Whiplash is an injury, unlike other conditions that can result in neck pain it is perhaps more of a description of a mode of onset than an injury itself. The occurrence of a traumatic whiplash will cause an injury to the neck, resulting in an injury such as a herniated cervical disc, or strained ligaments in the cervical spine. In more severe cases which might warrant emergency intervention, there might be fractures and more severe damage to the cervical vertebrae themselves.
Unfortunately there are many cases where a less severe whiplash turns into a chronic neck and shoulder issue, this is what we will spend the majority of today exploring.If you have had a severe whiplash and seriously injured the cervical spine, perhaps even being rushed into surgery, this will still be relevant. That being said, our hope is to help the many who have had a whiplash and are sent home with “bruising” after being given the all clear that nothing is broken. These individuals, frequently with next to no advice or guidance on how to recover, are told that the neck and shoulder pain will “go away on its own”. The problem is, all too often 6 months, a year, or even later… The pain is still there and the neck has not recovered.
Why is this the case?
Understanding the causes of whiplash and the resultant neck pain
Whiplash describes a very specific event, it could be a car accident, it could be a fall or knock, but typically it will involve a rapid forwards and then backwards motion of the neck. The reverse can also be true. Ultimately here, we are taking a large weight, your head, on a long thin stick with little in the way of muscular development in most cases, and shaking it really hard forwards and backwards. Your head might weigh a similar amount to a bowling ball, and for many of us we simply do not develop strength in the neck to a significant degree. Having the goal of a “girthy neck” is not top on the list of the vast majority of society. It is perhaps this reason why “whiplash” or the consequences of it, neck pain, tends to affect women more frequently than men. Some reports suggest two to three times more frequent.
Injury here occurs at the extremes. As your neck bends forwards it drives pressure through the front of the vertebral bodies, and the cervical discs. At the same time the back of the vertebral disc, the ligaments on the back part of the spinal segment as well as the musculature is stretched rapidly, creating the opportunity for damage. In the opposing direction the facet joints are driven into one another and the front of the cervical discs, the anterior longitudinal ligament and the muscles on the front of the neck become rapidly stretched. Any number of these structures could become injured, to any degree during this process.
In most cases, it is only the soft tissues that fail and become strained, Many of these deeper ligamentous tissues such as the discs and the ligaments are very slow to react which often means that inflammation will take a little time to build up and perhaps it is not until the next day that you wake up in trouble.
If you’ve seen any of our lower back information you’ll know the spine has peculiarities, one of the main ones being the presence of many bony tunnels. Through these tunnels our spinal cord runs, and our spinal nerves run, leaving the spine. These tunnels offer a somewhat “fixed space” and therefore if inflammation is running rampant slowly building up in a number of areas around these holes it is akin to feeding more and more people into an elevator that’s only meant to take 10 people. As you start getting to 11, 12 and more people in the elevator, the cramped nature begins to create problems! In the case of the neck, it is the development of the symptoms that will be all too familiar.
- Stiffness in the neck with a robotic movement
- Inability to look up without pain
- Pain around the neck and shoulders
- Possibly pain into the arms and hands in certain cases
The major concern in whiplash injuries
If you’ve had a severe incident and suspected whiplash, often the first concern of the medical team is that there is some significant damage to the bone which could have serious consequences. It is only right and responsible that these cases are investigated appropriately. Often they will be looking to see if there are crush fractures of the cervical vertebral bodies on X-ray, this will have occurred when the neck went forwards. They may also be looking for evidence of pars fracture and damage to the vertebral facet joints which would have occurred during the backward phase of the whiplash. These could result in instability and a spondylolisthesis in the neck. Naturally you would want these things ruled out pretty swiftly.
Thankfully they regularly are!
However once this has been confirmed and ruled out, the system often fails the patient. Just like with back pain, a “it will heal itself” approach is all too often taken. We know there are some great teams out there that will do a great job of supporting their patients, but chances are if you’re still reading this, you didn’t see such a team.
The hidden issue most whiplash sufferers have to contend with
As you can imagine, in the absence of the “serious damage” there is still often significant soft tissue damage, an understanding of how to move forwards here with good guidance can make all the difference in helping you recover smoothly from your whiplash injury.
The ligaments in your neck provide a degree of passive tension through the cervical vertebra, as well as into the thoracic spine and up to the skull. Good neck functioning is predicated on this innate “tension” being present. The muscles then pull the “neck” in one direction or another, naturally the “neck”, a series of vertebral blocks held together by these ligaments then smoothly unwinds in one direction or another. The key here is smoothly, equally, as designed.
Following whiplash, if the ligamentous integrity of a particular region has been compromised, say the C5,C6 junction, when the neck moves in certain directions the lack of tension at that level creates a focal point for future stresses. The neck no longer unwinds one way or other equally. Often there is a degree of instability, shearing instead of bending can also occur in the immediate aftermath of the injury.
