Whiplash (Cervical Strain/Sprain)

Also known as: Whiplash-associated disorder, WAD (whiplash-associated disorder), Cervical strain, Cervical sprain, Neck sprain, Neck strain

Last updated: December 18, 2024

Whiplash (cervical strain/sprain) describes a neck injury pattern from rapid acceleration–deceleration forces that move the head and neck back-and-forth beyond typical ranges. It can strain muscles and tendons and sprain ligaments, irritating facet joints and nearby soft tissues. Symptoms often begin within hours to days and include neck pain, stiffness with reduced motion, and headache. Many cases improve over days to weeks.

Key Facts

•Whiplash (cervical strain/sprain) describe a neck injury pattern caused by rapid acceleration-deceleration forces that move the head and neck back-and-forth beyond typical physiologic ranges
•Neck pain that range from aching to sharp discomfort and worsens with movement or sustained posture
•Diagnosed through history, physical exam, and imaging
•First-line treatment includes exercise, weight management, and activity modification

What It Is

Whiplash (cervical strain/sprain) may describe a neck injury pattern caused by rapid acceleration-deceleration forces that can move the head and neck back-and-forth beyond typical physiologic ranges. The mechanism can strain cervical muscles and tendons and can sprain cervical ligaments, with associated irritation of facet (zygapophyseal) joints and surrounding soft tissues. Symptoms often begin within hours to days and can include pain, stiffness, and headache, sometimes with neurologic-type complaints such as tingling that may reflect nerve irritation rather than structural nerve damage. The condition is typically diagnosed clinically, while imaging may be used to evaluate for fracture, dislocation, or other injuries when red flags or high-risk mechanisms are present.

Affected Anatomy

This condition affects several structures in and around the joint:

•Cervical paraspinal muscles (including splenius capitis/cervicis and semispinalis cervicis)
•Upper trapezius and levator scapulae muscles
•Cervical interspinous and supraspinous ligaments
•Facet (zygapophyseal) joints and their joint capsules (commonly C2–C3 and C5–C6 levels)
•Cervical intervertebral discs (annulus fibrosus) and adjacent endplates
•Cervical nerve roots and dorsal root ganglia (irritation may contribute to radiating symptoms)
•Vertebral arteries (rarely, high-energy trauma can be associated with vascular injury concerns)
•Temporomandibular region and suboccipital soft tissues (may contribute to headache and jaw discomfort)

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

•Neck pain that may range from aching to sharp discomfort and can worsen with movement or sustained posture
•Neck stiffness and reduced cervical range of motion, often most noticeable with rotation or extension
•Headache that often begins in the occipital region and can radiate toward the temples (cervicogenic pattern)
•Shoulder or upper back pain that may reflect muscle strain or referred pain from cervical structures
•Tingling, numbness, or burning sensations in the arm or hand that can suggest nerve irritation, typically without objective weakness
•Dizziness or a sense of unsteadiness that can occur after neck trauma and may be multifactorial
•Jaw pain or facial discomfort that can occur alongside neck symptoms, sometimes with temporomandibular involvement
•Fatigue, sleep disturbance, or difficulty concentrating that can accompany persistent pain and stress responses

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

•Motor vehicle collisions, particularly rear-end impacts, that can generate rapid acceleration-deceleration forces across the cervical spine
•Sports-related impacts (for example, contact sports) that can produce sudden neck hyperextension and hyperflexion
•Falls or sudden jolts that can transmit force through the head and neck, sometimes with rotational components
•Physical assault or other blunt trauma that can rapidly move the head relative to the torso
•High-energy trauma mechanisms that can be associated with additional injuries, where whiplash-type soft-tissue injury can occur alongside fractures or dislocations

Risk Factors

•Rear-end collision exposure and higher crash severity, which can increase the likelihood of soft-tissue neck injury
•Poor head restraint positioning or inadequate seat/headrest geometry, which can allow greater head excursion
•Pre-existing neck pain, prior cervical injury, or degenerative cervical changes that can lower tolerance to sudden loading
•Female sex, which is often associated with higher reported whiplash-associated symptoms in observational studies
•Older age, which can be associated with reduced tissue elasticity and coexisting cervical spondylosis
•High initial pain intensity or early widespread symptoms, which can be associated with a higher risk of prolonged recovery
•Psychological stress, anxiety, or catastrophizing features, which can influence symptom persistence and disability reporting
•Occupational or lifestyle factors involving prolonged static neck posture (for example, extended screen use), which can amplify post-injury discomfort

