Because WI is caused by trauma, WI patients are usually involved in some type of accident a few hours before presentation. Symptoms do not generally take more than 24 hours to develop.

The most common symptoms in WI patients are neck pain, stiffness and headaches, often originating from the base of the skull. Pain may also radiate to shoulders, arms and upper back and usually worsens with movement. Dizziness and vertigo are not uncommon and paresthesias, particularly in the arms, as well as cognitive disorders, may also be present [19][20]. Those cognitive disorders may encompass blurred vision and tinnitus. Psychological symptoms such as irritability, problems with concentration and memory and sleep disturbances may also occur and even result in depression.

Initially, the exact tissue damage causing these symptoms is usually not obvious [21]. Vertebrae, vertebral joints with ligaments and intervertebral discs and neck muscles may be involved as well as vessels and nervous tissue, particularly dorsal root ganglia.

To date, the origin of pain in chronic whiplash is not fully understood. While tissue damage may persist in some cases [22], many people suffering from chronic whiplash presumably adopt poor postures in order to avoid pain. Such pain may initially have been caused by tissue damage but is later probably sustained by the poor posture itself [23].

• Fatigue

  The dominant symptoms manifest in the musculoskeletal system and include increased fatigue. [ncbi.nlm.nih.gov]

  Common long-term consequences from whiplash include: headaches neck aches and stiffness fatigue, and anxiety. [disabilitysecrets.com]

  […] few days after the injury: Neck pain and stiffness Headaches Pain in the shoulder or between the shoulder blades Low back pain Pain or numbness in the arm and/or hand Dizziness Difficulty concentrating or remembering Irritability, sleep disturbances, fatigue [webmd.com]

• Arm Pain

  This usually causes more arm pain than neck pain. Muscle strain of the neck and upper back can cause acute pain. [spine.org]

  Symptoms such as neck pain and stiffness or arm pain or numbness are common with whiplash injury. The author reports a case of right facial numbness and right cheek pain after a whiplash injury. [ncbi.nlm.nih.gov]

  Arm pain and heaviness may be caused by nerve compression from a herniated disc. Arm pain can also “referred” from other parts of the neck, meaning the pain is felt at a place away from the injured areas but not resulting from pressure on a nerve. [spineone.com]

• Surgical Procedure

  Orthopedists are often called to treat trauma patients and sports injuries and are qualified to perform surgical procedures. [injuryclaimcoach.com]

  A modified surgical procedure for cubital tunnel syndrome: partial medial epicondylectomy. J Hand Surg Am. 1998 May. 23(3):492-9. [Medline]. Seradge H, Owen W. Cubital tunnel release with medial epicondylectomy factors influencing the outcome. [emedicine.medscape.com]

• Military Personnel

  Injurers :: injurers Injuries :: leziuni Other Refferences : Show English Meaning (+) Noun (1) any physical damage to the body caused by violence or accident or fracture etc. (2) an accident that results in physical damage or hurt (3) a casualty to military [romanian.english-dictionary.help]

• Nausea

  Clear indications include headaches, dizziness and sometimes nausea. Causes Traffic accidents are the most common cause of whiplash. [ottobock.com.tr]

  Nausea and Vomiting It is reported that nausea and vomiting are found in 17 to 29% of patients. Almost all cases have neck pain complications. Subsequently these symptoms persist for more than 6 months in 33% of patients [7]. 3.8. [hindawi.com]

  Whiplash is the most common of injuries when it comes to car crashes Common symptoms include: Neck pain Headache Stiffness in the neck and shoulders Arm pain or weakness (this indicates a pinched nerve in your neck) Jaw stiffness and soreness Dizziness, nausea [enjuris.com]

  First Symptons of Whiplash or a Neck Sprain Pain, stiffness and restricted movement in your neck Stiffness or soreness in your shoulders and upper back Headaches, nausea or dizziness Lethargy It is important to seek medical advice as soon as you suspect [spencerssolicitors.com]

  […] headaches are added, also severe pain on the nape, tinnitus or ear buzzing, sensitivity to loud noises, vertigo, unsteadiness sensation, blurred vision, myodesopsias or photopsias (lights), equilibrium disorders, difficulties for concentrating and thinking, nauseas [vertigo-dizziness.com]

