Brief overview
- Symptoms: Increasing headache and neck pain, severe muscle tension (stiff neck), sometimes nausea, dizziness, tinnitus, difficulty concentrating and fatigue, difficulty swallowing or painful temporomandibular joints, rarely complications such as nerve or bone damage.
- Causes: Very often due to an impact accident with the car, accidents during martial arts, climbing or horseback riding, risk factors are weak muscles in the neck area, pre-existing diseases such as herniated discs or narrowed nerve canals, rheumatism.
- Diagnosis: Physician checks mobility in the neck area, possibly imaging procedures (X-ray, MRI), sometimes neurological examinations, very rarely analysis of nerve fluid or ultrasound of neck arteries
- Prevention: In principle, well-trained neck and head muscles reduce the severity of such injuries. A good education of the affected person about the usually temporary discomfort is helpful to prevent chronification and to promote the healing process.
What is whiplash?
If the head is jerkily overstretched in this way, it strains the muscles and ligaments in the area of the cervical spine in particular. That is why the medical term for whiplash is “cervical spine distortion”, sometimes you also read about a cervical spine trauma or a cervical whiplash.
Whiplash is not an uncommon diagnosis and is even the most common complication after car accidents. Affected people usually complain of headaches and neck pain after accidents, and several other symptoms are possible in addition to muscle pain and tension.
What are the symptoms of whiplash?
Those affected by whiplash also report general complaints such as nausea, dizziness, ringing in the ears (tinnitus), concentration problems, difficulty swallowing and painful jaw joints, as well as fatigue. These, too, are usually temporary.
Although whiplash is unpleasant, it is usually harmless. In rare cases, more severe symptoms occur. These include:
- Loss of consciousness
- Memory loss for the period immediately before or after the accident event
- Severe nausea with vomiting
- Damage to the bony cervical spine, especially vertebral fractures
- Injuries to the spinal cord, possibly paraplegia
- Visual disturbances if the internal carotid artery, a specific vessel, has been damaged
- A simultaneous craniocerebral trauma
Nevertheless, a common international classification (Quebec classification) divides whiplash injuries into four degrees of severity plus a grade zero at which there are no symptoms. The highest degree includes fractures of the cervical spine. Some experts recommend eliminating this grade.
Course of disease and prognosis
As far as the duration of whiplash injuries is concerned, experts have different opinions. In principle, the majority of patients are completely free of symptoms again after some time, most of them after only a few days to weeks.
It is difficult to say how high the proportion of chronic courses is. Various studies on this subject come to different conclusions. The figures range from under ten percent to over 40 percent.
Causes and risk factors
By far the most common cause of whiplash is an impact accident. The seat belt secures the upper body, but not the head. After sudden braking out of the drive, the head thus moves forward unbraked in relation to the upper body. The muscles and ligaments in the area of the cervical spine intercept the movement, causing large forces to act on these structures for a short time. Injuries are the result.
If the symptoms of a whiplash injury become chronic, the individual’s perception and processing of pain often plays a role. Why the pain is more pronounced and/or of longer duration in some people often cannot be explained by physical causes alone.
Examinations and diagnosis
When a patient presents to the doctor with the typical whiplash symptoms, the doctor first asks whether the complaints were preceded by an accident and how the accident occurred. As a rule, the answer already provides the diagnosis. He also wants to know how severe the pain is and whether there are any other symptoms.
Physical examination
During the physical examination, the doctor carefully taps the spine. If there are bone fractures or sprains, this will cause increased pain. If this is not the case, he also moves the patient’s head in all directions and observes which movements are restricted or painful.
If an injury to the nervous system is suspected, the attending physician consults a neurologist. The neurologist uses special examinations to determine the possible nerve lesions more precisely. These include, for example, measurements of nerve conduction velocity (NLG) or electrical activity in the muscles (electromyogram, EMG).
Only in special exceptional cases are further examinations necessary, for example of the cerebrospinal fluid (CSF) or an ultrasound of the large neck arteries.
In addition to the thorough physical examination, it is equally important that the physician considers the psychological aspects of the injury experienced. Is the accident perceived as traumatic or is an acute stress reaction recognizable in the affected person? These factors increase the risk of persistent complaints. Careful explanation is important to relieve the patient’s fear of serious injury or negative expectations.
In principle, the physician avoids overdiagnosis, i.e. recognizably superfluous examinations, in order not to place unnecessary psychological stress on the patient and to promote a favorable spontaneous course.
How is whiplash treated?
To counteract tension and a stiff neck, the patient should also perform targeted loosening exercises and actively move his head. A neck brace is not advisable from a medical point of view.
Possible complications of whiplash such as bone or nerve injuries require special – often surgical – treatment. As long as it is unclear after an accident whether more serious injuries are present, the affected person should always keep his head still.
In the case of long-term pain caused by whiplash, the treatment concept is extended. There are psychosomatic practices and clinics that specialize in chronic pain patients and the therapy of long-term, complex complaints. In addition to additional pain therapy with antidepressants, special behavioral and physiotherapies may help to alleviate the pain.
Can whiplash be prevented?
In order to prevent the disease from becoming chronic, it is important for the doctor to provide good information. If the person affected knows that the symptoms will usually soon subside, this often has a positive effect on the course of the disease.
