Whiplash is one of those terms that people use to describe almost any neck injury. Whether they were on a rollercoaster or have been in a car accident, whiplash is the all-encompassing term that labels these injuries even though the treatments for varying grades of whiplash are widely different. Depending on the person and the degree of injury, recovery may take days or it may take years if treated poorly. Hold on tight 'cause we've got a lot of info to cover!
What is whiplash?
Whiplash is a specific type of neck injury that involves first an excessive bend in the neck and then a subsequent bend in the opposite direction similar to a whip’s motion. When in a car accident or taking a hard hit in football, a sudden jerk of the body can cause the neck to jolt and result in whiplash. Now that we understand that whiplash is a term used for a mechanism of injury and not the damage to the neck structures itself, we can talk about the specific neck structures that can be injured and what to expect for each type of whiplash. We’ll look at any damage to the muscles, ligaments and tendons, as well as the nerves.
Muscle
Muscle Spasm:
Whiplash often begets muscle spasms which is an increase in the tone or stiffness of a muscle due to nerve damage, instability, or misalignment. This can sometimes be massaged away but often remains even after being mobilized if it is a neurological tightness. The brain will unconsciously send signals to the muscle to continue to remain taut in order to stabilize a joint in the unstable area.
What to expect: With muscle spasms, the neck can feel very painful and sore, and the muscle itself will be tender to palpation or touch. The neck may also be limited in the range of motion in the direction opposite of the muscle. Usually, muscle spasms cannot simply be stretched either. They require restoration of joint alignment, strengthening of the deep neck flexors, or neuromuscular re-education performed by a physical therapist.
Muscle tears:
Usually, a muscle strain is the lowest type of injury. In the medical field, a muscle strain is actually a grade 1 tear of a muscle; but, this is just jargon. In reality, very few fibers of the muscle itself are torn, but many of the muscles cells are stretched and, like any other injury, need time to heal. With more serious muscle tears, more time and rest are required for healing. With complete tears of muscles, that is, the muscle fibers are now separate and no longer connected, surgery may be required.
What to Expect:
When there is a tear of the muscle, there will be pain during contraction of that muscle or, in the case of complete tears, there will be extreme weakness but little to no pain.
Ligaments and Tendons
*Ligaments are connective tissue that connect bone to bone, and tendons are connective tissue that connect muscle to bone.
Upper cervical ligament injury:
During an incident of whiplash, it is possible that the upper cervical ligaments can tear or become stretched. The transverse ligament, apical ligament, and alar ligaments keep the two topmost vertebrae (C1 and C2) stable. C1 and C2 are extremely important as these two vertebrae perform essential neck movements and also house vital arteries and nerves that go into the brain. They are different. Not only do they need to be stable so that the skull (a real heavy boy) can sit securely, but also mobile enough to allow for adequate rotation so that you can turn to see your blind spots while driving. If one or more of these ligaments are torn or strained, there can be instability of C1 and C2.
What to Expect:
When the nerves and arteries, or neurovascular structures, become compressed or damage due to this instability, it’s easy to imagine how ligament damage can create a multitude of symptoms including but not limited to:
Headaches
Nausea
Anxiety
Soreness and pain
Decreased range of motion
Numbness and tingling anywhere from the neck to the fingers
Numbness and tingling in the face
Muscle spasm…. this again? Yep!
Temporomandibular joint (TMJ) pain or instability
Your head may feel very heavy or that you may need to prop it up with your hands. This indicates a weakness of your neck stabilizing muscles such as the deep neck flexors and multifidi. These muscles can also be injured during whiplash and result in upper cervical instability, even with all ligaments intact.
Peripheral Nerve
Peripheral nerve damage:
Nerves begin in your spinal cord and exit your neck through little holes called foramina. These foramina can become closed during whiplash and compress the nerve roots that come out of them. As the nerves exit the neck and travel down the arm, they pass through muscles and other structures where they can also be impinged or stuck. For example, the scalenes are muscles that connect the cervical vertebra to the first and second ribs. The cervical nerves pass through these muscles. With whiplash or even chronic poor posture, these muscles become tight and clamp down on the nerves like a guillotine (one of Dr. Lin’s favorite expressions).
This is very common in instances of whiplash as nerves are easily agitated. Nerve damage presents itself in a spectrum of different symptoms. Don’t forget, since we are addressing the cervical nerves, these symptoms may be felt anywhere from the neck to the shoulders to the fingers. If there are symptoms into your legs and feet, there may be an issue with the lower back and the lumbosacral nerves. You can check out our video on the nerve behavior scale below!
Least severe: Pressure – this may feel like a tightness or pulling sensation that is different than muscle tightness
Hot/cold – there may be a feeling of coldness as if the blood is exiting the area or even a burning sensation like someone put a hot cup of tea close to you
Pain – surprisingly pain is in the middle of this spectrum and even though it may be the least tolerable sensation, sometimes going from numbness to pain could mean there is an improvement
Numbness and tingling – this is a strange sensation and unique to nerves which is why physical therapists and physicians always ask if there is numbness and tingling; it rules out nerve involvement
Most severe: Loss of function – when the nerve has been damaged enough, its connection to muscles will cease and the muscles may stop working
On the bright side, peripheral nerves have the ability to regenerate as long as the connection is not completely severed. After the nerve pathway is cleared and it’s no longer being compressed, the can regrow, though the process can be very slow (roughly 1-2mm/day).
Treatment
Though it may seem like a bleak outcome for whiplash, it is a well-understood disorder for physical therapists. It is more often than not that a person who experiences whiplash has more than one of the conditions stated above, and physical therapists are trained to treat the neck holistically. Here are some treatment techniques that physical therapists use. This is not a comprehensive list, but here we will address some of the common ones.
Soft tissue mobilization:
This is different from massage as the mobilization of the muscle is highly specific in both location, direction, and depth. Not only that, knowledge of the location and function of each muscle is very important as the physical therapist must be able to assess if the muscle is improving through treatment and also monitoring how this muscle is performing in relation to the structures around it.
Joint mobilization:
You don’t need to hear a pop for you to align a joint. Especially as a layperson without knowledge of joint mechanics, it would be very lucky if your joint popped into the correct spot from a random neck crack. Physical therapists can assess which joints are hypomobile, or not moving enough and perform the appropriate treatment, returning those hypomobile joints to their normal motion.
Nerve flossing:
To address the peripheral nerves there is an exercise called nerve flossing. Because nerves do not stretch like muscles, we cannot simply tension them to create more length. Instead, the nerves must be flossed from side to side through the pathway of structures that they travel through to loosen any adhesions that may be tacking them down. For further explanation, you can check out this video.
Motor Control:
One of the most important aspects of recovering from a neck injury is restoring proper posture and neck control. Just learning how to look up and down in the appropriate way will help to prevent further injury to the neck and also maintain a neutral neck throughout the day and promote faster healing.
Of course, these are not the only treatments that can be performed for those with a whiplash injury. These are only some basic techniques. It is important to look at the person as a whole and not just treat them as if they were just a neck. Every part of the body is connected and whiplash is no isolated event. Often, the brain, upper back, lower back, and even legs can be affected by what happens during whiplash. Proper treatment for whiplash will address the entire body not as individual parts but as a whole, interconnected system.
So, if you’re sitting there reading this article with your forward head and neck pain, don’t wait any longer. See your local physical therapist or physician today to start your journey toward recovery.