Neck Pain

Whiplash

The term whiplash describes both the mechanism of injury and the symptoms caused by that injury. The most common symptom of whiplash is neck pain. The most common cause is related to motor vehicle collision (MVC).

In addition to neck pain it may also include

  • Pain in one or both arms and/or between the shoulder blades and occasionally over the face and lower back.
  • Other symptoms usually called "Whiplash Associated Disorders" (WAD) include heaviness or tingling in the arms, dizziness, ringing in the ears, vision changes, fatigue, poor concentration or memory and sleeping difficulties.
  • Most people with whiplash injuries will get better in a few weeks or up to a few months. Only a few patients take longer to recover.
  • When the pain does not resolve or is not treated in the best way it may become chronic i.e. become a long term problem.

What are the commonest causes of neck pain in whiplash?

Facet Joint sprain / injury

  • Facet Joint Pain is the most common cause of chronic neck pain after a car accident. It may occur alone or along with disc irritation.
  • Pain is usually located to the right or left of the back of the neck.
  • The area might be tender to the touch, and facet pain may be mistaken for muscle pain.
  • We cannot tell if a facet joint hurts by how it looks on an X-ray or an MRI scan.
  • The only way to tell if the joint is a cause of pain is to perform an injection called "medial branch block (MBB)," which is discussed below.

Disc Injury

  • Disc irritation can also cause neck pain following whiplash. The disc allows movement between the bones of the neck (the vertebra), but at the same time keeps the neck from moving too much. The outer wall of the disc, called the annulus, can be stretched by a whiplash injury.
  • Usually the disc heals and sometimes it may take a long time to heal completely.
  • Disc irritation is one of the major causes of neck pain and there can be both disc pain as well as facet joint pain in some people.
  • Less often, a disc in your neck can herniate and irritate a nerve. Nerve irritation usually causes more arm pain than neck pain.

Muscle Strain

  • Muscle Strain of the neck and upper back can cause severe pain. However, there is no evidence that neck muscles are a primary cause of chronic neck pain. Muscles, however, can hurt if they are working too hard to protect injured discs, joints, or the nerves of the neck or there is something else wrong that sustains the muscle pain, such as poor posture and work habits.
  • Spinal nerves and the spinal cord can be compressed by a Herniated Disc or Bone Spur. This usually causes arm pain, but there can also be neck pain.

What are the Symptoms of Whiplash & WAD?

  • Headache due to neck problems is called cervicogenic or neck-related headache. It may be due to injury to an upper cervical disc, facet joint or higher joints called the atlanto-occipital or atlanto-axial joints. Cervicogenic headache can also make migraines worse.
  • Arm pain and heaviness may be due to nerve compression from a herniated disc, which is easy for your health care professional to diagnose.
  • Referred pain: More commonly, arm pain is "referred" from other parts of the neck. "Referred pain" is pain that is felt at a place away from the injured areas, but not due to pressure on a nerve.
  • Pain between the shoulder blades is usually a type of referred pain.
  • Lower back pain is occasionally seen and is quite common after whiplash and may be due to injury to the discs and facet joints of the lower back or the sacroiliac joints
  • Difficulties with concentration or memory can be due to pain itself, the medications you are taking for the pain, depression or mild brain injury. You might also experience irritability and depression.
  • Sleep disturbance can be due to pain or depression.
  • Other symptoms might include blurry vision, ringing in the ears, tingling in the face and fatigue.

What are the investigations that may be done to help diagnose whiplash?

  • Your health care professionals will do a detailed physical examination and decide whether further investigations are required.
  • In patients who do not get better after about 12 weeks, more detailed evaluation might be needed and some of the tests are described below. Not all patients need all tests.
  • X-rays are used straight after the injury if the health care professional suspects there may be a fracture or that the spine is not stable.  Otherwise they are often used in patients who do not get significantly better by about 12 weeks.
  • MRI scan is only necessary if the health care professional suspects a disc injury causing compression of a nerve or the spinal cord.
  • Medial branch block (MBB) is an injection done to determine whether a facet joint is contributing to neck pain.
  • Discography is an injection into the disc itself to determine if a disc may be contributing to the pain. Discography is only used for patients with severe pain that has not improved with good treatment, and for whom surgery is being considered.
  • Computed tomography (CT scan), usually combined with myelogram (dye injected into the spinal canal) can also be used to help diagnose neck pain that does not respond to treatment.
  • Electromyography and nerve conduction velocity (EMG/NCV) might be used if there is a suspicion that a nerve is being trapped (such as in carpal tunnel syndrome) or there is nerve damage.

How is Whiplash Treated?

  • It is important to commence treatment during the initial weeks after injury.
  • Active range of movement exercises & strength training are advised as soon as the pain allows. Strength training is important to help the muscles hold the head and neck in good positions.
  • Improved body mechanics. Training in proper posture decreases the stress on muscles, discs and vertebrae, allowing damaged tissue to heal.
  • Spinal manipulative therapy (SMT) may help with stiff joints.  SMT should be combined with strength training and movment exercise instruction.
  • Medications: These may include anti-inflammatory drugs and opioid (narcotic) pain relievers. The use of muscle relaxants may also be prescribed. For chronic and severe neck pain, the opioid analgesics and antidepressants are generally most helpful.
  • Spinal Injections can be helpful in carefully selected patients. Again, this should be only one part of a comprehensive treatment program. Epidural injections into the spinal canal can provide short-term relief in cases of nerve compression with arm pain, but are rarely effective for pure disc pain without radiating symptoms. Facet joint injections may help temporarily with neck pain.
  • Surgery for chronic neck pain is only rarely indicate when all conservative measures have failed and there is strong evidence of 2 or more cervical discs being damaged with nerve root and/or cord compression exist.

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