Ever got rear-ended while waiting in traffic or at a stop sign?  It’s a scary moment:  the calmness of being out in your car is viciously interrupted by screeching tires and a loud crash and bending metal.  It’s over in one second, but a lot happens to your body in that one second.

If a high speed camera was available to record your mishap, it would show your body violently moving forward with the car, back sinking into your car seat, your head slowly arching backwards at an unnatural angle; your neck muscles tense up; your head coming to a  stop in its backwards path and then reversing directions to move forward again, through a complete arc until your neck is fully flexed forward in an unnatural position; coming to a stop again, and then reversing directions and fully extending a few degrees less than before, and then reversing and flexing forward again, then righting itself.  That is your basic whiplash injury.

You’ll notice your neck become stiff, but very gradually.  You may be a bit dazed, and have a headache come on in about an hour.  You’ll likely feel tired.

As the day wears on, your neck is getting increasingly stiff and painful.  You may feel the onset of soreness in your upper shoulders and upper back; even your lower back.  You may have pain in your chest wall where the seatbelt dug into.

2-3 days after the accident your neck will reach maximum stiffness.  You will have difficulty turning your neck.  You’ll find yourself turning your whole body in order to see to one side.

So what is happening?  You have sustained what’s called a cervical acceleration-deceleration sprain strain injury; commonly known as whiplash.  Car accidents are a common cause of whiplash, but they can occur on roller coasters and similar jerky rides, horse riding, sky diving, and even wild dancing.  When this happens, tiny tears develop in the muscle tissue and fascia (muscle covering) which starts to release the inflammatory products of swelling.  The swelling is gradual, like a pinhole leak, which explains why it takes 2-3 days to reach max pain.  What makes a whiplash worse than other sprain strain injuries is that, due to the flexibility of the neck, spinal ligaments also incur damage.

When your neck flexed violently forward, the capsular ligaments and interspinous ligaments likely got damaged.  The capsular ligaments hold your neck bones together from the back; the interspinous ligaments hold them together at the spinous processes (the bumps you feel along your spine are the tips of the spinous processes).  When these ligaments injure, the swelling goes inside the joint space, building up pressure essentially splinting (immobilizing) the joint.  In severe cases, the ligaments can rupture (tear) causing dangerous instability, and you have a very serious condition that requires a visit to the ER.  A head halo support is usually attached to prevent the instability from causing damage to your spinal cord.

TREATMENT:

Obviously, it’s a good idea to go to the hospital if you were involved in a significant car accident and feel you’ve been injured.  The ER doctor will rule out serious conditions like ligament rupture, bleeding in the brain, and bone fractures.  Once those are ruled out, he/she will diagnose you as having a sprain strain injury and will usually prescribe pain meds (anti inflammatories and muscle relaxants).  You will be given home care instructions.

With whiplash, the goal is to first reduce the pain and swelling.  You will do this by applying an ice pack to your neck.

Buy two gel ice packs at your local drugstore (9″ x 6″ size); put in freezer.   Make a cervical roll using a small bath towel or hand towel:  roll it up tightly into a cylinder 1′ long with a radius of five inches.  Place it on the floor.

Place one ice pack on top of the roll, and one right under (next) to it.   Put a kitchen towlette on top of the ice to prevent iceburn.  Lie down, face up with the center of the back of your neck on top of the cervical roll/ice pack.  The other ice pack is for your upper back muscles.   Put a pillow under your knees for comfort, dim the lights and rest for 20 minutes.  Repeat this every two hours, for 2-3 days.

On the second day, while icing slowly turn your neck to the right as far as you can, then to the left, then to center.  Then, arch your neck and touch the carpet with the crown of your head and hold for 20 seconds.  Repeat these motions ten times.  Do this for each of your icing session, still at 20 minutes every 2 hours.  This helps to regain full neck range of motion.

On the 4th day, alternate ice with 10 minutes of moist heat using a hot water bottle with 150 degree water heated on your stove, and a wet face towel for heat conduction, on your neck and back muscles.

As the pain decreases, engage in active stretching exercises.  About two weeks post crash, or when the pain has gone down 90% and you have full range of motion in your neck, do neck strengthening exercises.  It is important to do these rehab exercises as they help align the reparative tissue in the axis of contraction of the muscles.  This will help reduce the chances of chronic pain and loss of range of motion following the accident.

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