Kamiah A. Walker
Medical Writer
SpineUniverse
Wheaton, IL

Whiplash treatment rarely requires surgery. However, surgery is appropriate in severe cases if you have persistent neck or shoulder pain. If your condition hasn't improved after extensive non-surgical treatment, an operation may be your best option.

Your spine surgeon will recommend the best surgical procedure for your injury. Make sure to ask plenty of questions about the procedure so that you fully understand how it's done, what the outcome will be, how long the recovery time is, etc. When it comes down to it, surgery is your decision alone: the surgeon can recommend it, but you have the final say.

The type of surgery depends on what parts of your cervical spine have been injured.

Ruptured or Herniated Disc
During your accident, you may have ruptured or herniated an intervertebral disc, which is located between the vertebrae. This can produce persistent arm pain, numbness, or weakness. In this case, disc removal is sometimes necessary. The surgeon removes all or part of the damaged disc in a process called a discectomy.

After the discectomy, your doctor may need to permanently stabilize the area. Discectomies usually result in an unstable spine, meaning that it moves in abnormal ways. That makes you more at risk for serious neurological injury. So when surgeons do a discectomy, they often restabilize the spine.

To stabilize the spine, the surgeon may use:

• Artificial Cervical Disc: This is a new—and very exciting—development in spine surgery. Recently, surgeons have begun implanting an artificial cervical disc after the discectomy. They're using this instead of fusion and spinal instrumentation. The advantage is that an artificial disc enables a patient to retain normal neck movement after surgery. Previously, if the patient had two or more vertebrae fused, neck motion would be greatly reduced. Cervical discs still are a fairly new technology; however, early results are encouraging.
• Fusion and Spinal Instrumentation: This kind of spine stabilization surgery has been has been common for many years. It can be done alone or at the same time as a decompression surgery. In spine stabilization, the surgeon creates an environment where the bones in your spine will fuse together over time (usually over several months or longer). The surgeon uses a bone graft (usually using bone from a donor) or a biological substance (which will stimulate bone growth). Your surgeon may use spinal instrumentation—wires, cables, screws, rods, and plates—to increase stability and help fuse the bones. The fusion will stop movement between the vertebrae, providing long-term stability.

Spinal Stenosis
Surgery may also be necessary if the injury causes a narrowing of the spinal canal in your neck. In this case, a cervical corpectomy might be performed to remove a portion of the vertebra and the intervertebral disc to reduce the pressure on the spinal cord and nerves. Your surgeon may also do a laminectomy or a laminoplasty. Both of those surgeries focus on the lamina, the bony plate that's at the back of each vertebra. It protects your spinal cord and spinal canal. The lamina may be pressing on your spinal cord, so the surgeon may make more room for the cord by removing all or part of the lamina—that's a laminectomy.

In a laminoplasty, the surgeon will re-shape the lamina to create more room for your spinal cord. Plasty means "to shape."

If there is a narrowing of the space where the nerve exits the spinal canal, a cervical foraminotomy may be performed. In this procedure, the foramen (the area where the nerve roots exit the spinal canal) is removed to increase the size of the nerve pathway. A larger pathway makes it less likely that the nerve will be pinched or compressed.

Surgical Complications
As with any operation, there are risks involved with cervical spine surgery to treat whiplash symptoms. Your doctor will discuss potential risks with you before asking you to sign a surgical consent form. Possible complications include, but are not limited to:

• injury to your spinal cord, nerves, esophagus, carotid artery or vocal cords
• non-healing of the bony fusion (pseudoarthrosis)
• failure to improve
• instrumentation breakage/failure
• infection and/or bone graft site pain
• pain and swelling in your leg veins (phlebitis)
• blood clots in your lung
• urinary problems
• very rare complications: paralysis and possibly death

Complications could lead to more surgery, so again—make sure that you completely understand your surgery and the risks before proceeding. The decision for surgery is yours and yours alone.