• Vomiting

  Nausea and Vomiting It is reported that nausea and vomiting are found in 17 to 29% of patients. Almost all cases have neck pain complications. Subsequently these symptoms persist for more than 6 months in 33% of patients [7]. 3.8. [hindawi.com]

  […] the most common of injuries when it comes to car crashes Common symptoms include: Neck pain Headache Stiffness in the neck and shoulders Arm pain or weakness (this indicates a pinched nerve in your neck) Jaw stiffness and soreness Dizziness, nausea or vomiting [enjuris.com]

  […] added, also severe pain on the nape, tinnitus or ear buzzing, sensitivity to loud noises, vertigo, unsteadiness sensation, blurred vision, myodesopsias or photopsias (lights), equilibrium disorders, difficulties for concentrating and thinking, nauseas, vomits [vertigo-dizziness.com]

  Trauma to the cervical sympathetic chain may occur with symptoms of nausea, vomiting, dizziness, Horner’s syndrome, and even complex regional pain syndrome type I. [boneandspine.com]

  They often are recurrent and have associated symptoms such as nausea, vomiting, sensitivity to light, and in some people, warning symptoms, termed auras, that a migraine headache is going to develop. [emedicinehealth.com]

• Tinnitus

  Once it is manageable, I start with amplification and change the sound therapy regimen for tinnitus retraining. [journals.lww.com]

  Chronic tinnitus resulting from head or neck injuries. [tinnitusformula.com]

  Tinnitus, where the patient hears nonexistent noises. Tinnitus usually sounds like ringing in your ears, but can also cause the patient to perceive hissing, static, or humming noises. [oklahomalawyer.com]

  A 70-year-old man with acquired hearing loss suffered a whiplash injury in a low-speed road traffic accident, and subsequently presented with bilateral 'tinnitus.' On closer questioning, he described hearing orchestral music. [ncbi.nlm.nih.gov]

• Benign Paroxysmal Positional Vertigo

  OBJECTIVE: The aim of the study was to evaluate the true incidence, diagnosis, and treatment of benign paroxysmal positional vertigo (BPPV) arising after whiplash injury and to distinguish this type of posttraumatic vertigo from other types of dizziness [ncbi.nlm.nih.gov]

  In another piece of research, 60 percent of subjects tested within 15 days of whiplash injury had ongoing complaints of vestibulopathy, including cervical vertigo, benign paroxysmal positional vertigo, or ocular motor system abnormalities, especially [journals.lww.com]

• Hearing Problem

  But you know well that this is not the case and that your pain is real, because you certainly had no such problems before the whiplash injury. [atlantotec.com]

  Passengers involved in these train crashes would sometimes come down with a peculiar constellation of symptoms, including back pain, arm pain, headaches, hearing problems, anxiety, insomnia, lowered sex drive, and memory problems. [theatlantic.com]

  […] with older age, greater initial neck and low back pain, post-crash dizziness, anxiety, numbness/tingling, vision and hearing problems [31] Degeneration Cervical Muscles Neck stiffness [28] [29] Fatty infiltrate may be present in the deep muscles in the [physio-pedia.com]

• Hearing Impairment

  Potential participants were excluded if there was a history of speech/language disorder or word reading difficulties identified either through telephone screening or prior school assessment completed within 1 year, evidence of visual or hearing impairment [ncbi.nlm.nih.gov]

• Neck Pain

  For a visual breakdown, take a look at our neck pain infographic (which, just as the IIHS reports, found neck pain to be more common than any other type of crash injury). You might also be interested in finding out how much a neck injury is worth. [oklahomalawyer.com]

  The Add On Head Rest, for whiplash injury protection and relief from back pain and neck pain. Click here Add On Head Rest [neurosurgeon.com]

  Sought treatment prior to their accident for neck pain. [clinicaltrials.gov]

  RESULTS: Irrespective of pain in other areas, 86% of respondents reported posterior neck pain, 72% indicated head pain, and 60% noted lumbar back pain. [ncbi.nlm.nih.gov]

