadequate to prevent most whiplash injuries, according to the IIHS. On many cars, it is often impossible to adjust the headrests up or down. Many models also have no protection for people sitting in the back. But that's changing. Some car companies have installed headrests in newer cars that are higher and closer to the passenger's heads. Check out the latest models if you're investing in a new car.

References

NINDS Whiplash Information Page, National Institute of Neurological Disorders and Stroke, May 19, 2010.

Q and A's: Neck Injury. Insurance Institute for Highway Safety. August 2010.

The enigma of whiplash injury: Current management strategies and controversies. Young, William F. MD. Vol. 109. No. 3, Postgraduate Medicine.

Save Your Neck, The Spinal Injury Foundation http://www.spinalinjuryfoundation.org

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