Recovery from Whiplash Surgery
After your surgery, you aren't going to be instantly better. You will most likely be out of bed within 24 hours, and you'll be on pain medications for 2 to 4 weeks. After the surgery, you'll receive instructions on how to carefully sit, rise, and stand. It's important to give your body time to heal, so your doctor will probably recommend that you restrict your activities: in general, don't do anything that moves your neck too much. You should avoid contact sports, twisting, or heavy lifting while you recover.

After surgery, be vigilant. Report any problems—such as fever, increased pain, or infection—to your doctor right away.

PREVENTION

Prevention

Prevention is the most effective way to avoid this injury.

• Always wear your seat belt and adjust your headrest to the proper height when driving. The middle of the headrest should be even with the upper tips of your ears. Seat belts with shoulder harnesses as well as headrests may not reduce the risk of cervical strain but should be used in all motor vehicles because they reduce the risk of death and serious injury.
• Child abuse can cause whiplash injuries in children through excessive or violent shaking. Parents need education and counseling. Report suspected child abuse to authorities.
• The effect of air bags on whiplash prevention is still being examined.

Correctly adjusting the headrests in your vehicle may help to prevent whiplash by stopping your head from moving backwards. It is difficult to prevent your head moving forwards or sideways.

See Useful links, right, for advice on how to adjust your headrest correctly.

Kamiah A. Walker
Medical Writer
SpineUniverse
Wheaton, IL

Physical therapy is an effective treatment option for whiplash, especially when combined with other treatments, such as bracing and medications. In whiplash, the soft tissues in your neck are damaged, so a physical therapist can work with you to restore proper function and movement of those tissues.

Physical therapy includes both passive and active treatments. Passive treatments help to relax you and your body. They're called passive because you don't have to actively participate. Most likely, you're experiencing acute pain because of whiplash, so you'll probably start with passive treatments as your body heals and/or adjusts to the pain. But the goal of physical therapy is to get into active treatments. These are therapeutic exercises that strengthen your body so that your spine has better support.

Passive Treatments for Whiplash

• Deep Tissue Massage: This technique targets muscle tension that can develop as a result of whiplash. The therapist uses direct pressure and friction to try to release the tension in your soft tissues (ligaments, tendons, muscles). This should help them heal faster.
• Hot and Cold Therapies: By using heat, the physical therapist seeks to get more blood to the target area because an increased blood flow brings more oxygen and nutrients to that area. Blood is also needed to remove waste byproducts created by muscle spasms, and it also helps healing.Cold therapy slows circulation, helping to reduce inflammation, muscle spasms, and pain. Your physical therapist will alternate between hot and cold therapies.(When you first injure yourself—either in a car accident or in another trauma-inducing event—you can use this hot and cold therapy technique at home. Use ice first to bring down the inflammation, and after the first 24 to 48 hours, you can switch between ice and heat. The heat will help relax tense muscles, and it will increase circulation to the injured area. Increased circulation promotes faster healing. As a reminder, never put ice or heat directly on your skin—wrap it in a towel, for example.)
• Ultrasound: By increasing blood circulation, an ultrasound helps reduce muscle spasms, cramping, swelling, stiffness, and pain. It does this by sending sound waves deep into your muscle tissues, creating a gentle heat that enhances circulation and healing.

Active Treatments for Whiplash
In the active part of physical therapy, your therapist will teach you various exercises to work on your strength and range of motion (how easily your joints move). Your physical therapy program is individualized, taking into consideration your health and history. Your exercises may not be suitable for another person with whiplash and neck pain.

If needed, you will learn how to correct your posture and incorporate ergonomic principles into your daily activities. Even after you recover from whiplash, this posture work should help you because you'll be able to prevent other forms of neck pain that develop from daily living.

Overall, the goal of physical therapy for whiplash patients is to help reduce muscle spasms, increase blood circulation, and promote healing of the neck tissues.

