The whiplash is a trauma that usually occurs during a car accident where the neck is fully projected forward (hyperextension and hyperflexion) followed by a rapid movement in the opposite direction.
Today, the whiplash is also referred to as cervical sprain.
The collision causes the classic whip blow, the head is pushed forward and the neck flexes beyond its physiological limit.
Then he jumps back hard and hits the headrest.
It is essential to know the dynamics of the accident to define the therapeutic program well.
Many people think that the problem of whipping is just the inflammation of the neck.
In fact, trauma can cause:
- Discopathy (intervertebral disc disease)
- Herniated Disc
- Ligament injury
- Muscle spasm
- Joint blockage.
The neck pain and other symptoms may occur even in the case of a low speed impact.
To indicate the vertebrae of the neck, write “C” followed by a number that indicates the position of the vertebra, starting from the top: (for example, C3 is the third vertebra from the skull to the back).
A whiplash may cause a herniated disc in young individuals. In the clinic, I see 20-year-old patients with disc protrusion or hernia, especially at C6-C7, C5-C6 and C4-C5 levels.
In the upper part of the neck the hernias do not form because between the occiput, C1 and C2 there is no intervertebral disc.
- 1 What is the cause of the whip blow?
- 2 What are the symptoms of whip stroke?
- 3 What are the most suitable exams for whipping?
- 4 Treatment for whip and natural remedies
- 5 How long does it last? What are the healing time?
- 6 How long do I have to stay at home?
- 7 How long does it take to use the immobilizer?
- 8 When is it possible to massage the neck?
- 9 I did laser treatment, ultrasound and massage, but I’m not cured, why?
- 10 When is it possible to start physical therapy?
- 11 Why does the doctor claim that I am cured even though I still have pain?
What is the cause of the whip blow?
The most frequent cause is the car accident, but the trauma may be the result of a sporting confrontation or a violent braking of the car.
If the passenger who has had the accident has fastened the seat belt, there will probably be only this injury, but if it does not work, it can be pushed forward by banging its head on the windshield.
If the head restraint is well positioned, ie no more than 5 cm from the head, and the back is well supported at the back, the trauma and consequences are minor.
What are the symptoms of whip stroke?
The most important thing to know is that the effect does not give immediate pain, often if you begin to feel discomfort the next day.
Symptoms vary according to age, health conditions and trauma violence.
- Pain and limitation of cervical movement
- Strong thrusts along the arm
- Blurred vision
- Difficulty swallowing
- Tingling in the region between the neck and the hand
- Pain in the jaw .
If the person who suffered the accident had his neck in rotation or lateral inclination during impact, the pain is more severe and the prognosis is longer.
In rare cases, the body’s reaction includes fever within the first 2 days.
Generally, most of these symptoms disappear spontaneously within a few days.
In most cases patients arrive at the clinic with the neck blocked in all directions because of severe pain.
Only the most severe trauma can cause long-term consequences such as injury to the brain and cranial nerves.
In the acute post-phase a change in behavior is possible, for example, insomnia, depression and irritability may occur.
You may have a straight neck because of the trauma, but you may have had it before, you do not have to worry about it because it should not cause problems.
If the patient has vertebral fractures, the symptoms can be caused by a herniated disc or a misalignment of the vertebrae of the neck.
Children may have the same disorders of adults, although it is much rarer because the spine is more hydrated and the herniated disc is rare before the age of 20.
The whiplash does not only affect the neck but also the lower back; in fact, the first trauma occurs at the level of the lumbar spine and pelvis.
Patients with spinal ( lumbar ) pain and movement restriction due to the accident are often present in the outpatient clinic .
In the case of untreated whip stroke, the symptoms may become chronic or may arise again in the future (relapse).
What are the most suitable exams for whipping?
An instrumental examination is not always necessary after a whiplash, but it is always necessary to consider that the pain may appear the day after the injury, so it is best to take the necessary exams.
The specialized doctor is the physiotherapist or orthopedist who first performs a physical examination and then can prescribe some exams.
The most useful examination is radiography showing any bone fractures or abnormalities such as spondylolisthesis or a dislocation (rare).
In the lateral projection we see the vertebrae from C3 to C7, but to see the second cervical vertebra with the tooth of the xx, an x-ray with the open mouth is necessary because it is located at the jaws.
The MRI can be useful in case of pain radiating down the arm, tingling in the hands , dizziness, or confusion because it also shows the soft tissues.
A herniated disc or a ledge may cause cervicobrachial neuralgia (or cervicobrachialgia) with pain that radiates to the hand, numbness, loss of strength and sensitivity.
In this case, the doctor may also prescribe an EMG (electromyography) to assess nerve conduction.
Treatment for whip and natural remedies
If medicines and home remedies are not enough, your doctor may recommend:
- Analgesics, people who have a lot of pain may have short-term benefits with non-steroidal anti-inflammatory drugs(NSAIDs) such as ibuprofen.
- An injection of anesthetic (lidocaine) into a sore muscle can relieve the spasms and contractures that can be caused by the chiote stroke.
