There are some whiplash exercises that you can do. However, it is not that easy. I have been a practicing orthopedic physical therapist since 2009 and have seen many, many people who have stiffness and pain from whiplash. Whiplash is both easy, and at the same time, difficult to treat. The joint stiffness and muscle strain treatment are straightforward, but there is a psychological component to whiplash which can lead to prolonged recovery and chronic pain. To learn more about this condition, read on. Let’s start with anatomy.
The spine
In order to understand whiplash, you need to be familiar with the structure of the spine. The spine is made up of 33 vertebrae. The vertebrae are the bones of the spine. Each is stacked on top of one another to make a column. The spinal cord travels through the column with nerves exiting at each vertebral level. The first 7 vertebrae make up the cervical or neck region. The middle 12 vertebrae are the thoracic or mid back region. The next 5 vertebrae are the lumbar, which is also known as the low back. The next five make up the sacrum which is the triangular bone at the base of the spine. The sacral vertebrae are fused meaning they have grown together. The last 4 vertebrae are also fused. This is the coccyx or tailbone. The discs are in between the cervical, thoracic, and lumbar vertebrae. The sacrum and coccyx have grown together and have no space between the vertebrae for a disc.
The spine has curves in order to absorb and distribute the stresses on it. The cervical spine has a lordotic, also known as an inward, curve. The thoracic has a kyphotic or outward curve. The lumbar curves inward and the sacrum curves outward.
The cervical spine
The cervical spine is made up of 7 unique vertebrae. It’s job is to support and soften loads to the head and neck while allowing movement. It also functions to protect the spinal cord. The cervical vertebrae are named C1 through C7. C1 is the first vertebra below the skull and C7 is the last vertebrae of the cervical spine.
The cervical spine has 8 cervical nerve roots. These nerve roots come off of the spinal cord and travel between the vertebrae at each level. The cervical nerves provide sensation and movement to our neck, shoulders, arms, and hands. Each nerve root innervates a different area of the body.
Along with the vertebrae, discs, and nerve roots, the cervical spine has many other structures which allow it to smoothly function. These include joints between the vertebrae which allow movements and several ligaments which add stability to the spine.
What is whiplash?
Whiplash actually refers to the mechanism of injury rather than the injury itself. The term whiplash associated disorders (WAD) is used to describe the pain and injuries that occur after a sudden acceleration-deceleration movements. This type of movement will cause the cervical spine to form a S-shape with the lower part of the neck in a hyperextension (looking up) and the upper part of the neck in flexion (looking down). This can cause a strain injury, edema, and/or pain in the joints, discs, muscles, ligaments, bones, nerves, and arteries of the neck and upper back.
How bad is my whiplash?
Not all whiplash is the same. There are grades of whiplash associated disorder depending on the severity.
- Grade 1 – Pain, stiffness, and/or tenderness in the neck but has no physical indications of injury
- Grade 2 – Decreased neck mobility and point tenderness
- Grade 3 – Neurological signs are present including abnormal sensation, muscle weakness, and decreased reflexes
- Grade 4 – Fracture (broken bone) is present
What are the symptoms?
There are many symptoms of whiplash. These include:
- Neck pain and stiffness
- Pain in the upper back and between the shoulder blades
- Pain and/or numbness in the shoulders, arms, and/or hands
- Headaches
- Jaw pain
- Visual disturbance
- Possible anxiety and/or depression
- Difficulty concentrating
- Tinnitis
- Dizziness
- Sleep disturbance
Who gets whiplash?
The most common cause of whiplash associated disorder is a car accident. However, it could also occur in sports or with a hard fall. Whiplash associated disorders are more common in women than in men. There are risk factors for developing whiplash associated disorder after an accident. These include:
- Severity of the impact
- Having neck pain prior to the accident
- Being younger – People age 18-23 are more likely to file claims and be treated for whiplash associated disorder.
What is my prognosis?
It depends. Most people make a full recovery from whiplash. However, a fairly large percentage (20-40%) will have chronic pain. There are some risk factors for the condition becoming chronic. These include:
- Poor expectation of recovery
- Post-traumatic stress disorder from accident
- Increased pain and disability prior to the accident
- More severe impact and not wearing seatbelt during accident
- Low education level
Who should I see?