Kamiah A. Walker
Medical Writer
SpineUniverse
Wheaton, IL

Depending on the severity of your whiplash symptoms, your doctor may prescribe medications and/or spinal injections to deal with the pain. To stress this point: the medications will help relieve your pain, but they won't help heal the injury. Instead, medications and/or spinal injections reduce your pain so that you can work on healing the soft tissue injuries (through physical therapy, for example).

Again depending on the severity of your pain, you may start with over-the-counter medications. If those don't work to relieve your pain, the doctor may prescribe stronger medications. If prescription medications don't work, the doctor may suggest injections. The progression of treatment depends on your individual symptoms and pain level.

Over-the-Counter Medications for Whiplash

• Acetaminophen: Tylenol is an example of an acetaminophen, a type of medication that has proven to be a good pain reliever. Your doctor may call this an analgesic, but most of us refer to acetaminophen medications as painkillers. They don't help reduce inflammation, though. Acetaminophen works by essentially blocking your brain's perception of pain, and it's good for those pain flare-ups that may come with DDD.
• Over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs): These will help reduce swelling (or inflammation) while relieving your pain. In whiplash, you can have inflammation from the soft tissue injury. If an over-the-counter NSAID is an option for you, you have plenty to choose from. You can use ibuprofen (Advil), aspirin, or Aleve.By taking an NSAID, you are building up an anti-inflammatory effect in your system, so it's necessary to take it for awhile. That is, NSAIDs won't be as effective if you take them just when you have pain. Because they build up in your body and work to limit inflammation, you may have to take NSAIDs for several weeks before you notice a significant effect on your pain.

Prescription Medications for Whiplash
If over-the-counter medications don't deal with your pain sufficiently, the doctor may prescribe something stronger. The exact type of medication depends on your symptoms, but the doctor may have you try:

• Muscle Relaxants: If you have muscle spasms caused by the whiplash trauma, you may need a muscle relaxant, which should help stop the spasms. Muscle relaxants may also help you sleep. Valium is an example of a muscle relaxant.
• Opioids (Narcotics): In the most extreme cases, and only under careful supervision, you doctor may also prescribe an opioid, such as morphine or codeine. Vicodin and Percocet are examples of narcotics.
• Prescription NSAIDs: You can take stronger NSAIDs than the over-the-counter variety, if your doctor thinks this is best for your pain. For example, he or she may recommend a COX-2 Inhibitor (Celebrex is an example). That's a type of NSAID, but it doesn't cause gastrointestinal side effects as other prescription NSAIDs can.

Injections for Whiplash
Injections for whiplash are most effective when combined with a physical therapy or exercise program that helps you work on strengthening the neck muscles. The injection should give you pain relief so that you can turn your attention to healing the actual injury. Several types of injections used for whiplash are:

• Epidural Steroid Injection: This is one of the most common injections. An epidural steroid injection (ESI) targets the epidural space, which is the space surrounding the membrane that covers the spine and nerve roots. Nerves travel through the epidural space and then branch out to other parts of your body, such as your arms. If a nerve root has become compressed (pinched) in the epidural space because of a whiplash injury, you can have pain that travels down your neck and perhaps into your arms (a symptom called radiculopathy).An epidural steroid injection sends steroids—which are very strong anti-inflammatories—right to the nerve root that's inflamed. This is a pain management therapy, so it's best to have a well-trained pain management specialist do the injection. You'll probably need 2-3 injections; generally, you shouldn't have more than that because of the potential side effects of the steroids.
• Facet Joint Injection: Also known as facet blocks, facet joint injections are useful if your facet joints are causing pain. Facet joints in your spine help you move and provide stability. If they become inflamed, though, because of how the whiplash injury affected your cervical spine anatomy, you'll have pain. A facet joint injection will numb the joint and can reduce your pain.
• Trigger Point Injection: In more extreme cases of whiplash, trigger point injections are a good option. (Trigger points are knots of muscle under the skin that form when muscles do not relax.) The injection contains a local painkiller that sometimes includes a corticosteroid to reduce the inflammation.

