Whiplash1 is a type of neck injury caused by sudden movement of the head forwards, backwards or sideways. It occurs when the soft tissues in the neck become stretched and damaged and is most commonly associated with car accidents, but can also affect people who play contact sports or who get struck by falling objects. When whiplash happens, the result could be a concussion, headache, nerve-root compression or torn muscles in the anterior and/or posterior aspects of the neck. Depending on the nature of the injury, pain may be immediate or could begin days or even several weeks later. Whiplash is amazingly common and often goes untreated.
The symptoms of a whiplash injury can heal themselves even without interventions such as physiotherapy. However, for many people, even with this care, pain and restricted movement can persist for months or even years after the injury and its common for sufferers to experience a wide range of physical, neurological and psychobiological symptoms. These can include but are not limited too:
Tissue damage at the sites of injury, from local overstretching or micro-tearing of fascia, muscle, or nerve tissues, typically in the neck, shoulders, and back. Harmonic forces in the body, bracing reactions, and fascial connections can cause tissue injury and inflammation in unexpected, nonlocal areas anywhere in the body, such as the rib cage, limbs, or pelvis.
Instability or weakness from tissue damage, and from dissociation of the muscle spindle/Golgi postural reflex relationships in the injured muscles, resulting from overstretching.
Restricted motion as a result of either acute muscle spasticity and splinting reflexes, or from chronically adhered and shortened connective tissues, including the tissues around articulations.
Pain, anywhere in the body. Causes include direct tissue injury, neurologically referred pain, or autonomically associated pain (e.g., post-traumatic headaches).
Vertigo (dizziness) and balance impairment. Cervical instability can result in splinting and fixing of the neck and head (especially by the suboccipital muscles), which reduces the adaptive capacity of the vestibular system. Post-traumatic vertigo is also postulated to be related to sympathetic nervous system imbalance.
Sympathetic (fight or flight) activation of the autonomic nervous system (ANS) from the trauma of the incident itself; from direct injury to sympathetic nerve fibers in the neck (Image 2)10; or from ongoing sympathetic stimulation from vestibular and balance impairment. Symptoms can include sleeplessness, headaches, anxiety, or depression.
Left untreated, therefore, whiplash can have a massive effect on your quality of life affecting movement, concentration, sleep and restricting participation in sports and other activities.
I have met people in the course of my practice who have carried untreated whiplash injuries for over 20 years and as a result, have all but lost the ability to be able to move freely and move with the expectation of pain always being present. I believe that in these cases the trauma of the whiplash has become locked away in the tissues of the body. This can lead to a number of other issues including restricted breathing patterns, TMJ problems and restricted fascia2. It is interesting to note that many people forget that they suffered a whiplash injury, often because they walked away from an accident unharmed or because their restricted movement patterns have become 'normal' to their body and mind. There is often an element of putting up with the pain and restricted movement along the lines of 'its has been this way for so long I just put up with it'.
Respected bodyworker Til Lichau differentiates between hot whiplash, which is generally recent (within 3-6 weeks), and cold whiplash (typically older):
Hot whiplash is distinguished by being sensitive, fragile, and reactive, as the fight-or-flight responses of the autonomic nervous system are still aroused. The head and neck are typically immobilised by muscular spasm or hypertonus since the postural reflexes recruit muscular tension to provide the inherent structural stability that has been compromised by the injury. Because of tissue damage, inflammation will be a factor in a recent or unresolved whiplash. The tissue in injured areas will feel softer or puffy to your gentle palpation (though not always literally hot). Your client may respond to direct touch with guarding, uneasiness, or pain, which further increases sympathetic activation.
Cold whiplash is typically older, less autonomically reactive, and restricted at the ligamentous or joint level (as opposed to muscularly spasmed). It is characterised by stubborn, dense, hardened tissue deep around the joints. Hot whiplash often becomes cold (restricted) once initial tissue damage has begun to heal; cold whiplash can become hot (reactivated) if worked too quickly or aggressively. We’ll focus on hot whiplash in this article and cold whiplash in the next.
The good news is that myofascial release and massage, breathwork, the use of modalities such as heat and focused exercises can ease the symptoms of whiplash, removing patterns of holding and tension throughout the body, ultimately returning the body to a place where pain is not longer present and full movement is possible.
There are many elements to treating whiplash successfully and due consideration of the type of whiplash - recent or older - must be given by the therapist. In all cases Range of Motion (ROM) testing, (a benchmarking process from which improvements in motion, perceived stiffness and pain can be measured) is important. ROM testing should be done at the start and end of each session so that both the therapist and client can see what (if anything) have improved or changed during the session. Myofascial work, deep tissue massage, trigger point treatment, the use of heat (such as hot stones or a hot wheat cushion) and traction are all key areas of work but must be done mindfully and conjunction with feedback from the client. Those suffering from recent whiplash need to have their autonomic nervous system calmed before tissue restrictions are worked on, and this process can take time. Breathwork can be incredibly helpful as it has the power to calm the nervous system and bring awareness to parts of the body that have been eclipsed by painful areas.
In my experience, going in too deeply too quickly is counterproductive and causes people to tense up rather than let go. People who have suffered from whiplash will usually find it difficult to allow their neck to be mobilised, and a mindful and gentle touch will be required when performing mobilisation and traction, which needs to ease into stiff areas and allow the brain time to see that movement is possible without pain. I find too that with a 'little and often' approach to self-mobilising, stretching and strengthening the neck/upper back, people tend to get better quicker and stay better.
It's important when you have suffered from whiplash that you invest in a series of treatments preferably every week for 6 weeks to start with. Regular treatments have a cumulative effect and will give you the best results. Be prepared to engage in the process of consultation, so that your therapist can understand the effect that the whiplash has had on you. This means thinking about any areas of tension which you are holding in other parts of your body which may seem unrelated to the whiplash itself. Be prepared too that things might feel worse before they feel better too, as whiplash can be a complex condition to treat. The good news is that with the right quality of touch and a therapist who can help you to treat the whole body, you need not suffer from the pain of whiplash forever.
1The term whiplash was first used to describe cervical injuries in 1928 by orthopedic surgeon Harold Crowe, and is subject to some controversy. Physical medicine texts variously prefer the terms acceleration-deceleration injury, hyperflexion-hyperextension injury, or cervical strain-sprain injury.
Luchau, T. (2010) 'Working with Whiplash Part 1', in ABMP Magazine March /April
Luchau, T. (2010) 'Working with Whiplash Part 2', in ABMP Magazine May/June
Lowe, W. (2003) “Assess & Address: Whiplash,” Massage Magazine 104 July/August 2003
Cailliet, R. (1991) Neck and Arm Pain. Philadelphia: F.A. Davies.