Whiplash Injuries Can Be Deceptive

Posted on Wed., Feb. 4, 2009
By Stephen Daniels, MD

ALTHOUGH THE ACCIDENT was frightening — Karl wa s rear-ended by a drunken driver traveling over 50 mph on a residential street — he walked away feeling physically fine.

The paramedics had checked him out, and said he appeared not to have been injured, even though the rear half of his small car had been demolished by the SUV. Despite being emotionally shaken, he caught a taxi and continued on to work.

The next morning, though, he could barely get out of bed. His neck, head and back hurt so much that even turning over or getting up to the bathroom caused agonizing pain. He thought he must have broken his neck, and not realized it in the excitement of moment. What else could cause such pain?

When he came to my office on the third day following the accident, Karl was worse. He could barely move. He held his head and shoulders stiffly, and winced with each movement. He and his wife were sure he had broken his neck. An X-ray showed soft tissue swelling, but no fracture. By the time Karl got the X-ray results, he was feeling much better, thanks to the medicine and therapy.

The best way to treat a whiplash injury is as follows:

First realize that whiplash injuries, in which there is relatively little pain or even discomfort immediately following the accident, can worsen for days or even weeks after the accident. That is, the pain may not start until hours or even 3-4 days after the accident, and may continue to worsen for up to 2-3 weeks. Generally, the quicker the onset and the worse the pain, the longer it will take to resolve — even 3-4 months or longer.
Although resting is good, because moving is painful, too much rest can cause the pain and stiffness to worsen. So, slow, gentle movement in all directions for 5 minutes every hour will hasten recovery and result in less pain in the long run.
Both heat and/or cold can be helpful. A heating pad over a moist towel applied to the painful area, or ice cubes in a zip lock bag wrapped in a thin towel, can bring dramatic relief. Alternating heat and cold may give the best relief.
Since the pain from whiplash is thought to be from a combination of small partial tears in the soft tissues, muscle spasm and inflammation, therapy directed at these can be helpful. Muscle relaxants (e.g., Flexeril, Baclofen, Robaxin, Soma) and anti-inflammatory medicines (e.g., Motrin, Aleve, Naprosyn, Celebrex) can provide dramatic relief. In severe cases, narcotic pain relievers such as codeine, Vicodin and Percocet may be necessary. If numbness, weakness or tingling develop, call your doctor immediately.
Many doctors prescribe a "soft collar" which is a wide firm yet spongy belt that wraps around the neck and supports the chin. In general they should not be used for more than a week, and should be removed every hour for 5 minutes, so the neck can be gently moved in all directions.
Be aware that in the long run persistent anxiety or depression from the accident experience may cause more debility than the physical damage. Talk to your doctor about this.

Daniels practices family medicine at the Pittsburg and Concord Health Centers, parts of Contra Costa Health Services, the county health department.