Whiplash (cervical spine distortion) • Symptoms & Treatment

Whiplash is the most common consequence of traffic accidents in Germany. The man behind does not pay attention for a brief moment and hits the car in front. The occupants of the front car are thrown forward with full force. This whip-like movement of the head quickly injures the soft tissues in the cervical spine (cervical spine). Doctors speak of a distortion (dislocation) of the cervical spine, or cervical spine distortion for short, or whiplash trauma. Most of the time, the excessive stretching "only" injures muscles, tendons and ligaments, and sometimes the bony structures of the vertebrae are also affected.

What is whiplash?

In the event of side or frontal impacts – such as a collision during sports or a rear-end collision – considerable acceleration forces act on the head and the cervical spine (Cervical spine), followed by enormous braking forces. The head is first overextended by the impact from behind and then literally catapulted forwards, which puts extreme stress and strain on the cervical spine and therefore damages it.

Whiplash: many names for the same symptoms

Whiplash is not a disease in the strict sense of the word, but comprises several symptoms that arise from the action of external forces. Further names are:

• Cervical spine distortion, cervical spine distortion
• Cervical trauma
• Cervical spine acceleration trauma, cervical spine
• Cervical spine strain
• Acceleration trauma to the cervical spine
• Whiplash syndrome
• in English: Whiplash Injury
• post-traumatic cervical spine syndrome

Cervical spine syndrome: possible consequence of whiplash

The term cervical spine syndrome is often used for whiplash, although the terms are not synonymous. A cervical spine syndrome describes the symptom complex of pain and neurological disorders in the shoulder-arm area, which can be caused by wear and tear and incorrect loading as well as by an accident. In the latter case, one speaks of post-traumatic cervical spine syndrome. In fact, it is a possible consequence of whiplash.

Tension and pain after a car accident

Whiplash is associated with strains, overstretching, tears or compression of muscles, tendons, ligaments or intervertebral discs in the region of the cervical spine. The bones, joints, blood vessels or nerves are rarely injured in a cervical spine. Those affected feel neck pain that can radiate into the shoulder or back, sore muscles and often headaches. The symptoms are usually not felt immediately after the accident, but develop a few hours later with a time lag.

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Whiplash is usually harmless

The severity of the trauma is not necessarily related to the severity of the rear-end collision. Even a slight impact can cause serious disruptions, while other people do not always develop complaints even after serious accidents. The cervical spine acceleration trauma is usually harmless and subsides within four weeks. However, there are some factors that increase the risk of a chronic course, for example severe headaches at the beginning or the psychological state of the person concerned. With the help of painkillers or physical therapies, such as heat and cold, those affected can usually get the consequences of the accident under control.

Serious complications are rare with cervical spine distortion

Injuries to the bony vertebral structures or the nerves in the vertebral canal can also occur. However, these are extremely rare in classic rear-end collisions, which can be attributed to the improved safety in cars with airbags, seat belts and, above all, headrests. Complications such as concussions or traumatic brain injuries are also rather rare.

Causes: how does whiplash occur?

A cervical spine distortion is triggered by acceleration beyond the normal, physiologically compensable level, which suddenly and unexpectedly acts from outside. After the extreme acceleration (acceleration), negative acceleration (deceleration) occurs within a very short time. Considerable forces act on the head and cervical spine, which can damage the muscles, especially the upper cervical spine, the ligaments and, in severe cases, the cervical vertebrae and intervertebral discs.

The acceleration forces are strongest in a rear-end collision with the rear of a vehicle. An additional acceleration rate of ten kilometers per hour and more from the impact is sufficient to affect the neck and neck muscles and the supporting apparatus such as tendons and ligaments. On the other hand, accelerations such as those that affect the vehicle when moving off quickly or when braking hard are not normally sufficient to cause a distortion of the cervical spine.

Whiplash after falls and sports accidents

Whiplash can also occur in sports and leisure accidents or falls. Martial arts such as kick boxing, wrestling, yudo, karate or Thai boxing can also put considerable strain on the head, neck and spine due to the fast, accelerated movements. In addition, there are frequent injuries to the cervical spine during leisure activities such as bumper cars or roller coaster rides. Falls also often lead to whiplash injuries, for example when climbing, skiing or riding.