- Your doctor may prescribe relaxing muscle medications such as Thiocolchicoside (Muscoril), which help reduce muscle tension and spasm.
Physical therapy is the main treatment for whiplash:
- It is useful to apply heat with a hot water bag, etc.
- Manual therapies, including massage therapy and muscle manipulations of the spine, are used to dissolve tension and reduce muscle stiffness .
- The instrumental therapies such as ultrasound , CRET ( t ransfer resistive and capacitive energy ) , and laser processing are useful to reduce inflammation.
If pain permits, McKenzie exercises for the cervical spine relieve neck pain, spinal pain, and other symptoms such as tingling in the arm and torture.
Many symptoms are temporary, for example, numbness, partial deafness ( hearing loss ) and dizziness pass within a month after the accident.
A hard immobilizer was recommended in the past for the whip blow, but today they are no longer needed. Immobilizing the neck for long periods of time can cause a decrease in muscle strength and can cause stiffness in the cervical spine, hampering recovery.
If your doctor prescribed a hard collar temporarily it is necessary to keep it for no more than three hours at a time and only within the first three days after the accident.
If the pain does not allow you to sleep well, especially in the first few days after the trauma, wearing a cervical collar may help you rest.
When the symptoms are stable or better, your doctor will recommend a stretching exercise program to restore movement.
Usually head rotation, neck flexion forward and backward.
Natural Remedies for Whip Beat
Many people with pain caused by whip blow have relief by applying something warm on the shoulders, neck and back.
Heat is especially useful for relaxing the muscles before performing the exercises to restore range of motion.
Many unconventional therapies have been used to treat whiplash pain including:
- The acupuncture is the insertion of fine needles at specific points on the skin, practitioners can relieve different types of pain.
Scientific studies have not been able to conclusively prove whether acupuncture relieves persistent neck pain caused by stretching.
- Many people seek a chiropractor for neck pain in certain types of neck pain, it has been shown to work equally well in physical therapy, but it is not better.
The combination of spinal manipulation and exercises gives more benefits. However, chiropractic manipulation of the neck can cause serious injury, though rarely.
- Massage therapy in the neck muscles can be helpful if there are muscle spasms or contractures for more than a week.
It is advisable to relax the muscles of the neck before the massage with a hot bath or a hot towel heated in the microwave.
How long does it last? What are the healing time?
The duration of symptoms (prognosis) is not the same for all people, depends on the following elements:
- The patient had neck pain or low back pain before the accident
- The severity of the trauma, for example, resulted in a disc herniation or disc protrusion
- The therapies performed
How long do I have to stay at home?
Resting in bed for more than two days causes muscle and joint stiffness with limited movement.
To avoid this consequence on the third day is necessary to resume activities that do not cause pain and especially to start therapy.
Is it possible to treat a sharp whip blow?
Of course, but only with certain therapies, the McKenzie method can be started immediately because it is a mechanical therapy on the joint, it is not a massage.
Even the ” t ransfer capacitive and resistive energy “ can be initiated after two days of whiplash, but only without the application of heat or the same body temperature, it is not very warm the inflamed neck because it may get worse.
How long does it take to use the immobilizer?
If the patient does not have a neck fracture it is not necessary.
There are studies of the 1980s that demonstrate the usefulness of movement after a whip stroke and the damage that can lead to immobility.
Unfortunately I still see patients arriving at the clinic with the immobilizer.
The immobilizer maintains a continuous cervical traction, when the patient takes off, feels nausea and dizziness.
Immobilizing a joint causes muscle and tendon weakness, early arthrosis , osteopenia and stiffness, all of these consequences can be avoided with movement.
When is it possible to massage the neck?
The first few days after the accident is not recommended because it can aggravate the disorder, but it is useful in the second stage of rehabilitationbecause it relieves tension.
I did laser treatment, ultrasound and massage, but I’m not cured, why?
The above mentioned treatments act locally as an anti-inflammatory, muscle relaxant and anti-edema also stimulate the activity of the tissues to heal.
If the problem is not solved, it means that the problem is mechanical, ie the bones of a joint are not well aligned or a muscle is contracted and it hinders the movement of the neck.
In this case, the appropriate treatment is manual, of the articular or myofascial type.
Osteopathy and physical therapy can align the joints (Maitland, Mulligan, Kaltenborn, McKenzie, etc.), while myofascial manipulation eliminates adhesions in the connective tissue responsible for pain.
The pompage is an excellent complementary therapy that can be performed on patients without injuries (cervical spine traction with slow relaxation) after this treatment, patients report a feeling of well-being and lightness that they have never felt before.
The mechanical pull in the chair has been used a lot in the past, but today it is almost abandoned because it does not give the desired results.
When is it possible to start physical therapy?
It is important not to wait too long before starting treatment because stiffness may occur.
I recommend starting within a week after the trauma, because treated in time the patient can recover.
Why does the doctor claim that I am cured even though I still have pain?
The doctor searches for ligamentous bone lesions, herniated discs, etc. visible in the resonance, if the patient does not have any of these injuries is structurally healthy for his doctor, but the pain can be caused by something that is not seen in the exams.