Whiplash injury

Whiplash injury (from English whiplash — whip strike, where whip — a whip and lash — strike) is a complex non-structural damage to the soft tissues of the cervical spine.

The injury occurs due to a sharp, forced, and uncontrolled movement of the head, the biomechanics of which resemble a whip crack.

Etiology and pathophysiology

The vast majority of cases are associated with car accidents, particularly rear-end collisions. The inertia of the body, tightly secured by the seat belt, causes the torso to move forward with the seat. The heavy head initially accelerates backward and then reflexively jerks forward.

In the hyperextension phase, there is overstretching or micro-tearing of the anterior neck muscles, damage to the anterior longitudinal ligament, and fascia. In the sudden flexion phase, injury occurs to the posterior ligamentous complexes, intervertebral joint capsules, and occipital muscles. The bone structures themselves are usually not affected.

Clinical severity is determined not only by the mechanical damage to tissues but also by the acute reaction of the central nervous system to abnormal proprioceptive impulses from damaged joint capsules.

Clinical significance

A deceptive feature of the pathology is the presence of a peculiar ‘lucid interval.’ At the time of the collision, the patient may not feel pain due to a powerful adrenaline rush; however, hours later, a progressively developing pain syndrome occurs, caused by edema and aseptic inflammation.

The clinical picture consists of pronounced neck stiffness, pain radiating to the occiput and shoulder girdle, as well as dizziness and rapid fatigue.

Diagnosis is made exclusively by exclusion. To confirm a whiplash injury, the physician must ensure the absence of bone fractures and herniated intervertebral discs through instrumental methods. The main problem is the high risk of pain progressing to a chronic form.