Whiplash

Whiplash is a neck injury caused by a sudden movement of the head, most often in a road traffic accident, a slip or fall, or a sports injury. Typical symptoms are neck pain and stiffness, headaches, and pain and muscle spasms in the shoulders and arms, and they can take several hours to appear. The NHS says whiplash usually gets better within 2 to 3 months, although some people have symptoms for longer (NHS). In research it is usually called whiplash-associated disorder, or WAD, and graded by severity.

How long does whiplash take to get better?

A review of 38 groups of people followed after car accidents found that a substantial proportion recover in the first 3 months. After that, recovery levels off, and pain and disability change little (Kamper et al., 2008).

An international task force estimated that roughly half of people with whiplash still report neck pain a year after the injury. Greater pain, more symptoms and more disability at the start predicted slower recovery. Details of the crash itself, such as its direction or the type of headrest, mostly did not. What people experienced afterwards did: a passive coping style, low mood and fear of movement were linked with slower or less complete recovery (Carroll et al., 2008). Those are examples of yellow flags, and fear of movement has its own entry under kinesiophobia.

What helps after whiplash?

The NHS advice is to keep up everyday activities, even if it hurts a little, because this speeds recovery. Don’t rest your neck for long periods, and don’t use a neck collar, which doesn’t help. Paracetamol or ibuprofen can ease the pain (NHS).

More treatment hasn’t clearly meant better results:

• Acute whiplash. In an NHS trial in 12 hospital trusts, training emergency staff to give active management advice made no difference to neck disability a year later in 3,851 patients. Among 599 people whose symptoms persisted, up to six physiotherapy sessions gave a modest benefit at 4 months over a single advice session, but not at 8 or 12 months (Lamb et al., 2013).
• Chronic whiplash. In 172 people with symptoms for more than 3 months, a comprehensive physiotherapy exercise programme was no more effective than advice for pain at any point up to a year (Michaleff et al., 2014).

When neck pain does persist, the small joints at the back of the cervical spine are a common source. In 50 people with chronic neck pain after whiplash, tested with double-blind nerve blocks, 54% had painful facet joints (Barnsley et al., 1995).

Going back to a desk job

The same advice to keep moving applies during the working day. The Health and Safety Executive says short, frequent breaks from screen work are better than longer, less frequent ones, and that breaks should let you get up and move about, or at least change posture (HSE). Microbreaks covers how to build them in, and neck pain from desk work the wider picture.

Do you need an X-ray?

Usually not. The Canadian C-spine rule was built from 8,924 alert adults seen in emergency departments after blunt trauma to the head or neck, of whom 1.7% had an important neck injury. It flags high-risk features, such as being 65 or over, a dangerous mechanism or pins and needles in the limbs, and low-risk ones, such as a simple rear-end collision or neck pain that started later, to decide who needs imaging (Stiell et al., 2001). More on imaging under X-ray.

When to see a doctor

See a GP if symptoms haven’t improved after a week, painkillers haven’t worked, or you’re worried. Ask for an urgent GP appointment or call NHS 111 if after a neck injury you have severe pain despite painkillers, tingling or pins and needles on one or both sides of the body, problems walking or sitting upright, a sudden electric-shock feeling in the neck and back that may travel into the arms and legs, or weakness in the hands, arms or legs. Avoid driving or cycling until you’ve spoken to a GP or 111 (NHS).