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Whiplash
Whiplash is a common injury to the soft tissues of the neck. Its name describes the motion that typically produces the painful symptoms associated with this injury. The neck is suddenly forced backwards and then forwards, stretching the muscles and ligaments of the neck beyond their normal range.
The neck, known as the cervical spine, consists of seven vertebral bones stacked on top of each other. These begin at the base of the skull and end at the beginning of the thoracic spine. Each vertebra is cylindrical and is cushioned by a cervical disc. Their structure provides protection for the spinal cord, support for the head, and allows the head to turn from side to side as well as bend forwards and backwards. The bones are held in position and supported by ligaments, muscles, and muscle tendons. Blood vessels and nerves travel in and out of the neck. This section of the spine is strong and not easily injured, but sufficient force can damage the soft tissues that support the cervical spine.
Causes:
Whiplash injuries are typically caused by motor vehicle accidents. In a motor accident, the normal course of events is that a moving vehicle hits a stationary car from behind, the cervical spine is suddenly and forcefully thrust into an abnormal S shape, and supporting tissues are damaged.
Whiplash injuries may also result from impact during contact sports such as football, although this is less common. Physical abuse such as shaking can cause whiplash, especially in the case of babies.
Symptoms:
Whiplash symptoms often appear after the moment of injury, but usually develop within a day. Typical symptoms include the following:
- Pain and stiffness in the neck, sometimes in the shoulder or between the shoulder blades
- Headaches, usually at the base of the skull
- Blurred vision
- Dizziness
- Tiredness
- Prickling or burning sensation
- Pain in the jaw
Less common symptoms can include
- Sleep disruption
- Irritability
- Ringing in the ears
- Difficulty with memory and concentration
Diagnosis:
Your doctor will ask you about your medical history, including any previous injuries to your neck. You will be asked about the circumstances of your current injury, and the type and severity of your symptoms. Your neck will then be physically examined. Diagnostic tests such as X-ray, CT (computerized tomography) and MRI (magnetic resonance imaging) scans may be taken to rule out other conditions, for example, dislocation, arthritis, or bone fracture. CT and MRI scans clearly show soft tissues, so are useful in detecting injuries to nerves or the spinal cord.
Treatment:
Most cases of whiplash respond to treatment and the patient fully recovers. During the acute stage of the injury, which is the first few days, you may find the following therapies helpful:
Ice: Ice, crushed in a bag and wrapped in a towel, can be applied to the neck for as long as is comfortable, several times a day. This will help to reduce swelling and pain.
Pain medication: Acetaminophen (Tylenol) can be taken for mild or moderate cases of whiplash. NSAIDs (over-the-counter non-steroidal anti-inflammatory drugs), taken according to directions, will help relieve pain and swelling. Examples of these are ibuprofen (Advil), naproxen (Aleve) and aspirin. Your doctor may prescribe stronger pain medication if necessary.
Muscle relaxants: Your doctor may administer an injection of lidocaine into painful muscles. This relaxes the muscles, which may have gone into spasm. Alternatively, you may be prescribed muscle relaxant medication, which can cause drowsiness, so should only be taken at bedtime.
Physical therapy: After the acute stage, heat applied to the neck can be both soothing and healing as it brings increased blood flow to the damaged area. The blood contains nutrients and substances that will promote healing of the damaged tissues. The warmth will also help to relax your muscles. Other physical therapies may include massage, ultrasound, and traction. Traction is used to gently stretch the neck.
Support: Foam neck collars were regularly used for whiplash injuries, but it is now believed that prolonged immobilization in a collar contributes to stiffness and loss of muscle tone and therefore delays recovery. You may find it helpful to wear a collar at night if pain is preventing you sleeping. If you do choose to wear a cervical collar, wear it for no longer than three hours at a time, and only during the acute stage of injury.
Exercise: Following the acute stage, your doctor will recommend that you begin stretching exercises to improve your neck’s range of motion. This has been demonstrated to improve the rate of recovery. These exercises will also help to strengthen the neck muscles, reducing the chances of further injury. Exercises usually consist of rotating the head, and gently bending the neck forwards and backwards.
Examples of exercises typically used for whiplash:
Do not attempt these if they cause you any pain, and check with your doctor before undertaking an exercise program. Go gently and carefully.
Range of motion 1:
Sitting in a chair with your head held as though balancing a book on top, carefully turn your head as far to the right as you can, without causing pain. Return to a forward facing position, then turn your head as far to the left as you can. Repeat 5-10 times.
Range of motion 2:
Sitting or standing, carefully bend your head downwards then up again. Make sure that only your head moves, not your shoulders. Now bend your head backwards, as though you are going to look at the ceiling. Go very gently. Repeat the exercise 5-10 times.
Range of motion 3:
Stand with your feet shoulder-width apart. Roll your shoulders back 2-3 times. You can also do this one shoulder at a time. Slowly tilt your head to one side, ear moving towards the shoulder, then to the other side, and finally back to face forwards.
Alignment:
Lie on the floor with your knees bent so that they are directly above your ankles. Your feet should be flat on the floor. Gently draw in your abdominal muscles. Drop your shoulders. Turn your head so that your ear moves towards the floor. Repeat to the other side. Repeat 5-10 times.
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