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

•Clinical history focusing on mechanism of injury, timing of symptom onset, pain distribution, and associated symptoms such as headache, dizziness, or arm paresthesias
•Physical examination including cervical range of motion assessment, palpation for soft-tissue tenderness, evaluation of muscle spasm, and assessment of posture and movement patterns
•Neurologic examination including strength, sensation, and reflex testing to evaluate for possible radiculopathy or myelopathy features
•Use of clinical decision rules (such as NEXUS criteria or the Canadian C-Spine Rule) to help determine when cervical spine imaging may be indicated after trauma
•Plain radiographs (X-rays) of the cervical spine, which can be used to evaluate alignment and screen for fracture in appropriate clinical contexts
•Computed tomography (CT), which can provide more sensitive evaluation for cervical fractures when higher-risk trauma features are present
•Magnetic resonance imaging (MRI), which can be used when there is concern for soft-tissue injury, disc pathology, spinal cord involvement, or persistent neurologic symptoms

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

•Activity modification with gradual return to usual activities as tolerated, which can support function while symptoms improve
•Early, guided range-of-motion and mobility exercises, often used to reduce stiffness and support recovery
•Short-term muscle relaxants in selected cases, which can be used when muscle spasm is prominent, recognizing variable benefit and potential side effects

Physical Therapy and Exercise

•Physical therapy approaches that can include manual therapy, stretching, strengthening of deep neck flexors and scapular stabilizers, and posture/movement retraining
•Heat or cold modalities, which can be used for short-term symptom relief in some individuals
•Multidisciplinary rehabilitation for prolonged symptoms, which can include education, graded activity, and psychological approaches (for example, cognitive behavioral strategies) to address pain-related disability

Medications

•Analgesic medications such as acetaminophen, which may reduce pain and support participation in rehabilitation activities
•Nonsteroidal anti-inflammatory drugs (NSAIDs), which can reduce pain and inflammation in some cases, with consideration of individual risk factors

Injections and Office-Based Procedures

•Interventional pain procedures in persistent cases, such as trigger point injections or facet-related interventions (for example, medial branch blocks and radiofrequency ablation) when facet-mediated pain is suspected

Surgery

•Surgical evaluation, which is generally uncommon for uncomplicated whiplash and may be considered primarily when imaging identifies structural instability, fracture, or significant neurologic compression from associated injuries

Prognosis and Recovery

The course of this condition varies between individuals:

•Symptoms often improve over days to weeks, and many individuals may recover within several weeks to a few months depending on injury severity and comorbid factors
•A subset of individuals can experience persistent neck pain, headache, or functional limitations that may span months or longer, sometimes described as whiplash-associated disorders
•Higher initial pain intensity, early disability, and psychosocial stressors can be associated with a greater likelihood of prolonged symptoms in observational studies
•Objective structural findings on imaging often do not correlate closely with symptom severity in uncomplicated cases, which can complicate prognosis discussions
•When neurologic deficits, fracture, or ligamentous instability are present, prognosis can depend on the associated injury pattern and the timeliness of appropriate evaluation and management

Physical Therapy (Physiotherapy)(Procedure)
Cervical Radiculopathy(Condition)
Cervical Disc Herniation(Condition)

Frequently Asked Questions

Common symptoms include: Neck pain that may range from aching to sharp discomfort and can worsen with movement or sustained posture; Neck stiffness and reduced cervical range of motion, often most noticeable with rotation or extension; Headache that often begins in the occipital region and can radiate toward the temples (cervicogenic pattern); Shoulder or upper back pain that may reflect muscle strain or referred pain from cervical structures; Tingling, numbness, or burning sensations in the arm or hand that can suggest nerve irritation, typically without objective weakness.

Diagnosis typically involves: Clinical history focusing on mechanism of injury, timing of symptom onset, pain distribution, and associated symptoms such as headache, dizziness, or arm paresthesias; Physical examination including cervical range of motion assessment, palpation for soft-tissue tenderness, evaluation of muscle spasm, and assessment of posture and movement patterns; Neurologic examination including strength, sensation, and reflex testing to evaluate for possible radiculopathy or myelopathy features; Use of clinical decision rules (such as NEXUS criteria or the Canadian C-Spine Rule) to help determine when cervical spine imaging may be indicated after trauma.

Treatment options range from conservative measures to surgical interventions, including: Activity modification with gradual return to usual activities as tolerated, which can support function while symptoms improve; Early, guided range-of-motion and mobility exercises, often used to reduce stiffness and support recovery; Physical therapy approaches that can include manual therapy, stretching, strengthening of deep neck flexors and scapular stabilizers, and posture/movement retraining; Heat or cold modalities, which can be used for short-term symptom relief in some individuals; Analgesic medications such as acetaminophen, which may reduce pain and support participation in rehabilitation activities.