Arn Strasser, DC
Chiropractor
Strasser Chiropractic Center
Portland, Oregon

If you have suffered a whiplash-type injury to the neck, chiropractic care is a good choice to reduce pain and return proper mechanics to the cervical spine.

To understand the chiropractic treatment of whiplash injuries, it is important to briefly review the nature of this type of neck injury. Whiplash is characterized as an injury to the muscles of the neck from the traumatic rapid forward and backward motion of the neck during an accident.

Chiropractic emphasizes a comprehensive picture of the mechanisms of neck sprain. As important as muscle injury is the response of the nervous system to trauma, and the injury to deeper tissues of the spine with resulting restriction or fixation of spinal joints.

The acute pain and restricted motion you experience after a whiplash injury is a product of injured tissue, and the protective response of the nervous system as it locks up spinal joints to protect you from possible injury to the spinal cord.

Chiropractic care emphasizes mobilizing restricted spinal joints and initiating rapid firing of neurological receptors using spinal manipulation, including non-force and flexion-distraction techniques. Your chiropractor will address the disturbed mechanics and the neurological responses that allow for treating the cause of neck injury and return a full functioning to injured spinal joints.

It is important to emphasize that spinal manipulation is introduced by your chiropractor only when the initial traumatic muscle injury is stabilized. Your chiropractor will be using various types of treatments depending on the stage of your whiplash injury.

The Stages of Whiplash Treatment
Shortly after the injury, in the acute phase, the chiropractor will concentrate on reducing inflammation with therapy modalities, such as ultrasound, and, if indicated, gentle stretching and manual therapies, such as muscle energy therapy. Ice will be recommended and sometimes a light neck support might be prescribed for a short period of time.

As the neck begins to be less inflamed and acute, the chiropractor will utilize gentle spinal manipulation, or adjusting, in order to return motion to spinal joints that have locked up and become restricted as a result of the injury. In some patients, non-thrusting and non-force methods are more appropriate, including Cox flexion-distraction technique.

Chiropractic Care and Whiplash
Chiropractors are doctors who specialize in the care of non-surgical conditions of the neck with gentle, time-saving approaches that address the mechanical and neurological causes of whiplash injury.

Chiropractors are rigorously trained to diagnose the different types of neck injuries. Your chiropractor will take an extensive history and provide a comprehensive examination to determine what tissues have been injured in an accident and what spinal joints may be restricted in motion.

The goal of chiropractic care in treating whiplash injuries is to optimize motion in the spine, treat the spinal discs, reduce muscle spasm and improve muscular strength.

Chiropractors are specialists in spinal manipulation—an active, hands-on care that returns motion to the spine. The restricted motion and disturbed mechanics that characterize whiplash injuries are especially helped by spinal manipulation in patients who are considered good candidates for this approach.

How a Chiropractor Diagnoses Whiplash Injury
Even if you go to the chiropractor complaining of neck pain following an accident, he or she will evaluate your spine as a whole. The chiropractor will check your neck (cervical spine), mid-back (thoracic spine), and low back (lumbar spine). It's important to examine the entire spine because even though it's just your neck that hurts, other regions of the spine may be affected.

Your chiropractor will determine areas of restricted joint motion, disc injury, muscle spasm, and ligament injury. One way the chiropractor does that is through motion and static palpation, diagnostic techniques unique to chiropractic. Motion and static palpation is an examination by means of touch. The chiropractor will feel for tenderness, tightness, and how well each spinal joint moves.

The chiropractor will also analyze how you walk and look at your overall posture and spinal alignment. Those details will help your chiropractor understand your body mechanics and how well your spine is working and moving.

You'll also go through your past medical history with the chiropractor. Your chiropractor will have x-rays of your spine taken to evaluate possible degenerative changes, or an MRI if it is indicated.

After the examination, the chiropractor will be better able to create an effective treatment plan for your neck pain.