• Shoulder Pain

  Pain, impaired ability to raise the ipsilateral shoulder, and scapular winging on abduction of the arm are the most frequently noted clinical manifestations. [ncbi.nlm.nih.gov]

  These are the most common symptoms of whiplash: Neck pain Neck stiffness Shoulder pain Low back pain Dizziness Pain in your arm or hand Numbness in your arm or hand Ringing in your ears Blurred vision Concentration or memory problems Irritability Sleeplessness [hopkinsmedicine.org]

• Upper Back Pain

  […] such as burning or tingling Shoulder pain Upper back pain Severe whiplash can also include injury to the intervertebral joints, discs, ligaments, cervical muscles and nerve of the neck or upper back. [thespineandhealthcenter.com]

  The primary symptom of whiplash is neck or upper back pain. Photo Source: 123RF.com. #2. Symptoms of Whiplash The primary symptom of whiplash is neck or upper back pain. [spineuniverse.com]

  Most patients recover quickly, but sometimes pain and other symptoms can last for a year or more. Physical Exam: The doctor will check to see if you have pain in your neck and upper back, and if you can move your head and neck normally. [aapmr.org]

  Risk factors for a less favorable recovery include older age, the presence of interscapular or upper back pain, occipital headache, multiple symptoms or paresthesias at presentation, reduced range of movement of the cervical spine, the presence of an [ncbi.nlm.nih.gov]

  Other symptoms can include neck stiffness or reduced range of motion, neck instability, shoulder and/or upper back pain, or headache. There could also be tingling, weakness, or numbness that radiates into the shoulder and/or down the arm. [spine-health.com]

• Torticollis

  Finally, rare sequelae of whiplash include torticollis, transient global amnesia, esophageal perforation, and descending mediastinitis. [whiplashinfo.se]

  See separate Neck Pain (Cervicalgia) and Torticollis article. [patient.info]

  Disordered fusion Reading and driving difficulties Reduced accommodation Paresthesias Trigger points Brachial plexopathy Cervical radiculopathy Spinal cord compression Weakness Brachial plexopathy Cervical radiculopathy Spinal cord compression Rare symptoms Torticollis [hindawi.com]

  There are some patients that present with post-traumatic cervical torticollis, possibly related to excessive hypertonicity of the SCM muscle, and may require anticholinergics or botulinum toxin injections. [practicalpainmanagement.com]

  In acute cases the picture may be torticollis-like. [6] Facet Joint Problems Whiplash may also lead to problems at the level of the zygapophyseal joint capsules. [9] Lord et al undertook a placebo-controlled prevalence study after whiplash and found that [physio-pedia.com]

• Cervical Osteoarthritis

  Cervical osteoarthritis often accompanies cervical degenerative disc disease. [verywellhealth.com]

  […] lesions: Cervical herniated disk [32] Mechanical Neck Disorder [41] Inflammatory: Inflammatory rheumatologic disease [32] Polymyalgia Rheumatica [32] Metabolic [32] : Osteoporosis Cervical osteoarthritis Infective: Infection or osteomyelitis [32] Malignancy [physio-pedia.com]

• Neck Swelling

  […] to minimize swelling and pain. [emedicinehealth.com]

• Facial Pain

  She described her facial pain as a constant ache, rating the level of pain at 4 out of 10. The onset of pain occurred and was noted by the patient shortly after the incident. [jaoa.org]

• Headache

  The association was most pronounced for those with a combination of headache and chronic MSC for both men (OR = 4.8; 95% CI 3.6-6.2) and women (OR = 5.2; 95% CI 3.7-7.1). [ncbi.nlm.nih.gov]

  Headache Headaches present as chronic symptoms in 70% of patients [8]. [hindawi.com]

• Dizziness

  Vertigo and dizziness are also reported in 25-50% of the cases. In otoneurologic studies, magnetic resonance angiography (MRA) is used for the evaluation of vertebrobasilar hemodynamics in patients who complain of dizziness and vertigo. [ncbi.nlm.nih.gov]

