A workup on whiplash

A holistic and handy guide on whiplash, its symptoms, causes, consequences, and how one can get it treated

CHENNAI: Whiplash, commonly called neck strain, occurs due to sudden, forceful impact causing the head to rapidly move forward and backward. This results in extension of neck muscles, ligaments and joints beyond the normal range of motion, leading to strain injury to the neck. This condition is commonly caused due to accidents but can also result from other types of traumas. The symptoms may not appear immediately, but it can cause long term pain and discomfort.

A whiplash could be a result of car accidents, physical abuse, contact sports or trauma such as falls or heavy blows to the head.

Mild symptoms may include:

• Pain and stiffness of the neck
• Headaches, beginning at the base of the skull
• Fatigue and dizziness
• Worsening pain with the movement of neck
• Decreased range of motion in the neck

Other severe symptoms:

• Blurred vision
• Pain and tenderness of upper back, shoulders and arms
• Ringing in the ears
• Difficulties related to concentration and memory
• Disturbances with sleep
• Irritability and depression

Symptoms indicating immediate medical care:

• Symptoms spreading to shoulders and arms
• Pain while moving the head
• Numbness, weakness or tingling sensation in the arms

For the diagnosis, your doctor may ask several questions about the incident, the severity and frequency of symptoms, location of pain, type of pain and ability to perform daily tasks to get a better understanding of the condition. They may also move your head, neck and arms, and ask you to perform simple tasks to assess:

• Range of motion in the neck, arms, shoulders
• Degree of motion causing pain
• Pain and tenderness in neck, shoulder and back
• Strength, sensation and reflexes of the arms and legs

Although imaging tests may not directly confirm whiplash diagnosis, your doctor may order imaging tests to eliminate other conditions which may be causing neck pain. These imaging tests include:

• X-rays to identify fractures, arthritis, or dislocation of the neck.
• A Computerised Tomography (CT) scan to provide cross-sectional images to assess bone damage.
• A Magnetic Resonance Imaging (MRI) to provide detailed 3-dimensional images to assess the potential damage to your spinal cord, discs, ligaments and soft tissues.

Most people with whiplash injury recover within few days to weeks. However, some people experience chronic pain and headache even years after their accident has occurred. Some complications associated with whiplash include persistent, severe neck pain and headaches, increasing limitation of movement, pain spreading to the arms, and neurological problems.

Some people are at a higher risk of complications:

• Older adults with previous neck/back injuries
• People with a history of whiplash
• People with existing lower back/neck pain
• People who have had severe injury, affecting multiple parts of the body
• Individuals with damaged neck joints, ligaments and discs

Treatment of whiplash:

Treatment of whiplash depends on the extent and severity of the injury. The main goals of treatment are pain control, restoration of normal range of motion and return back to normal activities. Longer the restriction of activity, the higher is the impact of de-conditioning on the patient. Various treatment methods include:
Heat or cold: Application of heat or cold to the neck in the first 24 hours.
Medications: Over-the-counter pain relief medications (ibuprofen) or prescribed medications (muscle relaxants/antidepressants).
Physical therapy: Stretching and strengthening exercises for neck muscles to help restore normal range of motion.
Rest and support devices: Resting along with support devices such as soft foam cervical collars for stabilising the neck, comforting neck muscles and supporting recovery.
Injections: Steroid or local anesthetic injections into the painful muscle and cervical facet joint blocks.

Frequently Asked Questions

Whiplash and concussions — are they the same thing?

No, a concussion is a traumatic brain injury and the most common symptoms include headache, loss of memory, nausea and vomiting, confusion or temporary loss of consciousness. Concussion may occur along with the whiplash injury.

Can whiplash cause neurological problems?

Sometimes. A whiplash injury can affect the brain and cause neurological problems such as memory loss, difficulty in concentrating, sleep disturbances, sudden mood changes, anxiety and depression in some cases.

What does whiplash feel like in the neck?

Whiplash may feel like a dull, aching pain in the front and back region of the neck, accompanied by stiffness and difficulty in turning the head from side to side. The severity depends on the type and impact of injury.

What happens if you leave whiplash untreated?

