Whiplash Recovery: Exercise & Advice

Neck Pain After a Car Accident

Man with whiplash

It’s been a couple of days and the pain in your neck is getting worse. You were in a car accident, hit from behind. Never mind the headache that comes from dealing with the insurance company and auto mechanic – you just want this pain to go away. Whiplash injuries are the most common injury following a car accident1,2. The good news is: a lot of the time they get better within a few weeks – and if you know what to do and what to expect, your likelihood of improving increases even more…

What Is a Whiplash Injury?

A Whiplash injury is a bony or soft-tissue injury of the neck caused by a quick acceleration followed by a quick deceleration of the neck and head3.”

These types of Whiplash injuries mostly happen after you’re rear-ended or hit from the side in a car accident.

Whiplash injuries can result in significant amounts of lost work productivity, medical care, and legal services4,5, making it one of the most costly musculoskeletal conditions to treat in the United States at roughly $29 billion dollars per year6.

Symptoms of Whiplash include:

  • Neck pain or stiffness with a loss of active range of motion
  • Headache
  • Radicular symptoms
  • Cognitive impairments7
  • Sensorimotor symptoms8:
    • Altered patters of muscle recruitment
    • Altered postural control mechanisms:

Structures in the neck that can be injured with a Whiplash injury:

  • Facet joints
  • Nerve roots
  • Ligaments
  • Cervical discs
  • Muscles15

Trigger points in the muscles of the neck and shoulders likely contribute to your pain16 following a Whiplash injury.

A trigger point is a hypersensitive spot within a taut band of muscle that refers pain to a distant location17.

Studies find that patients with Whiplash have more trigger points in the neck and shoulder muscles than normal subjects18.

The specific muscles with a higher prevalence of trigger points are:

  • Upper Trapezius
  • Suboccipitals
  • Levator Scapulae
  • Sternocleidomastoid
  • Scalenes19

The greater the number of trigger points in these patients, the greater their intensity of neck pain and higher self-reported disability. These findings suggest that active trigger points may be an important pain generator in patients with acute Whiplash20.

How Long Does Whiplash Last?

Many Whiplash patients get better with time – usually within 2 to 3 weeks of the injury21. Current research, however, is showing that about 50% of people still complain of neck pain even one year after the injury22. One study even found that 58% of patients report having symptoms 30 months after23.

How can we predict the likelihood of your recovery?

Early identification and getting the right resources for yourself can help24.

A Whiplash Clinical Prediction Rule (CPR) was created based on a tremendous amount of collected data from patients with Whiplash injuries and their recovery timelines. This CPR predicts 2 recovery pathways following injury25:

  1. Long-term moderate to severe pain and disability is predicted in individuals with:
    • A high level of self-reported disability
    • Age of 35 years or older
    • A high level of post-traumatic stress
  2. Full recovery is predicted in individuals with:
    • Age of less than 35 years
    • A low level of self-reported disability
      • Baseline NDI score of 32% or less

The greatest predictor of your outcome is how you rate your baseline pain intensity – greater than 55/100 predicts a poor outcome26,27,28,29,30.

Other predictors of a poor outcome worth mentioning are:

  • The presence of low back pain31
  • Psychological factors such as32,33,34:
    • Negative expectations
    • Catastrophizing (making things a bigger deal than they are)
    • A Passive coping style (expecting something or someone other than you to make things better)

To me, these last 3 are the most important, because they are factors that YOU can control – you’ll see how next…

What Are the Best Treatment Options for Whiplash?

If all of this talk of poor outcomes wasn’t bad enough, I’ll get the rest of the bad news out of the way now, then we can talk about the bright side…

Once a Whiplash injury becomes chronic, >3 months or so, most treatments have little to no effect35,36.

That’s why, as I stated before, it’s best to identify the problem early on and get to work.

The Best Treatment Options for Whiplash:

  1. Exercise37

Rather than having a passive coping style, you need to be active in your recovery. Being active with gentle exercise leads to better outcomes38. And, the higher your pain and disability levels, the more effective exercise is39.Good news: the exercise doesn’t have to be intense, and it doesn’t have to be sophisticated…

I usually give my Whiplash patients these few simple exercises to do regularly throughout the day:

  • Walk frequently
  • Active cervical rotations
    • Sit up straight
    • Gently and slowly rotate the head side to side in a pain-free range
  • Deep Neck Flexor endurance and coordination exercises
    • Chin tuck and hold in sitting, supine, and prone
    • Chin tuck with rotations
  • Wall Slides
    • Stand facing a wall
    • Slide both arms up and down the wall (with a towel) slowly and in a pain-free range

2. Psychological counseling40

Remember I shared with you earlier that negative expectations as well as catastrophizing tend to lead to poor outcomes following a Whiplash injury, right? You also saw that Post-traumatic stress leads to poor outcomes.For these reasons, even simple advice to improve cognitive-behavioral components can have a huge positive impact on your recovery – even equal to that of a comprehensive exercise program41.

Here are some important pieces of advice I usually share with my Whiplash patients:

  • Try to get back to your normal activities early on
  • Perform relaxation techniques
    • Deep, slow breathing
  • Stress management
  • Challenge irrational beliefs
    • Remember that 50% of Whiplash injuries improve within a few weeks. Other than age, the only differences between those who get better and those who don’t is related to self-reported disability and self-reported stress

Question: What have you found to be helpful in treating Whiplash? You can leave a comment by clicking here.

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  3. Spitzer WO, Skovron ML, Salmi LR, et al. Scientific monograph of the Quebec Task Force on whiplash-associated disorders: Redefining “whiplash” and its management. Spine 1995;20:2S-73S. ↩︎
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  8. Dall’Alba PT, Sterling MM, Treleaven JM, Edwards SL, Jull GA. Cervical range of motion discrimi- nates between asymptomatic persons and those with whiplash. Spine. 2001;26:2090-2094. ↩︎
  9. Alund M, Ledin T, Odkvist L, Larsson SE. Dy- namic posturography among patients with common neck disorders. A study of 15 cases with suspected cervical vertigo. J Vestib Res. 1993;3:383-389. ↩︎
  10. Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002;27:1835-1843; discussion 1843. ↩︎
  11. Sterling M, Jull G, Vicenzino B, Kenardy J. Sen- sory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery. Pain. 2003;104:509-517. ↩︎
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  13. Treleaven J, Jull G, Lowchoy N. Standing bal- ance in persistent whiplash: a comparison between subjects with and without dizziness. J Rehabil Med. 2005;37:224-229. http://dx.doi. org/10.1080/16501970510027989 ↩︎
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  20. Fernandez-Perez AM, et al. Muscle trigger points, pressure pain threshold, and cervical range of motion in patients with high level of disability related to acture whiplash injury. JOSPT. 2012;42(7):634-641. ↩︎
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  • I first find the dysfunctional joint. Then I mobilise it gently. Then a manipulation when the joint is ready. then apply ultrasound to the tension in the related muscle and finish off with a light massage. this is usually successful.