Whiplash is a collective term used to describe the injuries to the cervical spine (neck). This condition often results from an automobile collision, which suddenly forces the head and neck to whip back and forth (hyperflexion / hyperextension).
The neck consists of seven cervical vertebrae (C1-C7) held together by muscles and ligaments, intervertebral discs (shock absorbers), joints enabling motion, and a system of nerves. The complexity of the neck’s anatomy coupled with its diverse range of motion makes it susceptible to whiplash.
The symptoms of whiplash may include neck pain, tenderness and stiffness, headache, dizziness, nausea, shoulder and / or arm pain, paraesthesias (numbness / tingling), blurred vision, and in rare cases difficulty swallowing. Symptoms may appear as quickly as two hours following injury.
The symptoms usually result from injury to the neck’s soft tissues; the intervertebral discs, muscles, and ligaments. Muscle tears characteristically present with burning pain accompanied by tingling sensations.
Ligaments affected by excessive joint movement can cause muscles to defensively tighten limiting motion. ‘Wry neck’, a condition associated with whiplash, occurs when the neck muscles responsible for head rotation / extension cause the neck to twist involuntarily.
Age and pre-existing health conditions (e.g. arthritis) may increase the severity of whiplash. As people age range of motion declines, muscles lose flexibility and strength, and intervertebral discs and ligaments lose some of their elasticity.
A physical and neurological examination is performed to evaluate the patient’s general condition.
Initially, the physician orders radiographs (x-rays) to determine if fracture exists. Depending on the patient’s symptoms, a CAT Scan, MRI, and / or other imaging tests may be necessary to assess the condition of the cervical spine’s soft tissues (intervertebral discs, muscles, ligaments).
If surgery is being considered a discogram may need to be performed to confirm which disc is causing your pain. This is a procedure where a needle is inserted into the disc and then injected with some water soluble dye, while you’re sedated.
If it reproduces the pain you normally experience, then that disc can be targeted with surgery later on. This is a day case procedure performed in the operating theatre. There is a 1% risk of infection, which we minimize using IV antibiotics.
Conservative treatment includes use of pain killers, anti-inflammatory, and muscle relaxant medications; and physical therapy.
Physical therapy (PT) helps to reduce muscle spasms, increase circulation, and promote healing. PT may include the following modalities: moist heat, ice, ultrasound, electrical stimulation, and exercise to restore range of motion and build strength.
If symptoms persist, cervical traction may be incorporated into the treatment plan. A portable cervical traction device can be used at home or office. Trigger point injections containing a local anaesthetic may help alleviate pain and tenderness.
If symptoms continue more than six weeks, or new symptoms appear the patient’s condition is re-evaluated. Severe extension injuries can damage the intervertebral discs involved. When an intervertebral disc is affected, surgical intervention may in rare instances be required. Symptoms can take up to two years to settle.
Rarely does the treatment of whiplash require surgery. Surgical intervention is considered in severe cases such as those presenting with persistent neck, scapular or shoulder pain. The pain may indicate a tear in an intervertebral disc.
When surgery is necessary, one of the following procedures may be performed:
- Anterior Cervical Decompression and Interbody Fusion
- Cervical Disc Replacement
Once the target disc is removed, Spinal Instrumentation and Fusion provides permanent stability to the spinal column. These procedures join and solidify the level where an intervertebral disc has been damaged or removed.
Instrumentation, the use of medically designed hardware such as rods and screws, can be combined with Spinal fusion (arthrodesis) to permanently join two or more vertebrae.
During the recovery phase, the goal is to help the patient resume normal activities at their pre-injury level. The guidelines set forth by the spinal physician and / or physical therapist should be closely followed. A home exercise program customized by the physical therapist is a key to rebuilding strength and increasing range of motion. It may be necessary to continue physical therapy and modalities (e.g. moist heat) for a period of time.
Post-operative pain and / or discomfort should be expected. Patient Controlled Analgesia (PCA) enables the patient to control their pain without hospital staff assistance. PCA is eventually replaced by oral medication.
The patient may be encouraged to get up and walk the following day. Activity enhances circulation and healing.
Physical therapy is added post-operatively enabling the patient to build strength, flexibility, and increase range of motion. Physical therapy is usually continued on an outpatient basis for a period of time. Additionally, the therapist provides the patient with a customized home exercise program.
Prior to release from the hospital, the patient is given written instructions and prescriptions for necessary medication. The patient’s care continues during follow-up visits.