Possible Chiropractic Treatment Approaches for Whiplash Injuries
The exact treatment plan depends on your diagnosis. Your chiropractor may use a type of spinal manipulation, or spinal adjustment, to improve joint motion and soft tissue health.

Some spinal manipulation techniques are:

• Specific spinal manipulation: The chiropractor identifies the joints that are restricted or show abnormal motion, also called subluxations, and returns motion to the joint with a gentle thrusting technique. This gentle thrusting rapidly stretches soft tissue and stimulates the nervous system to return normal motion to the spine.
• Flexion-distraction technique: This is a gentle, non-thrusting type of manipulation used to treat bulging or herniated discs with or without arm pain. (The whiplash injury may aggravate a bulging or herniated disc.) This treatment is still hands-on, utilizing a specialized table to assist the chiropractor, but uses a slow pumping action on the disc instead of direct force.
• Instrument-assisted manipulation: This is another non-thrusting technique. Using a hand-held instrument, the chiropractor can apply force without thrusting into the spine. This is especially appropriate in older patients with degenerative joint syndrome.

The chiropractor may also use manual therapy to treat injured soft tissues such as ligaments and muscles. Some examples are:

• Trigger point therapy: The chiropractor identifies specific hypertonic (tight), painful points on a muscle. He or she puts direct pressure (using the fingers) on these points to relieve the tension.
• Manual joint stretching and resistance techniques: Muscle energy therapy, an osteopathic technique, is is an example of a resistance manual joint therapy.
• Therapeutic massage
• Instrument-assisted soft tissue therapy: The chiropractor may use Graston technique, an instrument-assisted therapy to treat the injured soft tissue. Your chiropractor will perform gentle repeated strokes of the instrument over the area of muscle injury.

In addition to spinal manipulation and manual techniques, the chiropractor may use various therapy modalities to help reduce inflammation caused by whiplash. Some examples are:

• Interferential electrical stimulation: This uses a low frequency electrical current to stimulate your muscles in order to reduce inflammation.
• Ultrasound: By increasing blood circulation, ultrasound helps reduce muscle spasms, stiffness, and pain. It does this by sending sound waves deep into your muscle tissues, creating a gentle heat that enhances circulation and heating.

To reinforce the improved joint mechanics (return of normal spinal motion), your chiropractor will prescribe therapeutic exercises.

Chiropractors are "whole person" doctors who view neck pain as unique to each patient. Therefore, they don't focus on just your neck pain. Chiropractic care includes nutrition, stress management, and lifestyle goals (because all of those can add to neck pain, so you need to address them if you really want to relieve your pain).

Chiropractors emphasize prevention as the key to long-term health—another example of chiropractors looking at the whole person, not just the painful problem. Keeping the neck and back healthy is vital to the chiropractic approach to care.

How Chiropractic Helps Patients with Whiplash Injuries
A chiropractor will help you return to your normal activities quickly so that you can enjoy your daily life without pain. He or she will work to address the underlying mechanical (how the spine moves) or neurological (nerve-related) causes of your whiplash injury.

Kamiah A. Walker
Medical Writer
SpineUniverse
Wheaton, IL

Whiplash is very treatable, and very often, the first treatment tried is a cervical brace, also known as a cervical collar. The brace will provide support to your neck as the soft tissues (muscles, ligaments, etc.) heal from the whiplash injury. Those soft tissues are supposed to help support your neck, but of course, when they're injured, they can't do their job very well. That's where the brace is very useful.
Cervical braces or collars limit movement and support your head, taking the load off your neck. This gives your muscles a chance to rest while healing. (Lying down has a similar effect.)
Your doctor will let you know how long you have to wear the brace. Generally, whiplash patients need to wear a brace for at least two to three weeks. Your doctor or a nurse will also explain how to wear the collar: how many hours every day, how to care for the collar, how to handle daily activities such as showering, etc.
Your symptoms should subside in two to three weeks, but if you still have pain, muscle soreness, or other whiplash symptoms, your doctor may have you try other treatment options.

Albert