Use Physical Therapy to Recover From Whiplash

Whiplash is primarily a neck injury that occurs when your head is thrown backwards (hyperextension) and then forward (hyperflexion) in violent fashion. Ligaments, muscles and tendons are injured mostly, but also nerves and spinal joints in severe cases. Whiplash is often a consequence of rear-end collisions in a car or from being hit playing sports (such as football or hockey). Common signs and symptoms of whiplash include neck pain and inflammation, reduced neck motion, weakened neck muscles, pain and weakness in the shoulders / arms, headaches and dizziness. There are various forms of physical therapy that are helpful for whiplash recovery.

Steps

Seeking Medical Attention First

1. See your family doctor. You should seek medical attention immediately after a whiplash injury. A complicating factor is that the pain and disability of whiplash can take a day or even a week to fully manifest, but see your family physician soon after any major trauma to your head and neck in order to rule out life-threatening injuries (fractures, dislocations, internal bleeding).
   • Your doctor will likely take an x-ray of your neck (cervical spine) to rule out obvious fractures or dislocations of the vertebrae or facet joints.
   • If you're in severe pain and having difficulty holding your head up, then you may be given a foam neck support collar for short-term use. However, research has shown that wearing a stiff cervical collar for much more than a few days can cause neck muscles to atrophy (weaken) and prolong pain.
2. Make sure your neck is stable. Your family doctor is not a musculoskeletal specialist, so if your neck feels severely injured then you may need to see a specialist for a second opinion. A specialist such as an orthopedist may take more x-rays, an MRI or a CT scan of your neck / head to better understand and diagnose your whiplash injury.
   • In addition to bone injuries, MRI can detect soft tissue injuries, such as spinal cord damage, herniated disks or torn ligaments.
   • Before starting physical therapy your doctor(s) need to determine if your neck is structurally intact, physiologically stable and able to safely withstand stretching and exercising.
   • Sharp or burning pain combined with grinding sounds with movements, shooting pains into your arms and severe dizziness are signs suggesting neck instability.
3. Control the pain and inflammation. Before you start to stretch and exercise your neck, you need to reduce the inflammation and pain. Your doctor may recommend non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen or naproxen for short-term use, although if your pain is severe, you might get a prescription for something stronger — typically an opioid, such as oxycodone.
   • Alternatively, you can try over-the-counter analgesics such as acetaminophen (Tylenol) or muscle relaxants (such as cyclobenzaprine) for your neck pain, but never take them concurrently with NSAIDs.
   • Keep in mind that these medications can be hard on your stomach, kidneys and liver, so it's best not to use them for more than 2 weeks at a stretch.
   • The application of ice is an effective treatment for essentially all acute musculoskeletal injuries, including neck pain. Cold therapy should be applied to the most tender part of your neck for 15-20 minutes every 2-3 hours in order to reduce the swelling and pain.
   • Always wrap ice or frozen gel packs in a thin towel in order to prevent frostbite on your skin.

Receiving Physiotherapy

1. Get a referral to a physiotherapist. If you doctor or specialist thinks your neck is stable enough to handle the rigors of physiotherapy, then start as soon as you can. People who keep moving their necks in some capacity (even just basic stretches and mobilizations) have a better prognosis with their whiplash injuries. Your physiotherapist will assess your neck and then develop a recovery plan that includes specific and tailored stretches and strengthening exercises.
   • With a referral / prescription from your doctor, physiotherapy is usually covered by private health insurance.
   • For pain control, a physiotherapist can use a TENS (transcutaneous electrical nerve stimulation) unit or therapeutic ultrasound on your neck and shoulders.
   • If need be, a physiotherapist can stimulate, contract and strengthen your neck and shoulder muscles with an electronic muscle stimulation device.
2. Start with neck stretches and mobilizations. Injured muscles and tendons quickly become tight and spasm. As soon as you can after your whiplash injury, and within pain tolerance, start stretching the muscles of the front, back and sides of your neck in order to keep them pliable. Additionally, slowly moving your neck in all directions (mobilizations) keeps the muscles flexible and prevents the spinal joints from getting too stiff. Use slow, steady movements and take deep breaths during your stretches. In general, hold stretches for about 30 seconds and repeat three to five times daily.
   • Lateral neck muscle stretch: while standing, reach around your back with your right arm and grab a little above your left wrist. Gently pull on your left wrist while laterally flexing your neck in the opposite direction, such that your right ear approaches your right shoulder. Hold for 30 seconds, then do the other side.
   • General neck mobilization: start with moving your head in circles, first clockwise and then counterclockwise, for about five to 10 minutes each way.
   • Target the main movements of your neck: forward flexion (looking down at your toes), lateral flexion (ear towards your shoulders) and extension (looking up towards the sky). Go as far as you can in each of the four directions about 10 times daily.
   • Its important to remember not to stretch into the range of motion that causes pain. If you feel pain, slightly bring your neck back until you no longer feel pain. That will be the furthest position you will need to reach for your stretching. By stretching in a pain-free range, there is less chance of irritating the injured muscle tissue, ligaments and joints.
3. Progress to isometric strengthening exercises. Once the pain and inflammation in your neck has settled down and you've reestablished good range of motion from stretching, it's time to start strengthening exercises. It’s best to begin your strengthening with isometric exercises.
   • Keep your head in a neutral position and bring your right hand up to your right cheek. Turn your eyes slightly to the right and attempt to gently turn your head to the right, while applying just enough resistance with your right hand to prevent your head from moving. You should only apply 5 to 10% of total effort when trying to turn your neck. Repeat this five times.
   • Next, place your right hand to the right side of the head. Now attempt to laterally flex the head to the right, as if trying to touch your ear to your right shoulder. Again, apply just enough resistance to prevent your head from moving (5 to 10% of total effort).
   • Bring your right hand and place it on the front of your head at the forehead area. Try to bring your head forward and flexing down, but apply just enough pressure with your right hand so that your head does not move.
   • Bring your right hand behind your head. Try extending your head, with just enough resistance (5 to 10%) so your head doesn’t move.
   • Repeat all the exercises again by using your left hand over the left side of your head. Perform this exercise three times per week.
4. Try other strengthening exercises using equipment. You can strengthen your neck using exercise bands, which are usually color coded to represent different levels of tension. You may also consider newer technology, such as a multi-cervical unit.
   • Tie the least resistive elastic band around your head and attach it to something stable that's at the level of your head. Walk a few steps away from it until you feel tension in the exercise band. Then do the four main neck movements (flexion, extension, right / left lateral flexion) under tension ten times each on a daily basis. After a week or so, change to a thicker exercise band with more tension.
   • Advance to treatment with a multi-cervical unit. This fairly-new type of machine allows a whiplash patient to sit in a machine and attach their head to a small set of weights. Starting with light weights, you can move your neck as instructed by the physiotherapist in order to strengthen the various muscles in your neck.

