Whiplash is an injury to the facet joints, ligaments and deep muscles of the neck. It happens when a crash throws the torso forward while the head lags behind. Then the head snaps forward.
It is a real injury to real structures. If it does not show on an X-ray, that is a limit of the X-ray, not evidence that you are fine.
What it is
In a rear-end crash, the seat throws the torso forward while the head lags behind. Then the head snaps forward. The neck bends into an S shape in well under a quarter of a second.
Three structures take the load. They are the facet joints at the back of the neck, the ligaments that hold the vertebrae together, and the deep muscles. None of these show up on a plain X-ray. That 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. It is usually worse on the second or third day than on the day of the crash.
- Headache starting at the base of the skull and traveling forward — this is a cervicogenic headache.
- Trouble turning the head to back up a car or check a blind spot.
- Pain across the shoulders and between the shoulder blades.
- Dizziness, poor focus and broken sleep. These often mean a concussion occurred alongside it.
How we treat it
- Early on: confirm nothing dangerous is present, then use controlled movement, not a collar. Keeping the neck still for a long time 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 (the small muscles at the front of the neck). They shut down after injury.
To be assessed, call us or request an appointment. If this began with a crash or a fall, see accident and injury care.
What usually gets missed
The single most costly miss in whiplash is the upper neck’s role in headache. The C1 to C3 nerve roots share a relay station in the brainstem with the trigeminal nerve, the main nerve of the face and head. So the brain reads signals from the upper neck as pain in the head. Patients then get treated for migraine for months. It does nothing.
The second is the deep neck flexors. These small muscles hold the head over the shoulders. They switch off within days of a whiplash injury. Once they are offline, the surface muscles take over. The neck feels tight, and massage buys a day of relief, over and over. Rehab that does not retrain them directly tends to fail.
What to expect over time
Most people improve a great deal within six to twelve weeks. A real minority do not. What sets that group apart is not how bad the crash was — it is whether the injury got a specific diagnosis or was managed as generic neck pain.
Pain that lasts past three months is much less likely to clear on its own. That makes a targeted diagnosis worth more. At that point medial branch blocks are worth doing instead of waiting, because if the facet joints are confirmed, radiofrequency ablation gives an option that time alone will not.
When this becomes urgent
Go to an emergency department for weakness or numbness in an arm or hand that is getting worse, trouble with balance or walking, clumsiness with buttons and keys, or any change in bladder or bowel control. Those suggest the spinal cord, not the joints. Severe headache with vomiting, confusion or drowsiness in the days after a crash also needs same-day assessment.
Common questions
How long does whiplash take to settle?
Most people improve a great deal within six to twelve weeks. A significant minority do not. That group does better with a proper diagnosis than with more time.
That is the subject of What to Do After a Car Accident.
My scan was normal. Does that mean nothing is injured?
No. Facet joint and ligament injury does not show on X-ray, and often not on routine MRI either. Diagnosis comes from the exam and from how you respond to targeted diagnostic blocks.
The mechanism is covered in Car Accident Injury Care.
Should I wear a soft collar?
Generally no. Early controlled movement gets better results than keeping the neck still.
Sources
- Sterling M. Physiotherapy management of whiplash-associated disorders (WAD). Journal of physiotherapy, 2014. PubMed 24856935
- Wong JJ et al. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. The spine journal : official journal of the North American Spine Society, 2016. PubMed 26707074
- Bussières AE et al. The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline. Journal of manipulative and physiological therapeutics, 2016. PubMed 27836071
- Nolet PS et al. Exposure to a motor vehicle collision and the risk of future back pain: A systematic review and meta-analysis. Accident; analysis and prevention, 2020. PubMed 32438092
Hurt in an accident? Start here.
You do not need a lawyer, a police report or a referral to be seen. Bring your symptoms and we will work out the rest.
Monday–Friday, 8:00 a.m. – 4:00 p.m. Same-day appointments are often available for new accident and injury patients.