  Symptoms such as dizziness, tinnitus, headache, memory loss, swallowing, and temporomandibular joint pain can appear in any grade. [hindawi.com]

  Symptoms of whiplash can include: Stiffness and pain in the neck Headaches and dizziness Pain in the shoulders or lower back Ringing in the ears Numbness in the hands or arms Difficulty concentrating Sleep disturbances If whiplash in a car accident inflicted [hcwlaw.com]

• Vertigo

  Vertigo and dizziness are also reported in 25-50% of the cases. In otoneurologic studies, magnetic resonance angiography (MRA) is used for the evaluation of vertebrobasilar hemodynamics in patients who complain of dizziness and vertigo. [ncbi.nlm.nih.gov]

• Neck Stiffness

  Here 0 = no complaints, 1 = neck stiffness and headaches, 2 = neck stiffness, persistent muscle tension and restricted head mobility and 3 = neurological failures in addition. [ottobock.com.tr]

  These are the most common symptoms of whiplash: Neck pain Neck stiffness Shoulder pain Low back pain Dizziness Pain in your arm or hand Numbness in your arm or hand Ringing in your ears Blurred vision Concentration or memory problems Irritability Sleeplessness [hopkinsmedicine.org]

  Symptoms may include: Neck pain Neck stiffness Dizziness Ringing in ears Blurred vision Concentration or memory problems Irritability Sleeplessness Tiredness The symptoms of whiplash may resemble other conditions and medical problems. [cumc.columbia.edu]

  Some other Whiplash symptoms are: Blurred Vision Dizziness Headaches Shoulder Pain Neck Pain Arm Pain Neck Stiffness Low Back Pain Reduced Range of Motion in the Neck The Consequences of Avoiding Orthopedic Treatment Ignoring your symptoms and delaying [aicaorthospine.com]

• Paresthesia

  More than one third of patients acutely complain of paresthesias, which frequently are caused by trigger points and thoracic outlet syndrome and less commonly by cervical radiculopathy. [ncbi.nlm.nih.gov]

  Trigger points are probably the major cause of paresthesias. Cognitive, somatic, and psychological sequelae are troublesome and controversial. [whiplashinfo.se]

  Cervico-Brachial Syndrome: To the above mentioned symptoms, it should be added sensitive disorders, loss of strength, paresthesias on shoulder and arm stretching towards the hand. This syndrome can be unilateral or bilateral. [vertigo-dizziness.com]

  Individuals who experience more severe symptoms such as numbness or paresthesia running down into their arms from the neck. [brydens.com.au]

  Other causes of paresthesias of the hands, particularly the ulnar region may be related to thoracic outlet syndrome, resulting in neurogenic, arterial or venous symptoms. [practicalpainmanagement.com]

A medical history involving a car accident or other traumatic experiences, as well as indications to physical abuse generally lead to the suspected diagnosis of WI.

A thorough clinical examination focusing on the patient's head and neck may reveal further evidence of a traumatic neck lesion. The skin may exhibit bruises, cuts and abrasions, while head and neck movement may be painful. In order to anatomically localize possible damage, cautious, controlled head movements up, down and to both sides have to be evaluated. Nerve damage may lead to numbness, tingling or other pathological sensations in different parts of the body and the patient should be asked if they experience such sensations.

Radiographic imaging is generally applied to check for fractures. If additional serious injuries are suspected, the corresponding imaging techniques (computerized tomography and magnetic resonance imaging) may help to detect them.

As long as no definitive conclusion regarding the severity of WI and possible involvement of the cervical spine or nervous tissue is made, the patient should wear a neck-stabilizing collar and a backboard.

WI therapy aims at pain control and restoration of head and neck mobility. Here, the latter is strongly associated with the former since painful movements may prompt the patient to adapt to poor postures and to avoid certain movements. This, in turn, may cause additional pain and eventually lead to chronic whiplash.

While rest may be necessary to avoid additional damage in severe cases of WI, the aim should be to restore full mobility as soon as possible. Therefore, pharmacological therapy should be complemented with the appropriate exercises.

