Diagnosis and Treatment of Whiplash
How is whiplash diagnosed?
After an accident the patient may be taken to the hospital or a doctor's office to be examined. The doctor will examine the patient to determine if they have any injuries that require treatment. Based on the symptoms and examination findings the doctor may place a collar on the neck for additional support. The doctor may also obtain x-rays of the neck to check for more serious injury. The most important first step is to make sure there is no major injury to the neck, head or the rest of the body requiring immediate treatment.
If the x-rays are normal but the patient continues to have neck pain, the doctor may keep the cervical collar in place and see the patient back in the office in about a week for an additional examination. At that time the doctor may obtain new x-rays to see if there have been any changes. If the doctor is still concerned about soft tissue injuries, he or she may obtain either x-rays with the head leaning forward and backwards (dynamic x-rays) or obtain an MRI (magnetic resonance imaging study). These dynamic x-rays or MRI scans are better able to detect injuries to the soft tissues of the neck, especially instability, that may not been seen with normal x-rays of the neck.
What is the treatment for whiplash?
Treatment of whiplash depends on the wide variety of symptoms present. Unfortunately, most treatments of whiplash have not been well tested to determine their effectiveness.
The most important issue in the management of whiplash is optimal education of the patient about their injury. This includes information on the cause, potential treatments, and likely outcomes. Patients should understand that this is a real injury, but that nearly all patients have the ability to fully recover. Patients that do not receive this information are much more likely to develop the more chronic "whiplash associated disorder."
In the past, the initial treatment for whiplash was often a soft cervical collar for several weeks. The goal of the collar was intended to reduce the range of motion of the neck and to prevent any additional injuries. More recent studies have shown that this prolonged immobilization actually slows the healing process. If there is no evidence of abnormal spinal alignment, early range of motion is advised.
Patients involved in early range of motion exercises have been shown to have a more reliable and rapid improvement in their symptoms. This treatment typically involves rotational exercises performed 10 times per hour as soon as symptoms allow within the first four days of the accident.
It seems that excessive rest and immobilization have been shown to have greater chances of chronic symptoms. This is explained by loss of range of motion leading to increased pain and stiffness. Immobilization also causes muscle atrophy (muscle wasting), decreased blood flow to the injured soft tissues, and healing of damaged muscles in shortened position that renders them less flexible.
Physical therapy can be useful in helping to wean a patient from a cervical collar as well as to help strengthen muscles and reduce painful motions. Occupational therapy can be used to help return the patient to the work environment.
If the patient begins to develop psychological symptoms including anger, anxiety or depression following an injury, prompt treatment of the emotional condition is recommended. This can help the patient better understand the good chances for successful recovery and reduce the chances of chronic symptoms.
Medically Reviewed by a Doctor on 1/7/2014