Those experiencing neck pain, stiffness, headache, shoulder and back pain may suffer from a whiplash injury. Can knowing whiplash signs and symptoms help individuals recognize the injury and help healthcare providers develop an effective treatment plan?

Whiplash Signs and Symptoms

Whiplash is a neck injury that typically occurs after a motor vehicle collision or accident but can happen with any injury that rapidly whips the neck forward and backward. It is a mild to moderate injury of the neck muscles. Common whiplash signs and symptoms include:

• Neck pain
• Neck stiffness
• Headache
• Dizziness
• Shoulder pain
• Back pain
• Tingling sensations in the neck or down the arms. (Johns Hopkins Medicine. 2024)
• Some individuals can develop chronic pain and headaches.

The symptoms and treatment depend on the severity of the injury. Treatment can include over-the-counter pain medicines, ice and heat therapy, chiropractic, physical therapy, and stretching exercises.

Frequent Signs and Symptoms

The sudden whipping movement of the head can affect several structures within the neck. These structures include:

• Muscles
• Bones
• Joints
• Tendons
• Ligaments
• Intervertebral discs
• Blood vessels
• Nerves.
• Any or all of these can be affected by a whiplash injury. (MedlinePlus, 2017)

Statistics

Whiplash is a neck sprain that occurs from a fast neck-jerking motion. Whiplash injuries account for more than half of vehicle traffic collision injuries. (Michele Sterling, 2014) Even with a minor injury, the most frequent symptoms include: (Nobuhiro Tanaka et al., 2018)

• Neck pain
• Next stiffness
• Neck tenderness
• Limited range of motion of the neck

Individuals can develop neck discomfort and pain shortly after an injury; however, the more intense pain and stiffness typically do not occur right after the injury. Symptoms tend to worsen the next day or 24 hours later. (Nobuhiro Tanaka et al., 2018)

Beginning Symptoms

Researchers have found that approximately more than half of individuals with whiplash develop symptoms within six hours of the injury. Around 90% develop symptoms within 24 hours, and 100% develop symptoms within 72 hours. (Nobuhiro Tanaka et al., 2018)

Whiplash vs. Traumatic Cervical Spine Injury

Whiplash describes a mild to moderate neck injury without significant skeletal or neurological symptoms. Significant neck injuries can lead to fractures and dislocations of the spine that can affect the nerves and spinal cord. Once an individual develops neurological problems associated with a neck injury, the diagnosis changes from whiplash to traumatic cervical spine injury. These differences can be confusing as they are on the same spectrum. To better understand the severity of a neck sprain, the Quebec classification system divides neck injury into the following grades (Nobuhiro Tanaka et al., 2018)

Grade 0

• This means there are no neck symptoms or physical examination signs.

Grade 1

• There is neck pain and stiffness.
• Very few findings from the physical examination.

Grade 2

• Indicates neck pain and stiffness
• Neck tenderness
• Decreased mobility or neck range of motion on physical examination.

Grade 3

• Involves muscle pain and stiffness.
• Neurologic symptoms include:
• Numbness
• Tingling
• Weakness in the arms
• Decreased reflexes

Grade 4

• Involves a fracture or dislocation of the bones of the spinal column.

Other Symptoms

Other whiplash signs and symptoms that can be associated with the injury but are less common or only occur with a severe injury include (Nobuhiro Tanaka et al., 2018)

• Tension headache
• Jaw pain
• Sleep problems
• Migraine headache
• Difficulty concentrating
• Reading difficulties
• Blurred vision
• Dizziness
• Driving difficulties

Rare Symptoms

Individuals with severe injuries can develop rare symptoms that often indicate traumatic cervical spine injury and include: (Nobuhiro Tanaka et al., 2018)

• Amnesia
• Tremor
• Voice changes
• Torticollis – painful muscle spasms that keep the head turned to one side.
• Bleeding in the brain

Complications

Most individual generally recover from their symptoms within a few weeks to a few months. (Michele Sterling, 2014) However, whiplash complications can occur, especially with severe grade 3 or grade 4 injuries. The most common complications of a whiplash injury include chronic/long-term pain and headaches. (Michele Sterling, 2014) Traumatic cervical spine injury can affect the spinal cord and be associated with chronic neurological problems, including numbness, weakness, and difficulty walking. (Luc van Den Hauwe et al., 2020)

Treatment

The pain is typically more severe the next day than after the injury. Whiplash musculoskeletal injury treatment depends on whether it is an acute injury or the individual has developed chronic neck pain and stiffness.

• Acute pain can be treated with over-the-counter medicines like Tylenol and Advil, which effectively treat the pain.
• Advil is a nonsteroidal anti-inflammatory that can be taken with the pain reliever Tylenol, which works in different ways.
• The mainstay of treatment is encouraging regular activity with stretching and exercise. (Michele Sterling, 2014)
• Physical therapy uses various range of motion exercises to strengthen the neck muscles and relieve the pain.
• Chiropractic adjustments and non-surgical decompression can help realign and nourish the spine.
• Acupuncture can cause the body to release natural hormones that provide pain relief, help relax the soft tissues, increase circulation, and reduce inflammation. The cervical spine can return to alignment when the soft tissues are no longer inflamed and spasming. (Tae-Woong Moon et al., 2014)

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Neck Injuries

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References

Medicine, J. H. (2024). Whiplash Injury. www.hopkinsmedicine.org/health/conditions-and-diseases/whiplash-injury

MedlinePlus. (2017). Neck Injuries and Disorders. Retrieved from medlineplus.gov/neckinjuriesanddisorders.html#cat_95

Sterling M. (2014). Physiotherapy management of whiplash-associated disorders (WAD). Journal of physiotherapy, 60(1), 5–12. doi.org/10.1016/j.jphys.2013.12.004

Tanaka, N., Atesok, K., Nakanishi, K., Kamei, N., Nakamae, T., Kotaka, S., & Adachi, N. (2018). Pathology and Treatment of Traumatic Cervical Spine Syndrome: Whiplash Injury. Advances in orthopedics, 2018, 4765050. doi.org/10.1155/2018/4765050

van Den Hauwe L, Sundgren PC, Flanders AE. (2020). Spinal Trauma and Spinal Cord Injury (SCI). In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Brain, Head and Neck, Spine 2020–2023: Diagnostic Imaging [Internet]. Cham (CH): Springer; 2020. Chapter 19. Available from: www.ncbi.nlm.nih.gov/books/NBK554330/ doi: 10.1007/978-3-030-38490-6_19

Moon, T. W., Posadzki, P., Choi, T. Y., Park, T. Y., Kim, H. J., Lee, M. S., & Ernst, E. (2014). Acupuncture for treating whiplash associated disorder: a systematic review of randomised clinical trials. Evidence-based complementary and alternative medicine : eCAM, 2014, 870271. doi.org/10.1155/2014/870271