Just like if you’d sprained an ankle, wrist or finger joint’s ligaments, the movement that ligament was protecting would become more “possible” for a period while the ligament heals. With joints outside the spine we can offer support during this short term window to give the ligaments time for a clot to form, scar tissue to lay down and the “tightening back up” to take place. In the neck and spine in general this is not possible, and even if it was, would come with serious downsides, such as the build up of inflammation in those tunnels we mentioned earlier.
This instability is one of the features that allows for the perpetuation of the problem, failure to help stability become restored in the first instance is the main issue. As we’ll get onto later, you’ll find all too often the little exercise guidance we are given, plus daily life activities make it so easy to fall into the trap of helping the instability from the whiplash injury get worse.
Why some whiplash sufferers have a harder time than others
It is worth mentioning this ahead of the next section, structurally your neck should have a smooth backward bending C-shaped curve to it. In the example of the movements of the neck we discussed earlier, the unwinding can happen nice and smoothly, even if a whiplash is occurring.
With modern technology, more and more of us are finding ourselves looking down regularly for long periods of time. This has an effect over time of changing the cervical alignment. Although we cannot point to specific research, over the years of seeing patients in our clinic with the consequences of whiplash, chronic neck issues, one thing was common to all of them. There was an absence of a normal neck curve, and in the majority of cases, there was either a straight neck or more worryingly a forward bending neck, often with a noticeable hinge point. For context in the case of the reversal of the neck curve, imagine how you would feel if you knee bent backwards instead of forwards. The supporting structures of the entire system are not built to function effectively in that reversed position. It is a problem.
It is difficult to know if the neck of these who were suffering most with the chronic result of neck pain had the significant cervical spine changes before their whiplash or as a consequence of the poor management after. One thing is clear however, it was a challenge. Having a hinge point in a series of stacked vertebra means that any time you bend one way or another that particular joint, and associated disc is under dramatically more strain than everything else. This makes it very difficult, not impossible, to recover. This is also one of the reasons a thorough examination and imaging can be so insightful in cases of long standing consequences of whiplash. Imaging must be under load bearing however, an MRI in a tube lying down creates distortions and does not give a view of the effectiveness of the cervical spine to bear load. Although it is on the lower back, a recent podcast episode on choice between MRI and X-Ray will be of relevance for “further reading”.
The main things stopping your whiplash from getting better
There are two major areas which prevent people from recovering after a whiplash event. These combine unfortunately to reinforce one another, making for a “perfect storm” to help a whiplash injury turn chronic.
How modern life is making your whiplash worse
We all spend way too much time on smartphones, and to be completely candid, if it wasn’t smartphones, it would have been books. Evenings spent on the sofa scrolling through social media with your head propped up at 90 degrees are terrible. Constantly looking down while out, or sitting with your head looking down again at 90 degrees all serve as habits that are so pervasive. Think about how often you’re checking your smartphone, and how often you spend your evenings in such positions.
This is made worse by anatomy. The tunnels in the spine we mentioned earlier can be made larger in one way. Forward bending of the neck. So for many with inflammation in the neck, the position that feels best is the above positions. Forward bending in the neck. The big issue with this is that the ligaments that have been damaged on the back of the spine are now being pulled apart at a time they want to “knit back together” and “stiffen up”. Going back to the example of the finger sprain. If you have sprained the ligaments that hold your finger straight, you would not dream of holding the finger bent to the side for extended and repeated periods, you would want the finger to be in a “neutral position” i.e. straight, not deviating left and right. With the neck it is no different, you want to be in that neutral C-shaped position, not looking at the ceiling in “extension” but not in “flexion” looking at the floor either! The issue is that looking at the floor often feels good! Stretching the muscles on the back of the neck “feels good”… At the time. But it is making your neck worse, slowly, which brings us to the next point.
The exercises people with whiplash gravitate to
If you are among the “self starters” you’ve probably tried to be productive, seeking out exercises and stretches to help: chin tucks, trapezius stretches, chin to chest stretches, the list goes on. Just as knee hugs and child’s pose are the popular stretches in the lower back, exactly the same terrible mistake is made in the neck too!
You spend all your day in the positions mentioned above with the neck flexed, then for good measure, a dose of more flexion and flattening of the neck is added. No wonder the neck is not getting better!
Understand that if you are one of the ones with a more significant misalignment of the neck, mentioned earlier, the consequences of such incorrect actions are simply more pronounced than in the individual who had normal alignment at the time of their whiplash. Either way, know this. From our experience with spinal remodeling, that is changing the alignment in the neck, 20 minutes of a practice, daily, for 3 to 4 months is enough to make a positive change of around 25% improvement in the curve in a healthy but misaligned neck.