Risk factors: Previous damage increases the risk

Anyone who suffers from previous illnesses such as severe signs of wear and tear of the cervical spine, instability of the vertebrae (sliding vertebrae), ankylosing spondylitis (chronic inflammatory disease of the joints) or inflammation of several joints (polyarthritis) has an increased risk of a cervical spine syndrome. In addition, previous injuries from previous injuries to the cervical spine are risk factors, as well as a generally poor constitution and muscle weakness.

Neck Pain and Tension: Symptoms of Whiplash

In the case of a cervical spine distortion, various symptoms affecting the cervical spine, head and neck can occur to varying degrees.

The first symptoms of whiplash are often:

• a headache
• Neck pain
• Muscle pain (myalgia)
• Muscle tension (myogelosis), muscle tension
• Neck stiffness (stiff neck)
• Restrictions on movement
• Radiation pain in the back of the head, shoulders and arms

Most often there is a typical complex of symptoms, consisting of neck pain radiating into the shoulder or back, sore muscles and a stiff neck. The pain and restricted mobility are triggered by the inflamed connective tissue and the smallest fiber tears in muscles and ligaments. Headaches, which often occur with them, usually arise due to the muscle tension in the neck. However, they can also be an indication of a concussion, especially if they occur immediately after the accident, are very severe and are accompanied by nausea and vomiting. In this case, a neurological evaluation should be carried out as quickly as possible.

Cervical spine syndrome: symptoms set in later

It usually takes a few hours after the accident, rarely up to three days, for the symptoms to show in their fullest form. Doctors suspect the cause of the delayed onset of symptoms, known as latency, to be that the accident mechanically damages the tissue and slowly causes inflammation. In most cases, symptoms such as sore muscles in the neck or stiff neck persist for a few days to a few weeks. In the majority of those affected, the symptoms have completely subsided after about four weeks.

Whiplash Complications: Injury to bones or nerves

Depending on the severity of the injury, the following additional symptoms and disorders may occur:

Doctors pay special attention to these symptoms because they may indicate a particularly severe whiplash with damage to nerves, intervertebral discs, or even broken bones (fractures) in the cervical vertebrae.

Basically, bony injuries such as vertebral separation, narrowing of the vertebral canal or so-called vertebral slippage – caused by instability of the spine – can occur in connection with whiplash. However, these consequences are rather rare, as are nerve tissue injuries (neural lesions) such as strains, contusions or constrictions of nerves.

Chronic whiplash: the psyche is involved

If the pain and discomfort have not completely subsided after about six months, doctors speak of chronification. The decisive factor for a chronic course is not so much the severity of the injury, but rather factors such as the psychological processing of the accident, the individual fear of permanent damage or the care situation by the accompanying doctor.

Diagnosis of whiplash and classification into degrees of severity

It is advisable if you experience neck pain and other disorders after a car or sports accident. to have the consequences of the accident clarified by a doctor. The doctor will inquire about:

• the course of the accident,
• the complaints and
• existing medical conditions.

The diagnosis of cervical spine distortion can usually be made from this. Early diagnosis and treatment of the injuries is important to reduce the risk of the whiplash becoming chronic. The division into different degrees of severity helps.

Classification according to possible disorders: four degrees of severity for cervical spine distortion

Doctors divide whiplash into four different grades, depending on the number and severity of the symptoms (whiplash severity 0 to IV). The classification of the Quebec Task Force (QTF) serves as the basis for the classification:

The majority of all whiplash injuries (90 to 95 percent) correspond to degrees of severity 0 to II.

Diagnostic methods for whiplash trauma

The following tests will help the doctor diagnose a cervical trauma:

• Physical examination: The doctor tests, among other things, mobility, coordination, reflexes, function of bones, muscles and joints, balance, sensitivity, orientation and memory. He also checks whether there are any acute psychological stress reactions to the accident.

• X-ray examination: It shows, for example, whether there are any fractures.

• Magnetic resonance imaging (MRI) or computed tomography (CT) of the spine if a more serious injury to the spine, nerve damage or soft tissue damage (muscles, tendons, ligaments) is suspected. Doctors will also do an MRI if the pain persists and is unexplained for four weeks.

• The doctor may ask about psychological stress and stress symptoms using a standardized questionnaire.

