Relieving Pain Due to Whiplash


Whiplash, an acute condition often associated with car accidents in which one car hits another from behind, also can occur as a result of a collision on a football or soccer field if someone is hit hard from behind by a fellow player. The impact of the collision engages the flexibility of the cervical spine; the head snaps forward or backward with the force of the blow and then whips back again.

Pain associated with whiplash may be severe at first and then abate overnight, only to return the next morning. In this condition, there is a temporary loss of the natural curvature in the neck, and the neck muscles are likely to go into spasms as a natural defense, to immobilize the area. The spasms can be very painful and can make treatment more difficult.

In 95% of whiplash cases, doctors can't distinguish any neurologic deficit, but whiplash is painful and frightening for the injured person, and the doctor can offer reassurance and stretching exercises to ease pain and promote healing.

A whiplash injury is purely muscular; an MRI or x-ray is usually not helpful in diagnosis. Images of younger patients generally show no changes in the neck, and images of older patients simply show osteoarthritic changes that were already present.

Immediately after injury, advise the patient to apply ice to the neck. Ice stops the nerves' ability to conduct the painful stimulus; thus, there are fewer nerve messages telling the muscles to tighten up.

In this month's column, I'll describe some exercises to relieve the pain associated with whiplash. (See illustrations and instructions below, which you can photocopy for your patients.)

The key to recovering from whiplash is to begin the limbering exercises right away. Much of the pain associated with whiplash occurs because people are told to wear a cervical collar, and they don't make any attempt to loosen their neck muscles for several days.

As soon as possible, usually 2–3 days after the injury, patients should start with some of the following exercises, and do them at least twice daily, without overextending themselves beyond where they feel pain. These exercises should be eased into gradually, following a doctor's instructions. The neck muscles are extremely sensitive to stretching, and overstretching will only exacerbate the spasms and pain. It is important to relax the muscles completely between repetitions of each exercise.

If the patient complains about numbness in any of the fingers, or pain shooting down into the arm, it is worth ordering an x-ray or MRI; the patient may have a more serious problem than whiplash and may need to be referred to a specialist.

Next month: Exercises to rehabilitate a sprained ankle.

Exercises for Whiplash

Shoulder shrug. Sit in a straight-backed chair with your arms relaxed at your sides. Slowly (while counting to six) raise your shoulders as close to your ears as you can without excessive strain. Slowly lower your shoulders to the starting position. Repeat five times, counting to five, to relax completely between each repetition. Keep your fingers and shoulders as loose as possible.

Side neck rotation. While standing up straight or sitting in a chair, stretch the neck by turning your head gently to the right while counting to three—not holding in a sideways position but returning to the center. Then turn your head to the left while counting to three, and return to the center. Begin with 4 or 5 repetitions, and work up to 10.

Forward neck flexion. Sit in a straight-backed chair with your feet flat on the floor, arms relaxed at your sides, and head level and relaxed. Slowly lower your chin toward your chest, stopping when you feel pain. Hold this position, and breathe slowly. You should feel some relief of the pain and tension, then try to bring your chin down a little more and continue breathing slowly. When you can't lower your chin any farther, hold the final position for 5 seconds, then slowly raise the chin and relax. Start with three repetitions, and work up to six.

Forward neck flexion, variation. After you have gradually brought your chin as close to your chest as possible, turn your chin toward your right shoulder, and hold for 5 seconds. Bring your chin back to the center, count to three, and then turn toward the left shoulder and hold for 5 seconds. Bring your chin back to the center again, then slowly lift your head back to a level position, and relax. Begin with three repetitions, and work up to six.

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