Untreated whiplash can lead to long-term complications such as chronic, severe neck pain and stiffness, loss of motion, neurological problems and degenerative disc changes.

The author is a senior consultant and spine surgeon at Institute of Advanced Spine Sciences, Gleneagles Global Health City, Chennai

Asanas for relief

Salamba Bhujangasana (Sphinx Pose)

• Lie down with your forehead resting on the floor.
• Then, lift your head placing the chin to the floor.
• After that, bring your hands forward, placing the forearms beside the head.
• Now, align the elbows underneath the shoulder.
• Inhale, pressing the forearms to the floor, lift the chin, chest, abdomen off the floor.
• Then, arch the neck lifting the ears away from the shoulders.
• Now, stretch the legs outwards, and keep breathing.
• You can stay in the pose for 5-10 breaths with your gaze fixed upwards.
• Exhale and bring the chest, abdomen, and forehead to the floor.
• Then, extend the arms over the head and relax in Savasana.
• You can repeat this once more, if possible, and relax.

Vakrasana (Twisted Pose)

• Sit down, stretching your legs forward.
• Keep the hands beside the thighs or buttocks.
• Bend your right leg straight and stretched.
• Keep the left foot beside the right knee and the left knee raised upward.
• Inhale and raise the arms to shoulder level, keeping the elbows straight.
• Exhaling, twist to the left, place the right arm by the outer side of the left knee and hold the left ankle with the right hand.
• Take the left hand behind the back, palms on the floor and look back on the left side. Hold this pose as long as comfortable.
• Then inhale and raise the right arm at shoulder level, keeping the elbows straight.
• Exhaling, release the left twist, place the right hand by the side of right buttock and left hand by the side of left buttock.
• Take a deep breath and relax.
• Repeat the same from the other side.

Jathara Parivartanasana (The Spinal Twist Pose)

• Lie on the floor in the supine position with legs straight and relaxed.
• Bring the hands to the sides at the level of the shoulders. Relax them and touch the floor.
• Bend your knees and bring them towards the abdomen. Let the knees point straight up.
• The back and head must be fully resting on the floor.
• Now, breathe out and turn the legs to the left. The left leg can touch the floor on its left side and the right hip will be in the air. The two feet must touch each other on the sides.
• Make sure your back is still on the floor. Don’t twist upper trunk along with legs. The legs will be at 90 degrees to the spine touching the floor. Breathe normally in this final position and remain like this for as long as comfortable.
• Now, breathe in and bring back the legs to the upright position with the knees still bent.
• Repeat the same on the right side.
• You can do 3-4 rounds for as long as the body feels comfortable.
• Lie down in a relaxation asana like Shavasana for one to two minutes.

Trikonasana (Triangle Pose)

• Stand straight with your feet together and hands beside your thighs or in Tadasana.
• Keep a distance of 2 to 3 feet between your feet and lift your arms upto your shoulder level.
• Now, while inhaling slowly, move your right arm over the head so that it touches the ear.
• Then, exhale and slowly tilt your body to the left.
• Don’t bend your knees and don’t let your hands move away from your ears.
• In the final pose, your right arm should be parallel to the ground and your left arm should be parallel to the left leg, but the arm should not rest on that foot.
• Breathe in and exhale slowly and maintain this posture.
• Breathe and slowly come back to the old position.
• Repeat the same action on the other side as well.
• Perform this asana 4 - 5 times.

Marjariasana (Cat Cow Pose)

• Pose on both hands and legs.
• Ensure that your arms are straight and the hands are flat on the floor.
• Concentrate on your legs, slightly apart from each other. Your knees need to be hip-width apart.
• Look straight ahead and make yourself comfortable in this position.
• Inhale as you breathe and simultaneously raise your chin as you slowly tilt your head backward. With this, push your navel down and raise the tailbone. Now compress your buttocks. While performing this step you may feel some pain or sensation.
• Be comfortable in this particular pose as you need to hold this pose for a few breaths. While holding this pose, continue to breathe long and deep.
• Now, do the countermovement, which includes exhaling and dropping your chin to your chest as you arch your back and also relax your buttocks. Hold this position also for a few breaths.
• Now, you can come back to the position on all fours.
• Do the combination of the movement and countermovement for at least five to six times before you stop.