Further examinations for cervical spine trauma

If injuries to the nervous system and organ of equilibrium in the inner ear are suspected, further examinations are carried out:

• Derivation of somatosensitive evoked potentials (SEP): They show damage to the peripheral or central sensitive system.
• Derivation of magnetically evoked motor potentials (MEP): evidence of damage to the peripheral or central motor system.
• Electromyogram (EMG): Evidence of damage to the peripheral motor system. The examination is useful two to three weeks after the injury.
• Measurement of the nerve conduction velocity (NLG): detection of nerve damage.
• Otoscopy and thermal labyrinth test: damage to the organ of equilibrium can be detected.

In special cases, doctors will perform further examinations to diagnose possible damage from the whiplash trauma. These include, for example:

• Examination of the cerebral and spinal fluid (CSF examination) if inflammatory diseases are suspected.
• Ultrasound of the major cervical arteries
• CT or MRI of the skull if there is a reasonable suspicion of a brain injury, such as a brain contusion.

Therapy options: what to do in the event of whiplash?

Whiplash trauma can almost always be treated conservatively, i.e. without surgery. It is important for the success of the therapy that the patient is involved in the decisions for or against a treatment and actively participates.

Painkillers for whiplash symptoms

Nonsteroidal anti-inflammatory drugs (NSAIDs), for example ibuprofen, naproxen or diclofenac, help against pain and inflammation. Paracetamol also has an analgesic effect. The pain relievers should not be taken for more than four weeks. Doctors use lidocaine for chronic pain. The local anesthetic is injected into the muscle. In addition, muscle relaxants (muscle relaxants) are used, for example tetrazepam; Those affected should not use these for more than two weeks. Some antidepressants also have an analgesic effect, for example amitriptyline.

Physical therapies

The following physical therapies can relieve the pain of whiplash injuries:

• Heat treatment, mud packs
• Cold therapy
• Massages promote blood circulation
• Electrotherapy: Transcutaneous Electrical Nerve Stimulation (TENS)
• Exercise therapy
• Stretching and loosening exercises
• targeted physiotherapy (formerly physiotherapy) for neurological failures
• Light movement exercises and gymnastics

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Whiplash home remedies – you can do that yourself

In the acute phase of pain, simple home remedies can often bring about good pain reduction and thus relaxation, for example with:

• Cushions with hot water bottle or warm cherry stone pillow
• Heat patch
• Cold applications (cold pack)
• Ointments with blood circulation-promoting and warming capsaicin

Psychotherapy for whiplash

Psychotherapy, for example behavioral therapy, can help those affected with long-term symptoms. Therapists try to break down negative thought patterns and behaviors and replace them with positive ones. The right people to contact are specialists in psychosomatic medicine, psychotherapy or psychiatry.

Sick leave for whiplash: no longer than necessary

A sick leave of three weeks or more is usually not necessary in the case of whiplash. Of course, injuries to the nerves, intervertebral discs or cervical vertebrae are an exception. Studies have shown that returning to everyday life as soon as possible and resuming normal lifestyle accelerates healing and counteracts chronification.

Therapies That Don't Help

Doctors no longer recommend the following therapeutic measures:

• Neck cuff: The "neck ruffs" (Schanz collars) that were often used in the past or other aids that immobilize the head and the cervical spine are now considered superfluous. An exception is when patients experience massive pain when moving and the head and neck area is very unstable. A prolonged immobilization by a neck brace causes more severe discomfort in the long term and can also contribute to the chronification of the whiplash. It is only advisable to immobilize the cervical spine if the bone is severely injured.

• Passive mobilization during acute pain phases, for example chiropractic or osteopathy, should initially be avoided. It increases the risk of re-injury, but can be helpful later in the event of chronic complaints.

• Neuropsychological therapy ("brain performance training") has also proven to be ineffective for uncomplicated whiplash injuries.

Good information favors healing

The behavior and attitude of the attending physician have a decisive influence on a speedy recovery. He should not warn his patient about permanent long-term damage or make an unfavorable prognosis early on. Because that increases the likelihood that the cervical spine syndrome will become chronic.

Rather, the doctor should point out that whiplash is usually harmless and reassure the patient that the pain, even if it is very severe, is completely normal and goes away on its own.

