It happened so quickly. You were waiting for the traffic light to turn green when a large vehicle rear-ended your car. The neck and head pain have been constant and it is difficult to move your neck. Your doctor thinks you have a whiplash injury. What is whiplash? Which structures in the neck can be injured with whiplash? What are the 7 untreated whiplash symptoms you need to watch for? Are all whiplash injuries the same? What are the consequences of not treating whiplash symptoms? Let’s dig in.
What Is Whiplash? (Traumatic Neck Injury)
Whiplash is a common injury associated with motor vehicle accidents affecting up to 83% of patients involved in collisions (1). The overall economic burden of whiplash injuries, including medical care, disability, and sick leave, is estimated at $3.9 billion annually in the United States (2). A car accident can cost a lot more than just money: chronic pain, vertigo (cervicogenic dizziness), migraines, concussion, soreness, neck strain, tinnitus, and much more.
Whiplash is an injury to the neck and its supporting structures that occur as a result of unexpected impact or collision. The energy of the impact causes the neck to change its normal S-shaped curve and is forcefully pushed back while the body continues to move forward. This is referred to as hypertension of the neck. This can cause significant injury to the neck which is discussed in detail below.
The Quebec Task Force (QTF) defined whiplash as ” bony or soft tissue injuries resulting from rear-end or side-impact as a result of an acceleration-deceleration mechanism of energy transfer to the neck (3)
Whiplash is a traumatic neck injury. It is commonly the result of a motor vehicle accident. It can also occur in sports where there is an impact on the upper body that causes the head to forcibly move backward. In both cases, there can be a significant injury.
Which Structures in the Neck Can Be Injured with Whiplash? (Many!)
The neck is compromised of many different structures which are susceptible to irritation and injury during whiplash. The most common structures injured include
Ligaments
Ligaments are thick pieces of connective tissue that connect bone to bone providing important stability. There are a large number of ligaments in the neck and head. Injury to these ligaments can cause instability both in the head and neck. This instability can cause a large number of symptoms and injuries. Craniocervical instability is one such example. To learn more about this serious condition and nonsurgical treatment option please click here.
Tendons
Tendons are thick pieces of connective tissue that connect muscle to bone. They are important for movement and stability. They are also susceptible to injury. Common examples include inflammation of the tendon, AKA tendonitis or tendon tears such as a tear in the Achilles tendon. In the upper neck, there are a large number of muscles and tendons called the suboccipitals. When injured in a whiplash these tendons can cause reduced motion and significant neck and head pain. To learn more about these important muscles please click here.
Joint Capsules
A joint capsule is the cellophane wrapping on the outside of a given joint. It is essential to the vitality of the joint as it seals the joint space and provides stability (4). It also has nerve endings that provide important information about one ‘s position. The neck has 14 facet joints all of which have capsules. When injured the stability and integrity of the joint itself can be compromised. Whiplash can cause injury to joint capsules which in turn can cause pain and a cascade of degeneration.
Discs
A disc is a cushion that is situated between the building blocks (vertebral bodies) of the spine. In the neck, there are 6 cervical discs. They are numbered in relation to the two building blocks that they are sandwiched between. For example, the C6/7 disc is sandwiched between the C6 and C7 vertebral bodies. Disc absorb the forces of daily living and provide additional stability to the spine. Injury to a disc can cause pain, reduced range of motion, arm pain, and numbness. It is a serious injury.
Bones
The neck is composed of 7 boney building blocks that are stack one upon another in a vertical fashion. They are called vertebral bodies. They are numbered 1-7. For example, C1 is the top bone in the neck. They are susceptible to injury including fracture.
Facet Joints
The facet joint is a small paired joint located on the backside of the spine, and there’s one at every level of the spine. For example, the lowest facet in the neck is the C6/7 facet joint. It provides important stability and limits the movement of the neck. The facet is susceptible to injury after trauma. Symptoms vary depending upon the location and severity of the injury. Common symptoms include headaches, neck pain, and pain referred to the shoulders.
Muscles
Muscles are important for motion and stability in the neck. Muscles can be irritated or injured after a whiplash injury causing pain, reduced motion, and dysfunction.
A whiplash injury can cause damage to any or all of the structures discussed above. Symptoms can vary depending upon a number of factors. Symptoms may also vary from patient to patient. Some may be mild whereas others are severe. The most common untreated whiplash symptoms include:
Pain is the most common symptom. It may be in the upper neck, with radiations into the top of the head, or maybe in the lower neck with radiations into the shoulder blades. The severity, frequency, and quality of pain can vary significantly. Pain is a warning signal that you have a problem that warrants attention and further investigation.
Loss of Range of Neck Motion
Limited neck movement is common after whiplash and may be indicative of an injury to facet joint, ligament, tendon, or disc. Some cases respond to conservative therapy such as physical therapy or chiropractic care. This is the case with muscle strains. Limited range of motion that persists despite conservative therapy, rest, and medications is a warning sign that a significant injury may have occurred.
Headaches
Headaches can be debilitating and can vary in location, quality, and severity.
A ram’s horn distribution headache is common after whiplash. The pain starts in the upper neck and then radiates into the base of the skull extending upward into the forehead and behind the eyes. This is typically the result of an injury to the upper cervical facet joint. Headaches can also arise from nerve irritation or compression, ligament instability, and chronically tight neck muscles.
Fatigue
Lack of energy despite adequate nutrition and sleep can be common. Many patients have difficulty completing daily tasks due to fatigue.
Balance dysfunction is common. In some cases, patients feel lightheaded and at times may feel at times as though they may lose consciousness. Balance requires that the information from the eyes, brain, and neck are continuously exchanged and processed. Whiplash oftentimes compromises this delicate informative network. The end result can be mild to severe dizziness and challenges with balance. A simple walk down the hall can be almost impossible at times. Dizziness can cause falls and nausea because it makes you feel as though you are falling or spinning while standing still.
