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Integrated Pain Management


Whiplash is…

a non-medical term used to describe a number of neck injuries caused by the sudden distortion of the neck and associated with extension.

Though this is the case, the exact mechanisms of the injury are unknown. CAD or cervical acceleration-deceleration describes the injury mechanism while whiplash associated disorders abbreviated as WAD is used in the description of symptoms and injury sequelae.

Whiplash is most commonly associated with motor vehicle accidents and occurs when a vehicle has been hit from the back.

This is simply one of the ways that can lead to this injury as there are many others such as bungee jumping, headbanging, and falls. Whiplash has become one of the main injuries that are covered by insurance with millions of insurance claims being made every year.

Prior to the invention of cars, whiplash was known as railroad spine as the condition was mostly identified with the occurrence of a train collision.

The first case of whiplash to be documents as a result of an accident was in 1919. Since then, whiplash cases, have been on the rise and are mostly caused by rear-end vehicle collisions. There are many different symptoms that are associated with the neck injury leading to the coinage of the term Whiplash associated disorders (WAD).

Signs and Symptoms

Some of the symptoms that have been reported by whiplash patients include aching and pain in the neck and back, sensory disturbances to the legs and arms, referred pain to the shoulders, and headache.

While the symptoms can be experienced soon after the injury, there are cases where the pain might start appearing after some days.

Whiplash is confined to the spine with the most common places affected being the middle of the spine and the neck. The pain is mostly experienced between the neck and the shoulder, and there is a missing link associated with whiplash which explains the fact that neck therapy alone fails to address the problem completely.

There are cognitive symptoms which are linked to whiplash such as irritation and the patient being easily distracted but most are associated with poor prognosis.


Medical science has not yet pinpointed the exact mechanisms behind the whiplash injury. The injury is believed to be a result of the impulsive stretch of the spine especially the anterior longitudinal ligament which tears or stretches when the head snaps forwards fast then backwards causing the injury which has come to be referred to as a whiplash.

Whiplash is caused by any motion that resembles the rear-end collision and can take place on a roller coaster or different rides in an amusement park. Other causes might include traveling by air, skiing accidents, sports injuries and when shaken, hit or kicked from behind.


The prevention efforts have mostly been focused on the car seats. This is because most of the whiplash injuries result from vehicle accidents. This is a problematic approach because it follows an unproven theory that whiplash is purely caused by mechanical factors.

The effort to reduce injury through better car seats has been successful with the cases reducing by 5 to 10%. Other than the prevention measures used in cars, there is little information associated with whiplash injury caused by other factors.



Whiplash associated disorders have been divided into five grades all with their own unique diagnosis programs.

Grade 4

Dislocation, fracture and neck complaints, and spinal cord injury

Grade 3

Neck complains accompanied by neurological signs such as weakness, sensory deficits and deep tendon reflexes.

Grade 2

Neck complains accompanied by point tenderness in the neck and decreased motion range.

Grade 1

Neck complaints of stiffness, pain, or just tenderness and no physical signs noted by physicians

Grade 0

There are no neck pains, no stiffness or physical signs observed.



Symptoms which are experienced for more than 6 months after the initial trauma are considered whiplash syndrome. The early rehabilitation of a whiplash is aimed at reducing risks of whiplash syndrome development.

The rehabilitation process depends on the grade of the whiplash injury. While grade 0 to grade 3 can be treated on an outpatient program, grade 4 will require hospitalization.

Research has indicted that active mobilization will result in better recovery for short and long term cases.

The involved treatments are light repetitive exercises which work the affected area to maintain its normality. There is basic information given to the patient for exercise that will not compromise their neck.

The exercises can be done at home and under the care of healthcare professional. The exercises should begin slowly and light and progress to another level as the neck heals to avoid strain or stress that might cause more damage.

As a complement to the rehabilitation exercises, other passive treatments may be used. These may include stimulation, massage therapy, and acupuncture.

The patient should not return to normal activities until; full recovery is achieved. Patients suffering from chronic whiplash who have entered into rehabilitation programs have reported being able to control the pain and following the exercises and strategies they learn, they were able to recover and go back to their normal activities.


Patients with whiplash grade 0 to grade 3 can use non-narcotic analgesics, NSADs might be prescribed for WAD 3 and WAD 2 though it is highly recommended that their use be restricted to a period not longer than 3 weeks.

Muscle spasm and involuntary contractions can be treated using Botulinum toxin A. Botulinum toxin type-A is temporal and for the effects to be felt there has to be repeated injections.

Whiplash can occur when a vehicle is at 15 miles per hour or less and happens when there is a sudden jolt caused by a rear-end collision. The more sudden the motion is the more damage is done.

There are multiple whiplash incidents in vehicle accidents and this is why people are advice to be careful while driving and protect themselves through using car seats designed to protect divers and passengers from whiplash.

In any incident, the injured individual should immediately see a doctor for diagnosis and treatment commencement.