Only 20 minutes a day.
Now think about the soft tissue injury you might have had after your whiplash, and the amount of time each day, you spend forward bending your neck continuously. If you didn’t have neck alignment issues before your whiplash, it is easy to see how the pain and frustration could drive you to more and more forward bending that ultimately has an impact on the cervical alignment when you stop the stretches and peculiar positions.
5 Strategies for the recovery of whiplash
We spend so much of our time highlighting all the areas of error before because if you are not aware of the many ways you’re making things worse, even when doing the right activities, you will have limited results. You must fully embrace the understanding of your neck. From there you can see how and why you must do the activities to fix the neck pain, and why they work.
Now, we’ll get into the 5 strategies that can help you improve your neck health and start to undo the damage from the whiplash itself, as well as the actions that you might have taken following it.
Understand your neck posture and alignment.
A simple test of standing with your head, back bum and heels against the wall will quickly reveal any postural issues that might be present. Often with more severe neck pain from whiplash it is difficult at first to get the head back against the wall without pain. Do not force it, just take note to begin with. Try working on adopting a “closer to vertically aligned” position than you currently are, all the time. Yes this will be robotic and require concentration in the short term, but long term it will pay off.
Posture is the observation of the surface markers, these we can see, but the alignment is deeper, the neck should have the backward bending C-shape to it and this is important for normal functioning. Supporting this natural position will be of paramount importance. If you have significant alignment issues or are concerned you might, you’ll need imaging to be assessed to know for sure. If you are uncertain regarding this, you can always reach out to the Back In Shape Team.
How you hold your head dictates the forces that travel through it and whether they are exaggerated or minimized, as a general rule the further away from center you are, the more load you’ll be placing on the structure. Considering there is damage in your neck when you have a whiplash injury, unnecessary load amplification is a bad idea!
Avoid actions that will make your neck worse
This is very important, think about the damage in your neck specifically. You might think tucking your chin to your chest feels nice, by now in the article you should understand, academically, that that is making your neck worse. Rapid movements in the short term, extreme ranges of motion in the short term are not helpful. Unnecessary loading, for example, wearing a heavy helmet at work might be a part of your uniform, working to adjust this necessity might be a sensible option, particularly in the early days.
Other examples could include using heat over the neck, which will drive more fluid and circulation to the area, feeling nice, but this will often have the delayed effect of filling the bony tunnels mentioned earlier, therefore resulting in a symptom spike later and a return to the hot water bottle or chin-to-chest stretch to try to alleviate the neck pain.
You can see how one wrong action for short term relief can lead to a cascade of actions that ultimately might offer short term relief, but are making your neck worse.
Take pressure off your neck by supporting normal
Our favorite neck health exercise, just like the lower back, is the towel stretch. Why is this a good stretch for you if you have neck pain from whiplash?
- It puts your neck in the best possible position, gently supporting the natural lordosis of the neck and neutral alignment.
- In doing so it takes pressure of your cervical discs
- Takes stretch off the ligaments that have likely been stretched out
- Takes the load off the muscles that have equally been stretched out
In short, it does the exact opposite of the “mode of injury” and almost the opposite of the exercises so commonly recommended. It’s important to clarify, the exact opposite would be full range extension, which is NOT what the towel stretch does.
Strengthen your neck for the future
Although you might not begin this action immediately, steadily feeding in the presence of strengthening work, helping you learn to maintain neutral and a centered neck posture will be vital for your long term neck health. This can be done easily with resistance bands which offers you a mechanism for progression. SImply pressing against your hand or a wall is not good enough if you’re taking your progression seriously.
Remember, quite often you will find that your neck instability makes these things challenging, this is why a gentle introduction of resistance, and then a steady progression over weeks and months is infinitely better than trying to do things in the course of days.
Time is a healer for you neck pain
Ultimately your body has been trying to heal, but the actions you’ve likely been taking have been getting in the way of this healing process. Coming this far through the article we hope some light bulbs have gone off already and you can cease some of the bad practices, it will be hard at times but it works. The deeper structures of the neck that we’ve been talking about today that give rise to the muscle spasm and soreness so commonly associated with neck pain take a longer time to heal than muscle or skin tissue. They have a less adequate blood supply. So know that your symptoms may start to abate faster than anticipated when you cut out the bad, and start doing the right exercises. But the vulnerability will take time to mend and patch up.
The good news is there is a lot you can do, and with time you’ll start to feel strength, stability and freedom of movement return to your neck, without pain!
If you have been struggling for a while with whiplash and the terrible neck pain it can cause, do check out the full neck program recently released, with over 50 video segments, exercises, stretching instructions and a programmatic progression you can follow, it will remove the doubt and get you the neck pain relief you’ve been looking for. You can check it out here and get started immediately with practices that will help you finally be rid of neck pain.