Whiplash

Whiplash is a neck injury caused by the head being thrown sharply back and then forward, or the other way round. The classic setting is being hit from behind in a car, but the same thing happens in a fall, in contact sport or on a fairground ride. The name describes the movement rather than the damage: the head flicked like the tip of a whip. What takes the strain is soft tissue — the muscles, ligaments and the capsules of the small joints of the neck. Bone and spinal cord are usually left alone, and in the great majority of cases the whole thing ends well, though not in a couple of days: the first few are unpleasant.

What it feels like

The core of it is pain and stiffness in the neck: turning the head, looking to the side or tipping it back all become difficult. Headache often joins in, typically starting at the back of the head, along with pain and muscle spasm in the shoulders, between the shoulder blades and across the upper back.

Less often, but entirely normally, other complaints appear: dizziness, ringing in the ears, tiredness, trouble concentrating, irritability, poor sleep, jaw pain on chewing, blurred vision. They frighten people more than they deserve to — they travel with muscle tension and broken sleep rather than signalling that something serious has been damaged, and they go as the neck pain goes.

One point matters a great deal: immediately after the impact people usually feel fine. The pain and stiffness build over the following hours, sometimes only by the next morning, because adrenaline blunts sensation at the time. So "nothing hurt straight after the crash" does not mean no injury happened, and pain that turns up by the evening is not something new and alarming.

When help is needed urgently

Whiplash itself is not dangerous, but occasionally that same movement of the head damages a vertebra, a blood vessel or a nerve. This shows itself through fairly specific signs. Call an ambulance — in Spain, Italy, Portugal, Poland and Ukraine the single European number is 112 — if after the injury any of the following appears:

• numbness, pins and needles or weakness in the arms or legs, or an electric-shock sensation running down the spine;
• difficulty passing urine, or loss of bladder or bowel control;
• severe pain exactly in the midline of the neck, over the vertebrae themselves, particularly if even touching them hurts;
• being unable to turn the head to either side;
• after a blow to the head: confusion, drowsiness, deteriorating consciousness, repeated vomiting, seizures or a headache that keeps worsening;
• slurred speech, double vision, unsteadiness on the feet, weakness down one side of the body.

Do not drive yourself and do not wait until morning. While waiting for help it is sensible not to move the neck sharply, but there is no need to strap it up with anything improvised.

Who should be checked over in any case

The threshold for being seen is lower in two situations. The first is older age: bone becomes more brittle over the years, and a neck vertebra can fracture from an impact that would have left a younger person unmarked. The second is taking blood-thinning medicines — anticoagulants and antiplatelet drugs: in these people a bleed inside the skull after a knock to the head can develop gradually, over a day or longer, while they feel reasonably well at first. In both cases any noticeable injury to the neck or head should be assessed by a doctor even if nothing in particular is troubling you.

Separately, it is worth seeing a doctor the same day, without an ambulance, if the impact was heavy, if the pain is very severe, if it has not eased at all after a few days, or if the person injured is a child.

Collars and rest do not treat it

This is the main thing to take away, because the opposite belief has been entrenched for decades. The soft cervical collar is still widely regarded as treatment: people buy one at the pharmacy themselves, acquaintances recommend it, it looks convincing and in the first few hours it does seem to bring relief.

But in ordinary whiplash a collar does not speed recovery up — it slows it down. Immobilised neck muscles lose strength quickly, the joints lose their range, and after a week in a collar turning the head is harder than it was on day one. There is a psychological side too: a collar persuades both the wearer and everybody around them that this is a serious injury and that movement is forbidden, and that impression is difficult to climb out of afterwards. The same applies to bed rest — spending a week lying quietly is the worst thing you can do to a sore neck.

The right course is the opposite one: move, and get back to ordinary life as early as you can, starting in the first days. Not by forcing it and not with sudden jerks, but not by nursing the neck indefinitely either. Gentle turns and tilts of the head through whatever range you have, several times a day; the usual jobs around the house; walks; a return to work without a long gap. Moving will hurt a little, and that is expected — it does not mean you are doing damage. A collar is justified only when a doctor has prescribed it for a specific reason, such as a confirmed fracture.

What to do in the first few days

• Pain relief. Paracetamol or a non-steroidal anti-inflammatory such as ibuprofen, in a short course and with the contraindications in the leaflet in mind. The point is not to "tough it out": movement is the treatment here, and it is much easier without pain. If over-the-counter medicines are not enough, a doctor can prescribe a stronger painkiller or, briefly, something to ease muscle spasm.
• Heat. A warm shower, a hot water bottle or a heat pad across the shoulders relaxes tight muscle. Some people find cold more helpful on the first day; both are worth trying.
• Sleep. One pillow of ordinary height, so that the neck lies in line with the spine. Special orthopaedic constructions settle nothing here.
• Your desk. Screen at eye level, a break every hour to move the neck and shoulders. A long motionless posture at a computer aggravates the pain more than exertion does.
• Driving. Go back behind the wheel once you can look freely over your shoulder. While head turning is restricted, driving is not safe.
• Exercise. Walking, swimming and light activity are useful from the outset. Contact sport and heavy lifting are worth postponing until the range of movement is back.

How long it lasts

Most people recover completely within a few weeks, and most of the remainder within two to three months. The force of the crash and the state of the car afterwards have surprisingly little bearing on the outcome: recovery depends more on how the person behaves after the injury.

There is one finding worth knowing: what people expect is bound up with what they get. Those who count on recovering from the outset and carry on with ordinary life do better and faster than those who are convinced the pain is permanent and restrict themselves in advance. This is not a call to suffer in silence, nor a hint that the pain is imagined — the pain is real. But fear of movement and the constant checking of whether things have got worse genuinely draw recovery out, and turn acute pain into chronic pain.

If there is no improvement after several weeks, that is a cue for the next step rather than for alarm. Usually the next step is physiotherapy: a prescribed programme of mobility and strengthening work for the neck outperforms any passive method. When pain drags on for months, a pain specialist becomes involved, and sometimes psychological support as well — not because "it is all in your head", but because persistent pain after a crash is often interwoven with anxiety, disturbed sleep and a fear of getting back into a car, and those need untangling together.

Are scans needed?

For ordinary whiplash, as a rule no. X-rays and scans show bone, whereas what is injured here is soft tissue that will not appear on the image anyway; a normal result changes nothing about the treatment, and the radiation has been received regardless. Imaging is not ordered for everyone but when there are warning features: pain strictly in the midline over the vertebrae, neurological symptoms, older age, anticoagulant treatment, a high-energy impact, an inability to turn the head. If none of those apply, the absence of a scan is not carelessness but the correct approach.

Online consultation

After a crash it is convenient to have someone to go through the situation with, without travelling anywhere on a painful neck. In a remote appointment the doctor will ask about the circumstances of the impact, when the pain began and where it spreads to, and above all will work through the urgent signs one by one: numbness and weakness in the arms, problems passing urine, midline pain, symptoms coming from the head. That determines whether home measures are enough or whether an examination in person and imaging are needed.

Everything else can be covered online too: which painkiller suits you given your other conditions and medicines, which movements to start in the first days, when to drive again and go back to work, why the collar is better left in the drawer, and at what point physiotherapy makes sense. The limits are obvious: the neck cannot be examined and reflexes cannot be tested at a distance, and any of the urgent signs listed above calls for an ambulance rather than an appointment.

This material is for information only and does not replace medical advice.