Whiplash Injury Features and Management
Early mobilization with gentle range of motion exercises should be started as soon as possible for whiplash injuries, avoiding prolonged immobilization and collar use, as this is the most effective approach for reducing pain and disability. 1
Clinical Features of Whiplash
Whiplash-associated disorders (WAD) result from rapid acceleration-deceleration mechanisms affecting the neck, typically occurring during motor vehicle accidents, especially rear-end collisions 2, 3. Key clinical features include:
- Neck pain (present in 84% of cases within 7 days of injury) 4
- Headache (present in 60% of cases within 7 days, often occipital/suboccipital) 4, 2
- Neck stiffness and reduced range of motion 2
- Muscle tenderness in cervical paraspinal and suboccipital regions 2
- Upper extremity weakness or paresthesia in some cases 2
- Dizziness (vestibular, central, or cervical in origin) 5
- Symptoms typically develop with a latency of several hours 3
Diagnostic Approach
Whiplash diagnosis is primarily clinical, with imaging playing a limited role 2:
- Imaging has little usefulness in diagnosing and predicting prognosis of WAD 2
- CT is preferred over radiography for identifying cervical injuries when imaging is indicated (98% vs 36% sensitivity) 2
- MRI may show soft tissue injuries but tends to overestimate their severity (specificity 64-77%) 2
- Flexion-extension radiographs are often inadequate in acute settings but may be useful in outpatient follow-up for persistent symptoms 2
Management Recommendations
Acute Phase (First 48-72 hours)
- PRICE protocol (Protection, Rest, Ice, Compression, Elevation) 1
- Ice application for 15-20 minutes every 2-3 hours
- Limited rest (24-48 hours maximum)
Early Treatment (After 48-72 hours)
Medications
- First-line: Non-opioid analgesics 1
- Second-line: Oral NSAIDs for moderate to severe pain 1
- Third-line: Acetaminophen when NSAIDs are contraindicated 1
- Topical options: NSAIDs applied directly to affected area 3-4 times daily 1
- Avoid: Opioids (including tramadol) as they are not more effective than NSAIDs and carry significant risks 1
Physical Interventions
- Progress from gentle range of motion exercises to strengthening exercises as pain allows 1
- Manual therapy as part of multimodal care, not as standalone treatment 1
- Massage therapy has moderate evidence for pain reduction 1
Prognosis and Risk Factors
Prognosis
- Most patients recover within 3 months 1, 5
- Persistent neck pain after 2 years is reported by more than 30% of patients 5
- Headaches persist in approximately 10% of patients after 2 years 5
Risk Factors for Poor Recovery 1, 5
- Older age
- Presence of interscapular or upper back pain
- Occipital headache
- Multiple symptoms or paresthesias at presentation
- Reduced cervical range of motion
- Presence of neurological deficits
- Pre-existing degenerative changes
Common Pitfalls to Avoid
Prolonged immobilization leads to muscle deconditioning and delayed recovery 1
- Cervical collars should be minimized during the first 2-3 weeks and then avoided 5
Overreliance on imaging for diagnosis and prognosis 2
- Routine imaging is not recommended unless there are red flags suggesting serious pathology 1
- Active interventions show better outcomes than passive approaches or prolonged rest 6
Opioid use for pain management 1
- Not more effective than NSAIDs and carries significant risks
Ignoring psychological factors in chronic cases 2
- Diagnosis and prognosis assessment of WAD is based on both clinical and psychosocial data
By following these evidence-based recommendations, particularly emphasizing early mobilization and appropriate pain management while avoiding prolonged immobilization, clinicians can optimize outcomes for patients with whiplash injuries.