- Physical therapy – Physical therapy has good success with treating whiplash. A physical therapist can help improve mobility of the neck and upper back with mobilization and manipulation techniques. Also, releasing some of the musculature around the neck and shoulder blades with soft tissue mobilization or dry needling will help decrease the pain. Physical therapy can help strengthen the neck and shoulder muscles, and improve posture.
- Primary care physician – Consulting with your primary care physician is very important with whiplash. Your primary care physician can examine you and provide medications such as anti-inflammatories or muscle relaxers if appropriate. Imaging of the spine will be needed to rule out fractures or other pathologies. A referral to a specialist might also occur depending on your symptoms and the results of the imaging.
What can I do?
- Return to normal activities – It is important to return to your normal activities as soon as possible. This means that you should do the activities that are tolerable. So if folding laundry is okay but vacuuming hurts, then fold the laundry and skip vacuuming for now. Try to increase your activity steadily. Immobilization and bed rest do not tend to help pain and stiffness, and can increase the chances the developing chronic pain. Movement is the key to recovery.
- Aerobic exercise – Performing low impact aerobic exercise is very beneficial for the spine. It increases the flow of nutrients and blood and decreases pressure on the discs. It can also be a good way to relieve stress. Examples of low impact aerobic exercise include walking, swimming, and biking. If you don’t currently have an exercise program, then carefully work into one. You might begin by walking for 5 to 10 minutes a day and slowly work up to 30-60 minutes over several weeks or months. Be sure that whatever you choose does not exacerbate your symptoms.
- Ice – Ice can help decrease irritation and pain in the neck. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- Posture – Whiplash tends to cause issues with posture especially in the shoulders and neck. Having forward rounded shoulders causes the chin to poke forward and the neck to forward flex. This takes the cervical spine out of its natural alignment. The shoulders should be back so that they are in line with the hips. They should also be held down the back so that the upper trapezius and levator scapula do not become overly tight. To prevent the chin from jutting out, the ears should be in line with the shoulders. This will automatically bring the chin in and align the cervical spine. If the pectorals and biceps are tight, they will cause the shoulders to round. Below is a video showing how to stretch the pecs and biceps and also how to use a wall to check your posture.
- Strengthen and stretch the muscles around the cervical spine – Strengthening the deep neck flexors are vital in strengthening the neck and being able to stabilize this area of the spine. The deep neck flexors are attached to the vertebrae and are the key stabilizers of the cervical spine. The upper trapezius and levator scapula are muscles that attach to the neck and shoulder. These muscles are commonly tight after whiplash and can cause neck pain and headaches. Below is a video on how to strengthen the deep neck flexors and stretch the upper trapezius and levator scapula.
- Strengthen the scapular stabilizers –The scapular stabilizers are the muscles around the shoulder blade which help stabilize the shoulder joint while your arm is performing different activities. They are also very important in maintaining good posture. Activating these muscles will help properly align the thoracic spine which will help with proper alignment of the cervical spine. The videos below review some strengthening exercises for the scapular stabilizers. Using loop resistance bands and resistance bands can increase strength and difficulty.
- Latex pillow – There has been some research showing that an ergonomic latex pillow can help decrease neck pain. The pillow can support the spine and the head which can improve sleep and decreased pain.
In review
- The cervical spine is made up of 7 unique vertebrae. It’s job is to support and soften loads to the head and neck while allowing movement.
- Along with the vertebrae, discs, and nerve roots, the cervical spine has many other structures which allow it to smoothly function.
- Whiplash actually refers to the mechanism of injury rather than the injury itself.
- The term whiplash associated disorders (WAD) is used to describe the pain and injuries that occur after a sudden acceleration-deceleration movements.
- There are grades of whiplash associated disorder depending on the severity.
- Symptoms of whiplash associated disorder include pain and stiffness in the neck.
- Whiplash most commonly occurs with car accidents, but can also be the result of a sports injury or fall.
- Women and younger adults are more likely to develop whiplash associated disorder.
- About 20-40% of those with whiplash associated disorders will have chronic pain.
- Being under the care of your primary care physician and physical therapist is important in recovery.
- There are things that you can do
- Return to normal activities
- Aerobic exercise
- Ice
- Posture
- Stretch and strengthen cervical muscles
- Strengthen scapular muscles
- Ergonomic latex pillow
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Whiplash_Associated_Disorders
https://www.ncbi.nlm.nih.gov/books/NBK541016/
https://emedicine.medscape.com/article/822893-overview