Patients who have sustained a whiplash injury can struggle with memory, concentration, and their ability to complete daily responsibilities. Tasks that were previously easy to complete can be almost impossible. Some patients often feel as though their brain is stuffed with cotton. Others describe a mental quicksand following the injury.
Neck Muscle Weakness
The neck is composed of big and small muscles. The multifidus is a very important small muscle in the neck that provides neck stability. It can be injured in a whiplash injury. In whiplash patients who fail to recovery by 3 months this important muscle withers away rapidly (5). This can compromise the strength and stability of your neck.
Are Whiplash Injuries All the Same?
Absolutely not. The onset and severity of symptoms vary. Some patients might not notice any symptoms for several days whereas others may have an immediate onset of pain and dysfunction. A classification system for whiplash injuries has been developed based upon the severity of signs and symptoms (6).
Grade Classification
0 – No complaint about the neck. No physical signs
1 – Neck pain with stiffness and tenderness only. No physical signs
2 – Neck complaint and musculoskeletal signs that include reduced range of motion and
point tenderness.
3 – Neck complaint and neurologic symptoms that include abnormal reflexes, muscle
weakness, and changes in sensation.
4 – Neck complaint and fracture or dislocation.
What Are the Consequences of Not Treating Whiplash Symptoms?
Whiplash is a serious injury that requires evaluation and treatment. Specific treatment will depend upon the type of injury and its severity. Long-term effects of untreated whiplash symptoms include:
Chronic Neck Pain
Whiplash can cause injury to the cervical discs, facet joints, muscles, and ligaments. If left untreated these injuries can progress leading to chronic neck pain (7).
Loss of Spinal Curve
Normal Cervical Curve (Lordosis)
A healthy neck has a normal C-shaped curve that is called lordosis. This curve allows for the optimal alignment and functioning of all the joints, discs, muscles in the neck. Whiplash can cause loss of this curve. Loss of curve is an early manifestation of degenerative changes in the spine (8).
Decreased Blood Flow to the Brain
Blood flow to the brain is essential for daily function. Researchers have demonstrated that loss of the normal curve in your neck can reduce blood flow to your brain (9) Ouch!. Decreased blood flow to the brain is bad and can significantly compromise one well-being and ability to function. It is like turning off the water in your blooming garden.
Possible Spinal Cord Injury
In some whiplash cases, there is an injury to the spinal cord. A new, specialized type of MRI called Magnetization transfer MRI ( MT-MRI) uses specialized protocols that can detect damage to neurologic tissues at a molecular level. In a recent paper, Eliott evaluated 30 recovered whiplash patients. They demonstrated subtle defects in the spinal cord in some severe chronic whiplash patients (10). If the whiplash injury is never evaluated such a finding will go undetected and the patient will continue to suffer.
Numbness and Tingling in the Arm and Hands
Whiplash can cause injury to the disc and small joints in the neck. If untreated these injuries can progress leading to irritation and or compression of nerves. Nerve compression can cause a number of symptoms including numbness and tingling in the arms and hands. If left untreated they can become permanent in nature with muscle weakness. Simple tasks like opening a jar may be impossible.
At Increased Risk for Future Disc Injuries
Injury to the neck and the associated loss of normal curve increases the risk of future disc injuries (8). These injuries include disc bulges, protrusion, and herniations.
In Conclusion
Whiplash is a traumatic neck injury that occurs as a result of an unexpected impact or collision that forcefully pushes the neck backward.
Whiplash is commonly the result of a motor vehicle accident but can also occur in other settings including sports.
7 Untreated Whiplash Symptoms you need to watch for include:
Neck Pain
Loss of range of motion
Headaches
Fatigue
Dizziness
Brain Fog
Neck Muscle Weakness
Whiplash injuries are NOT all the same and can be graded based upon the severity of the symptoms
The consequences of not treating whiplash symptoms can be significant and include:
Chronic Neck Pain
Loss of Spinal Curve
Decreased Blood Flow to the Brain
Possible Spinal Cord Injury
Untreated whiplash symptoms are a warning sign that you have a problem that warrants further evaluation and possible treatment. Untreated whiplash symptoms that are ignored can progress leading to life-altering changes in function and well-being. The Centeno-Schultz Clinic are experts in the evaluation and treatment of whiplash injuries. Treatment starts with a thorough evaluation and review of imaging by a board-certified, fellowship-trained physician. Treatment options include an x-ray or ultrasound-guided injection of PRP and or bone marrow-derived stem cells. The only way to get lasting relief from a whiplash injury is to treat the underlying cause of your pain.
If you or a loved one have been involved in a whiplash injury please schedule a telemedicine schedule a new patient consultation where you can learn what regenerative treatment options are best for you. We are experts in the field and will compassionately listen to you and your loved ones. Act now because the untreated whiplash symptoms can progress potentially eroding your future and quality of life.
4.Ralphs JR, Benjamin M. The joint capsule: structure, composition, ageing and disease. J Anat. 1994 Jun;184 ( Pt 3)(Pt 3):503-9. PMID: 7928639; PMCID: PMC1259958.
5. Elliott JM, Courtney DM, Rademaker A, Pinto D, Sterling MM, Parrish TB. The Rapid and Progressive Degeneration of the Cervical Multifidus in Whiplash: An MRI Study of Fatty Infiltration. Spine (Phila Pa 1976). 2015 Jun 15;40(12):E694-700. doi: 10.1097/BRS.0000000000000891. PMID: 25785961; PMCID: PMC4466088.
7. Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. Open Orthop J. 2014;8:326-345. Published 2014 Oct 1. doi:10.2174/1874325001408010326
