Overview of Whiplash

Whiplash is a term used to describe an injury to the soft tissue (e.g., muscles, ligaments, tendons) in the neck. Whiplash injury, also called neck strain, neck sprain, cervical sprain, or cervical strain, can occur when a sudden force (e.g., a car accident) causes forward, backward, or sideways movement of the head that is beyond the normal range of motion, or from a sudden jolt.

The neck, or cervical spine, is comprised of seven bones (called vertebrae) and is part of the spinal column. The vertebrae are separated by gel-like cushions (intervertebral discs) and are held together by ligaments, which are attached to muscles by tendons. Whiplash injury involves damage (i.e., stretching or tearing) to these muscles, ligaments, and tendons. The term whiplash is not used to describe additional injuries such as a fractured vertebra, a herniated disc, or a head injury.

Causes and Risk Factors for Whiplash

The most common cause for whiplash is a motor vehicle accident. Whiplash injury often results from a rear-end collision, but it can occur as a result of a collision in any direction. The speed of the car and the extent of car damage do not determine the risk for neck injury. Whiplash can occur even at speeds of 15 mph.

In a collision, drivers and passengers are at increased risk if the headrest is not positioned at the correct height. To reduce the risk for whiplash, the top of the headrest should be just below the top of the head and seatbelts with shoulder straps should be worn.

Other causes for whiplash injury include the following:

• Amusement park rides (e.g., roller coasters)
• Assault (i.e., being punched, shoved, or shaken)
• Falls or slips
• Sudden straining to lift or pull a heavy object also can cause a whiplash-type injury.

The elderly and patients who have chronic conditions that affect the neck (e.g., arthritis) are at increased risk for sustaining a whiplash injury. Infants and young children often experience whiplash as a result of being shaken ("shaken baby syndrome"). People who participate in sports-related activities, especially contact sports such as football, are at increased risk for neck injuries, including whiplash.

Signs and Symtoms of Whiplash 

Signs of whiplash occur in response to soft tissue (e.g., muscle, ligament, tendon) damage. Common symptoms include neck pain, tenderness, stiffness, and headache. Symptoms can occur immediately following the injury (may indicate more severe damage), or can develop several hours to days later. Pain, which may be mild at first, may worsen 12–72 hours after the injury.

Additional symptoms that may develop with a whiplash injury include the following:

• Abnormal sensations (e.g., numbness, tingling, prickling)
• Back pain
• Cognitive changes (e.g., difficulty concentrating, memory loss, irritability)
• Dizziness (vertigo)
• Muscle spasms
• Pain that radiates from the neck into the shoulders and arms
• Ringing in the ears (tinnitus)
• Swelling in the neck area
• Vision changes (e.g., blurred vision)
• Weakness

Most patients recover from whiplash within 3 months. In some cases, patients develop depression or experience difficulty sleeping that may require treatment. Activities of daily living and work-related activities also be affected. Studies have shown that about 18 percent of patients experience related symptoms (e.g., chronic neck pain) as long as 2 years after a whiplash injury.