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Course, chances of recovery and duration of whiplash

In most cases, the whiplash is harmless and the symptoms subside within four weeks – largely regardless of the initial severity and strength of the symptoms. The behavior of the attending physician plays an important role, as does the patient's own initiative.

The following have proven to be positive for rapid healing:

• Good education from the doctor that symptoms usually heal completely without complications
• short sick leave, no longer than three weeks
• mobilization soon
• early conservative activating treatment, for example with physiotherapy

The most common complication: chronic whiplash disease

The cervical spine syndrome can also develop chronically. If symptoms such as neck pain, myalgias, or headaches persist, doctors speak of chronification. In about twelve percent of patients, the symptoms last longer than six months. In some cases, accompanying complaints such as dizziness, concentration disorders or tinnitus persist for a long time. Doctors have identified some risk factors that promote chronic whiplash:

• female gender
• older age
• great pain at the beginning
• early disturbances of sleep, attention and memory
• early severe headache after the accident
• Numbness and pain radiating from the neck to the arms
• mental illness such as anxiety and depression before the accident
• Stress from conflicts in the family and at work
• individual experience of illness, coping with illness, personal sensitivity to pain and the ability to cope with pain

Chronic whiplash: the psyche plays a role

Psychological factors appear to play a large role in whiplash symptoms becoming chronic. Many people relive the event again and again in their memories or imagine it anew. In studies in which researchers simulated a fictitious rear-end collision, around 20 percent of the study participants subsequently reported symptoms even though neither a collision nor an injury had occurred. The accident alone does not always adequately explain why the whiplash becomes chronic and why a person suffers considerably from the consequences over a long period of time.

The initial strength of the pain, the subjective experience of pain, the processing of pain and stress, but also social reinforcement systems such as the expectation of compensation for pain and suffering seem to play a role. What is certain is that existing fears and depression increase the likelihood of complaints after an injury.

Compensation for pain and suffering after whiplash

The cervical spine distortion is one of the most common complications after car accidents and is a rather controversial syndrome overall. Whiplash is often a case for insurance companies and lawyers because it is about compensation in the form of compensation for pain and suffering. Over the past 30 years, a growing number of victims have sought medical help due to cervical spine acceleration trauma. There are considerable differences between the individual countries in terms of legal regulations, cultural characteristics and expectations of those affected. Studies have shown that whiplash injuries are almost unknown in countries where no compensation can be expected. In Germany, however, around 400,000 people are affected each year.

What are you entitled to compensation for pain and suffering?

The basis for the assessment of the compensation for pain and suffering is the degree of the disturbance according to the Quebec Task Force classification. X-rays and other evidence of the injury are also used for assessment. It often proves to be problematic that an injury to soft tissues such as muscles and ligaments, in contrast to a bone fracture, is difficult to document.

The prerequisite for a possibly successful claim for compensation for pain and suffering is:

• Consult a doctor as soon as possible after the damage or the occurrence of pain.
• Then contact a lawyer.
• In the event of a lawsuit for compensation for pain and suffering, the extent to which the injured party has consistently carried out the prescribed treatment and actively participated in rehabilitation measures may have a positive effect.
• A pain diary for documenting complaints can also prove helpful when awarding compensation for pain and suffering.

These measures are also important in order to prove possible long-term consequences and corresponding claims for recourse.

Prevent whiplash with head restraints and airbags

One of the most important aspects to protect against cervical spine distortion is a correctly adjusted headrest in the car. Many drivers pay little attention to this safety device, but crash tests by the automobile manufacturers or the ADAC have shown that it plays a major role in preventing and mitigating damage in rear-end collisions. According to recommendations, the headrest should not be more than two to four centimeters away from the head. It is also important that it is not set too high, as otherwise the head can be thrown far back in the event of a shock from behind. Seat belts, airbags and side airbags also weaken the forces acting on them and prevent the head from hitting hard.

Can you prevent whiplash injuries?

In general, well-trained back and neck muscles offer some protection against injuries such as whiplash. Particularly in sports that involve an increased risk of injuries in the neck and neck area – such as climbing, horse riding or racing – attention should be paid to building up muscles accordingly. On the other hand, unnecessary strain on the cervical spine such as deliberate collision maneuvers when driving bumper cars should be avoided as far as possible.

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