Whiplash - Definition, Signs and Treatment

Dr. Silverman. How does treatment of whiplash as a pain management doctor differ from a chiropractor's treatment of whiplash?

Whiplash is an injury to the neck where your head is suddenly forced into flexion and then extension; your head whips forward and whips backwards causing neck and or back pain. This happens often in car accidents. We see cases like this often in pain management clinics. People will typically have neck pain and often have headaches after a whiplash incident. If it is serious enough they can have arm pain or numbness. Whiplash is really a very old or generic term for an 'injury to the neck'. The term comes from the days of the horse and buggy.

What happens during whiplash?

It depends on how severe the incident is but a lot of whiplash consists of soft tissue industry, muscle spasm, muscle injury even tendon tears . Sometimes the underlying structures can be injured during whiplash. For example, the facet joints between the cervical spine can actually be seriously damaged during a whiplash injury. Medical researchers have conducted studies, dissections on people who have died in serious car accidents and the researchers found hemorrhaging inside their facet joints. So the facet joints between the cervical spine can emanate pain and be pain generators.

Tissue and Nerve Damage

There are also the tissues between the vertebra or the discs. These tissues can herniate and can compress nerves or release chemicals that are inside the discs and be very irritating. So you have different areas of the cervical spine that can be effected. Furthermore, the cervical spine is much more innervated than the lumbar spine, in terms of nerves, it is a very sensitive area. Your head, your neck and your face are very sensitive. Muscles in your neck can actually be damaged and go into spasm and they can squeeze the nerves inside of them, causing neck pain.

Occipital neuralgia

There is a symptom called occipital neuralgia where the occipital nerves go through the muscles to the head and if those muscles are in spasm they will squeeze those nerves and that will give you what's called an occipital headache or occipital neuralgia. Occipital neuralgia consists of pain emanating from the back of the skull, radiating all the way up and if you press on the back of the skull pain shoots up all they way up. We typically treat this type of condition with nerve blocks.

What is the treatment for whiplash?

Starting with the easy to the more complicated, first of all there is diagnosis. As a pain management physician, we start with a complete neurological exam. You must make certain there is not a serious neurological injury prior to treatment. Serious neurological injuries are fractures, spinal cord compressions from herniated discs or broken bones. A physical exam that doesn't reveal a significant neurological deficit is pretty good sign. If this is the case, then the treatment for whiplash initially can consist of anti inflammatory medicines, steroids, muscle relaxers and analgesics.

More Serious Whiplash

Often what happens with whiplash however is that after a while a person's pain begins to 'declare' itself. After a few days, the person starts to have arm pain or numbness in one or two fingers radiating out like sciatica of the arm. At that point, as a pain management doctor, we start thinking about herniated discs or nerve injury and the patient would likely need to be imaged with an MRI right away. If the MRI shows that the person does in fact have a herniated disc and a pinched nerve, the treatment is elevated to a completely different level. The treatment of herniated discs and radiculopathy, cervical radiculopathy is typically treated with epidural injections.

Silver Lining Medical Consultants offers consulting relating to whiplash and pain management as well as expert medical witness services on these topics in South Florida and around the United States.