In detail, therapy usually consists of:

• Analgesics. Generally, paracetamol and non-steroidal anti-inflammatory drugs are applied to control pain.
• Muscle relaxants. May be necessary to further control pain and allow for greater mobility and restful sleep.
• Local anesthetics. If analgesics and muscle relaxants do not suffice to alleviate muscle pain, an injection of local anesthetics may be considered.
• Stabilizing collars. Collars may be initially helpful to stabilize the neck and avoid additional tissue damage. They should, however, not be used for longer periods of time since they impair recovery due to muscle loss.
• Physiotherapy. The physiotherapist has the patient perform certain movements to strengthen muscles and regain mobility. The physiotherapist may also assist in correcting poor postures.
• Home exercises. In addition to supervised exercises in physiotherapy, the patient should carry out some simple movements and stretching exercises at home. These may include neck rotation, head tilting and shoulder rolling, as long as the overall condition of the patient allows these movements.

Prognosis of WI strongly depends on the severity of the initial injury. While patients suffering from minor WI usually recover within a few weeks, moderate injuries involving  ligament strains and muscle stiffness may require a few months to heal. Severe WI involves damage to the cervical spine, the vertebral joints or to nervous tissue. Their prognosis is doubtful. In some cases, chronic whiplash may develop and permanent neck pain or even disability may ensue.

If a car accident leads to WI, the severity of the reported accident does not necessarily affect the patient's prognosis in a significant way. Allegedly minor accidents happening at low speed may even expose the car's occupants to greater acceleration and deceleration forces since the crumple zone does not deform and thus, the metal does not absorb physical forces [17][18].

WI results from traumatic experiences, most commonly from car accidents. Indeed, this type of neck injury is one of the most frequent injuries sustained in motor vehicle accidents and it is therefore often seen in emergency departments [2]. Car accidents involving considerable rear-end, front or side impacts provoke a sudden acceleration and subsequent deceleration that neck muscles and bones fail to withstand. The head moves rapidly forward and backward, muscles, ligaments and tendons are overstretched, and the bones forming the cervical spine may be damaged as well as intervertebral discs, vessels and nerves.

Other situations exposing the neck to similar physical forces, e.g. sports accidents and physical abuse, may cause similar tissue damage and trigger WI.

The very same event may cause WI of different severity to different individuals, depending on the affected person's posture at impact, their overall condition and gender. One of the most important factors that determine the severity of the injury is the patient's awareness of the upcoming impact. Those factors influence neck stability at the time of the impact.

A healthy nervous system is a prerequisite for an effective stabilization response. Furthermore, women generally suffer more severe WI than men, a fact that may be due to less muscling and more fragile bones. Awareness is especially important to withstand minor to moderate physical forces whereas the patient's strength may not suffice to resist a strong impact even when they are aware of it. Previous studies have shown that the driver of a car involved in an accident often suffers less severe WI than the passenger, because the driver may have important split seconds to prepare themselves for the impact after seeing the other vehicle in the rear mirror.

Due to the high number of car accidents, WI is very common. The number of WI has considerably increased during the last decades, presumably due to the increase in traffic volume. Of note, the growing incidence of WI is one of several factors contributing to rising insurance premiums. In order to prevent insurance frauds, a standardized system for WI diagnosis should be developed. At the same time, the automotive industry is working on new interior designs to reduce the number of WI victims.

Incidence rates of up to almost 1 per 100 persons have been reported, whereby this high incidence corresponds to women aged 20 to 24 in the United States [3]. The mean incidence, independent of age and gender, seems to range between 1 and 3 per 1,000 people. Such rates have been reported from Canada [1], Australia [4] and the Netherlands [5]. Whereas somewhat higher rates have been reported for Western Europe [6], low incidences have been calculated for Northern Europe [7].

Chronic whiplash is diagnosed when symptoms persist for more than six months. Although some studies report that the vast majority of cases achieves full recovery and only 6% of all patients suffer from residual neck pain for long periods of time, other studies estimate this number to be as high as 66%.

Due to the high number of anatomical structures possibly damaged during WI, the pathophysiology behind that traumatic injury is complex. No two WI happen under exactly the same circumstances, which is why experiments with dead bodies or animals are of little value.