Receiving Other Physical Treatments

1. See a chiropractor or osteopath. Chiropractors and osteopaths are spinal specialists who focus on establishing normal motion and function of the small spinal joints that connect the vertebrae, called spinal facet joints. Manual joint manipulation, also called an adjustment, can be used to unjam or reposition facet joints that are slightly misaligned due to a whiplash injury. You can often hear a "popping" sound with a neck adjustment. Traction techniques may also help reestablish the normal curvature (lordosis) of your neck and reduce pain.
   • Misaligned upper neck (cervical) facet joints greatly inhibit the ability to rotate your head and contribute to dizziness and headache symptoms.
   • Although a single spinal adjustment can sometimes completely relieve your neck issue, more than likely it will take 3-5 treatments to notice significant results.
   • In addition to chiropractors and osteopaths, some physiotherapists also use manual adjusting techniques for spinal and peripheral joints.
2. Get a deep tissue massage from a massage therapist. Whiplash injuries often involve significant ligament sprains and muscle / tendon strains, which leads to inflammation and spasm. A deep tissue massage is helpful because it reduces muscle spasm, combats inflammation and promotes relaxation. Start with a 30 minute neck massage, focusing also on your shoulders and muscles at the base of your skull (suboccipitals). Allow the therapist to go as deep as you can tolerate without wincing.
   • Tight suboccipital muscles can trigger severe head pain called cervicogenic headaches.
   • Always drink lots of water immediately following a massage in order to flush out inflammatory by-products and lactic acid from your body. Failure to do so might cause a dull headache or mild nausea.
3. Consider acupuncture. Acupuncture involves sticking very thin needles into specific energy points within the skin / muscle in efforts to reduce pain and inflammation and to potentially stimulate healing. Acupuncture is not commonly recommended for whiplash recovery and should only be considered as a secondary option, but anecdotal reports suggest it can be very helpful for relieving pain and restoring mobility. It's worth a try if your budget allows for it.
   • Based on the principles of traditional Chinese medicine, acupuncture reduces pain and inflammation by releasing a variety of substances including endorphins and serotonin.
   • Acupuncture is practiced by a variety of health professionals including some physicians, chiropractors, physical therapists, naturopaths and massage therapists — whoever you choose should be certified by NCCAOM.
4. Consider infrared therapy. The use of low-energy light waves (infrared) is known to be able to speed up the healing of injuries, decrease pain and decrease inflammation. Use of infrared radiation (either through a hand-held device or within a special sauna) is believed to penetrate deep into the body and improve circulation because it creates heat and dilates blood vessels.
   • In most cases, significant pain reduction can start within hours after the first infrared treatment.
   • Pain reduction is often long lasting, weeks or even months.
   • Practitioners most likely to use infrared therapy include some physical therapists, chiropractors, osteopaths and massage therapists.

Tips

• Since your body is under stress from the whiplash injury, a well-balanced diet along with possible vitamin and mineral supplementation is a great strategy for a quick recovery.
• Avoid carrying bags that distribute weight unevenly across your shoulders and strain your neck, like single-strap messenger bags or purses. Instead, use a bag with wheels or a two-shoulder backpack with padded straps.
• Practice better posture at work and at home. Sit up straight and don't slouch or lean to one side excessively.
• Abstain from smoking because it impairs blood flow, resulting in oxygen and nutrient deprivation to muscles and other tissues.

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Sources and Citations

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