Cervical Whiplash


A complicated system of ligaments and muscles serves to control movement, maintain posture, and support the head and neck. Ligaments are fibrous bands of soft tissue that attach bone to bone. The ligamentous system of the spine protects the intervertebral discs and spine from injury, and prevents excessive movement of the head and neck. The muscular system of the cervical spine is complex, and includes the deep erector spinae or paraspinal muscle groups that run parallel to the spine. There are also larger and more superficial muscles that help to move and protect the neck and head. When neck or spinal motion is pushed to the extreme, such as in a car accident or whiplash injury, these ligaments and muscles can be damaged. Ligament damage sprain and muscle damage strain can produce pain, soreness, loss of motion, and, if severe enough, joint instability. Irritation or injury of the structures of the spine may produce spasm and pain of the muscles of the head and neck. This can cause symptoms that radiate into the arms and hands.

“Whiplash” is the term used to describe the pain that occurs following an acute injury to the soft tissue of the neck, including the ligaments, tendons and muscles. This type of injury is typically associated with a car accident, in which the head and neck “whip” around, due to the added momentum of the impact. The mechanism of injury is usually a sudden backward and than a snapping forward of the head and neck. Contact sports can also result in a  whiplash injury.

  • Pain in the neck
  • Swelling or redness at the neck
  • Tenderness along the back of the neck
  • Muscle spasms
  • Stiffness or difficulty moving the neck
  • Headaches
  • Pain that radiates from the neck, to the shoulder and arm

If you suspect that you have suffered whiplash, first try avoiding the positions and activities that produce any pain. Some other treatments that are usually recommended include rest and immobilization, ice, physical therapy and non-steroidal medications to reduce inflammation. If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy.

  • Rest: avoid the activities that produce the pain.
  • Anti-inflammatory and other pain medications.
  • Ice the effected area to help reduce pain and any associated muscle spasms. Apply ice right away and then at intervals for about 20 minutes at a time. Do not apply directly to the skin.
  • Physical therapy for back and disc problems must remain conservative at the beginning to avoid aggravation. Your therapist will probably emphasize rest, reducing the inflammation and increasing the blood circulation for healing. Once the initial inflammation has been reduced, stretching and strengthening exercises will be started to restore flexibility to the joints and muscles involved. The exercises will also improve the strength and stability of your spine. Each program  should be based on the structure causing the problem and symptoms so as to not further aggravate the problem.
  • Instruction to correct and maintain good posture.
  • A brace or the use of supports may be necessary to reduce stress on the disc, muscles and cervical spine.

In mild cases rest, ice and medication may be enough to reduce the pain. Many patients find these treatments sufficient in reducing pain. Physical therapy is recommended to develop a series of postural, stretching and strengthening exercises to prevent re-occurrence of the injury. Return to activity should be gradual to prevent a return of symptoms or aggravation.

  • A clinical evaluation may entail a physical exam, X-rays, or an MRI may be necessary in the cases of Grade III injuries.
  • Use of ice and immobilization to stabilize and rest the injured joint.
  • Your pain management specialist may prescribe anti-inflammatory medication or pain medication as deemed necessary.
  • A brace may be needed.
  • Surgery may be required in the case of severe Grade III injuries.

If the problem persists, consult with your health care provider. Your physician will perform a thorough evaluation to determine the possible cause of your symptoms, the structures involved, the severity of the condition, and the best course of treatment.

Procedures that your physician may recommend and perform in addition to physical therapy may include:

  • REST and ICE
  • Splinting or bracing such as a cervical collar on the affected area
  • The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
  • Steroidal injections to reduce inflammation
  • Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
  • Trigger Point Injections
  • Plasma Rich Platelet Therapy
  • Botox Injections

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