The physical forces observed during a car accident or similar traumatic experiences may damage the cervical spine, its vertebral joints and capsular ligaments [8][9] and the craniovertebral junction [10], in addition to cervical muscles [11], vertebral arteries and dorsal root ganglia [12][13]. While muscle injuries are certainly responsible for a significant share of neck pain and stiffness [14], only damage to vertebral joints could be linked to chronic whiplash [15].

Because full recovery is the overall aim of any WI treatment, scientific studies nowadays focus on joint involvement in WI. In this context, it has been found that neuromuscular patterns are altered in patients suffering from chronic whiplash. However, as of yet it is not known whether alterations in muscle activity result from pathological neuronal input or if they are  part of an intended, protective strategy to avoid pain. Such protective measures are not unlikely, since different types of adaptive responses have been observed in WI patients [16].

Whiplash injury can be prevented by avoiding situations causing it.

With regards to car accidents, that means seatbelts should always be used, cars with airbags should be preferred and the seat headrest should be properly adapted to the respective passenger in each journey. The seat headrest is of particular importance in avoiding WI because the headrest stops the head when snapping backwards after an impact. These safety instructions basically apply to all kinds of vehicles, i.e. for cars, buses but also roller coasters.

Since contact sports such as football and rugby may also lead to WI, these sports should be carried out with the proper safety equipment.

Physical abuse should not only be avoided due to ethical and legal reasons, but also be reported to the authorities when suspected.

Chronic whiplash may be prevented by compliance with the treatment regimen. Patients should be consulted towards a certain behavior that may help to prevent the pain from becoming chronic [24].

Whiplash injury (WI) affects both hard and soft tissues of the neck that are exposed to considerable acceleration and deceleration forces, e.g. during rear-end car accidents. Due to the sudden exertion of strong external forces, the affected person is not able to maintain his or her head upright. The head is rapidly thrown forward, backward or even sideways. Tendons and ligaments are stretched beyond their limits and this provokes tissue damage that results in a variety of symptoms called whiplash-associated disorders [1]. 

Although rear-end car accidents are the most common cause for WI, other traumatic experiences may also lead to WI. Collisions from the front or from the side may also cause WI. Of note, for an accident to provoke WI, it does not necessarily need to happen at high speed. Furthermore, WI has been associated with sports accidents, particularly those happening in contact sports such as football or rugby, physical abuse, punching and shaking (such as shaken baby syndrome), domestic and other types of accidents.

Anamnesis usually leads to the suspected diagnosis of WI. Tissue damage may then be confirmed with diagnostic imaging. Radiographic imaging and computerised tomography are the techniques of choice in order to detect fractures and other damages to the skeleton, whereas magnetic resonance imaging may be applied to reveal soft tissue damage.

Pharmacological therapy is generally based on analgesics, e.g. on paracetamol and non-steroidal anti-inflammatory drugs. Appropiate exercises may help patients to regain mobility. However, chronic whiplash may develop if symptoms last for more than six months.

WI results from car accidents, sport accidents, abuse and other traumatic experiences that involve a sudden forceful back-and-forth movement of the head. This movement causes damage to tissue structures of the neck, e.g. to the cervical spine, its vertebrae, muscles, ligaments, vessels and nerves. The medical terms for injuries like this are cervical sprain and cervical strain and they are associated with neck and shoulder pain and stiffness, headaches, dizziness and possibly with cognitive disorders.

If WI is diagnosed due to preliminary report and clinical examination, imaging techniques such as X-rays are likely performed, to check if any anatomical structure suffered serious damage.

Therapy consists of pharmacological treatment with analgesics and muscle relaxants with additional physiotherapy and home exercises.

While mild and moderate cases of WI usually achieve full recovery after a few weeks or months, severe cases involving considerable damage to the cervical spine or nerves may take a long time to heal. In these cases, the prognosis for full recovery is worse.

Some patients do still experience neck pain years after the accident and are thus suffering from chronic whiplash. While there is a certain correlation between severity of the initial lesion and probability of chronic whiplash, it is not possible to give a certain prognosis.

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