whiplash

Whiplash is a neck injury caused by a rapid acceleration–deceleration of the head, typically occurring during rear-end vehicle collisions, but also seen in sports, falls, or physical abuse. The sudden movement can strain muscles and ligaments, and may injure intervertebral discs, facet joints, or nerve roots.

Classification: In many guidelines, whiplash-associated disorder (WAD) is graded from 0 to 4, with Grade 0–1 involving no or mild symptoms and no neurological signs, Grade 2 including neck pain with musculoskeletal signs, Grade 3 adding neurological signs, and Grade 4 involving fracture or dislocation.

Symptoms: Onset is usually within hours to days and can include neck pain and stiffness, headaches (often at the base of the skull), shoulder or back pain, dizziness, fatigue, blurred vision, and sleep disturbance. Range of motion may be reduced, and some individuals may develop radicular pain, facial pain, or cognitive disturbances.

Diagnosis: Primarily clinical, based on history and examination. Imaging is not routinely needed unless red flags exist or there is concern for fracture or serious nerve injury; X-ray is used to exclude fractures, and MRI or CT may be obtained for persistent symptoms or neurologic involvement.

Management: Early treatment emphasizes activity within tolerance and rehabilitation. Recommended measures include analgesics or NSAIDs, short-term use of a cervical collar is generally discouraged, and physical therapy focusing on range of motion, strengthening, and postural training. Some patients benefit from manual therapy, ultrasound, or injections for persistent pain. Education and gradual return to normal activities reduce fear-avoidance.

Prognosis and epidemiology: Most people recover within weeks to months, but a minority experience chronic neck pain. Risk factors for prolonged symptoms include greater initial pain, mobility limitation, age, and psychosocial factors. Whiplash injuries are most common in automotive crashes and are a leading cause of neck pain in adults.