Whiplash

Whiplash is a real injury to real structures, and the fact that it does not show on an X-ray is a limitation of the X-ray, not evidence that you are fine.

What it is

In a rear-end collision the torso is thrown forward by the seat while the head lags behind, then snaps forward. The neck passes through an S-shaped deformity in well under a quarter of a second.

The structures that take the load are the facet joints at the back of the neck, the ligaments that hold the vertebrae together, and the deep muscles. None of these appear on a plain X-ray, which is why so many people are told nothing is wrong.

How it usually presents

• Pain and stiffness at the back and sides of the neck, usually worse the second or third day than on the day of the crash.
• Headache starting at the base of the skull and travelling forward — this is a cervicogenic headache.
• Difficulty turning the head to reverse a car or check a blind spot.
• Pain across the shoulders and between the shoulder blades.
• Dizziness, poor concentration and disturbed sleep, which often means a concussion occurred alongside it.

How we treat it

• Early on: confirming nothing dangerous is present, then controlled movement rather than a collar. Prolonged immobilization makes whiplash worse, not better.
• If pain persists past six weeks, a medial branch block identifies whether the facet joints are the source.
• Where blocks confirm the facet joints, radiofrequency ablation can give many months of relief.
• Physical therapy to restore range and rebuild the deep neck flexors, which shut down after injury.

To be assessed, call (314) 310-5577 or request an appointment. If this began with a crash or a fall, see accident and injury care.