Diagnosis

Questions about the event and your symptoms are the doctor's first step for making a diagnosis. You also may be asked to fill out a brief form that can help your doctor understand the frequency and severity of your symptoms, as well as your ability to do normal daily tasks.

Examination

During the exam your doctor will need to touch and move your head, neck and arms. He or she will also ask you to move and perform simple tasks. This examination helps your doctor determine:

  • The range of motion in your neck and shoulders
  • The degree of motion that causes pain or an increase in pain
  • Tenderness in the neck, shoulders or back
  • Reflexes, strength and sensation in your limbs

Imaging tests

Your doctor will likely order one or more imaging tests to rule out other conditions that could be causing or contributing to neck pain. These include the following tests:

  • X-rays of the neck taken from multiple angles can identify fractures, dislocations or arthritis.
  • Computerized tomography (CT) is a specialized X-ray technology that can produce multiple cross-sectional images of bone and reveal details of possible bone damage.
  • Magnetic resonance imaging (MRI) is a technology that uses radio waves and a magnetic field to produce detailed 3-D images. In addition to bone injuries, MRI scans can detect some soft tissue injuries, such as damage to the spinal cord, disks or ligaments.

Treatment

The goals of treatment are to control pain, restore normal range of motion in your neck and return you to normal activities. The course of treatment will vary depending on the severity of your whiplash injury. For some people, over-the-counter drugs and at-home care may be sufficient. Other people may need prescription drugs, specialized pain treatment or physical therapy.

Pain management

Your doctor may recommend one or more of the following treatments to lessen pain:

  • Rest. Rest may be helpful during the first 24 hours after injury, but prolonged bed rest may delay recovery.
  • Ice or heat. Apply ice or heat to the neck for 15 minutes up to six times a day.
  • Over-the-counter pain medications. Over-the-counter pain relievers, such as acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others), often can control mild to moderate whiplash pain.
  • Prescription painkillers. People with more-severe pain may benefit from short-term treatment with prescription pain relievers.
  • Muscle relaxants. These drugs may control pain and help restore normal sleep if pain prevents you from sleeping well at night.
  • Injections. An injection of lidocaine (Xylocaine) — a numbing medicine — into painful muscle areas may be used to decrease pain so that you can do physical therapy.

Exercise

Your doctor will likely prescribe a series of stretching and movement exercises to help restore range of motion in your neck and enable you to resume normal activities. You may be advised to apply moist heat or to take a warm shower before exercise. Exercises may include:

  • Rotating your neck in both directions
  • Tilting your head side to side
  • Bending your neck toward your chest
  • Rolling your shoulders

Physical therapy

Your doctor may refer you to a physical therapist if you need help learning range-of-motion exercises or if you experience chronic pain from whiplash. The therapist may introduce additional exercises to strengthen muscles, improve posture and restore normal movement. The goal is to create a customized routine that eventually you can do independently at home.

Foam collars

Soft foam cervical collars were once commonly used for whiplash injuries to hold the neck and head still. However, studies have shown that immobilizing the neck for long periods of time can decrease muscle strength and impair recovery.

Recommendations for the use of a collar vary, but use is generally restricted to no more than three hours at a time during the first week after injury, when you are experiencing more-severe pain. Your doctor may also recommend use of a collar if it helps you sleep at night.

Alternative medicine

Nontraditional therapies have been employed to treat whiplash pain, but research about the effectiveness of these treatments is limited. These alternatives include the following:

  • Acupuncture. Acupuncture is a treatment in which ultrafine needles are inserted through specific locations on your skin. This treatment may offer some relief from neck pain.
  • Chiropractic care. Chiropractic care involves the manipulation of joints. There is some evidence that this care may provide pain relief. Some research suggests that results are best when chiropractic care is paired with exercise or physical therapy. Manipulation of the spine may cause minor problems, such as numbness or dizziness, and rarely damage to spinal tissues.
  • Massage. Massage — kneading of muscles in the neck — may provide some relief of neck pain from whiplash injury.
  • Transcutaneous electrical nerve stimulation (TENS). TENS is a device that applies a mild electric current to the skin. Limited research suggests this treatment may lessen neck pain.

Preparing for your appointment

In the case of a car accident, you might receive on-site paramedic or emergency room care. But a whiplash injury may not cause symptoms immediately. If you experience neck pain and other symptoms after an injury, see your doctor or an urgent care center as soon as possible.

Be prepared to describe in detail the event that may have caused the onset of symptoms and to answer the following questions.

  • How would you rate your neck pain on a scale of 1 to 10?
  • Does movement make the pain worse?
  • What other symptoms have you experienced?
  • How long after the event did the symptoms appear?
  • Have you experienced neck pain in the past, or do you experience it regularly?
  • Have you taken any drugs or used other treatments to lessen the pain? What was the effect?
  • What medications do you take regularly, including dietary supplements and herbal medicines?
Jan. 20, 2015
References
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