What's happening to the neck
When hit from behind, the torso sharply shifts forward along with the seat, and the head, by inertia, remains in place and tilts back, after which it rushes forward. The cervical spine goes through a range of motion in a split second that it was not prepared for. Muscles and ligaments are stretched and torn, the capsules of the facet joints are injured - they are considered the main source of persistent pain. The spinal cord is most often not affected. A headrest installed at the level of the back of the head significantly reduces the severity of the injury, while one lowered low, on the contrary, increases hyperextension.
- Sharp hyperextension followed by flexion of the neck
- Tears of muscles and ligaments of the cervical spine
- Damage to the capsules of small joints of the spine
- Swelling and reflex muscle spasm
- Bones and spinal cord are usually not damaged
- The severity depends on the position of the headrest and the preparedness for impact.
Symptoms and their timing
Immediately after the incident, the person often does not feel anything due to the release of adrenaline. Pain and stiffness in the neck appear after a few hours, reaching a maximum on the second or third day. The pain may radiate to the back of the head, the shoulder girdle and between the shoulder blades; turns and tilts of the head are limited. Often accompanied by a headache from the back of the head, dizziness, tinnitus, difficulty concentrating, sleep disturbance and anxiety. These complaints are real and understandable, but do not indicate brain damage. Numbness and weakness in the hands require a separate evaluation by a neurologist.
- Neck pain and stiffness 6–48 hours after injury
- Limiting head turns and tilts
- Headache from the back of the head
- Pain in the shoulder girdles and between the shoulder blades
- Dizziness, tinnitus, difficulty concentrating
- Sleep disturbance and increased anxiety
Diagnostics
The doctor examines the neck, checks the neurological status and assesses the need for imaging according to generally accepted clinical rules: an X-ray or CT scan is needed for severe pain in the midline of the spine, neurological impairment, severe mechanism of injury, age over 65 years, intoxication or inability to adequately assess the condition. If the risk is low, imaging is not required and will only delay the start of treatment. MRI is indicated for nerve root and spinal cord symptoms, and functional imaging is indicated for suspected instability, usually not in the acute setting.
- Examination and assessment of fracture risk using clinical criteria
- X-ray of the cervical spine in two projections
- CT scan if there is a high risk of bone damage
- MRI for numbness, weakness and persistent pain
- Functional films if instability is suspected
- Neurological examination over time
Treatment
The modern approach is simple: stay active and move your neck early. A soft collar is permissible only for the first day or two and only to relieve pain; Prolonged wear weakens muscles, increases stiffness and prolongs recovery. Heat, short-course painkillers prescribed by a doctor, light exercises for turning and bending in a painless range, and a gradual return to work and usual activities help. Massage, chiropractic care, and physical therapy can provide relief as an addition to exercise. Information is also important: understanding that there is no serious damage actually reduces the intensity of pain.
- Maintaining daily activity from the first days
- Soft collar for no more than 1–2 days for severe pain
- Short course pain relief as prescribed by a doctor
- Exercises for turning and tilting the head several times a day
- Warmth on the neck and shoulder muscles
- Gradual return to work and driving
Prognosis and what to do with prolonged pain
Most people recover fully in two to eight weeks. For some patients, the pain and stiffness persist longer—this is called chronic whiplash syndrome. Factors of a protracted course are considered to be very severe pain in the first days, widespread pain, severe anxiety and expectation of an unfavorable outcome, as well as prolonged immobilization. If there is no improvement after 6-8 weeks, a structured program of physical therapy, work with a pain doctor and, if necessary, psychological support are included. The key principle at any stage is not to avoid movement out of fear.
- Recovery usually takes 2–8 weeks
- Early movement improves prognosis
- Wearing a collar for a long time worsens the outcome
- Structured exercise therapy for persistent pain
- Working with anxiety and fear of movement
- Re-examination if neurological symptoms appear