Treatments for Whiplash and the Risks of Not Treating

There are many treatments available to help reduce the symptoms associated with whiplash. In general, this article will focus more on the conservative end of things—those treatments that help the body heal itself without the invasiveness that comes with medications and surgery.

Chiropractors and physical therapists both use similar approaches to helping the body heal. Chiropractic tends to focus more on a treatment known in the profession as the adjustment (known to medicine as manipulation), while physical therapy airs on the side of therapeutic exercise. Both use a variety of adjunct therapies to reduce symptoms during care; our office blends the two approaches together to aim for the best results.

Adjustments

In the chiropractic office, the first line of treatment is to adjust the patient’s spine or extremities, depending on the location of the injury. Whiplash injuries produce stiffness as a result of injured muscles and joints, which can lead to poor alignment, unfavorable muscle patterns, and increased sensitivity to pain.

An adjustment consists of a high velocity, low amplitude thrust using the hands or an instrument. It is, in essence, a quick motion with low force that moves the joint in a desirable direction to help increase motion, reset muscle tension, and improve communication in the nervous system.

Your chiropractor will select different ways to adjust based on their training and your personal preference. Different techniques may be more effective for some patients; instrument-based treatments tend to be effective for highly sensitive patients or those that fear the sound produced by air escaping from joints during an adjustment.

Hand adjustments tend to reduce pain slightly quicker than instruments but require special positioning and leverage. Many patients prefer the hands-on approach, as it stretches the muscles and relieves joint inflammation.

In spite of the occasional sensational news article, adjustments are generally safe, with serious adverse events occurring between 1 in 3,000,000 and 1 in 6,000,000. Typical side effects include mild soreness, stiffness, feeling tired, and the occasional headache. Your doctor will screen for any contraindications to adjusting before providing treatment.

Ice and Heat

In the early phase of injury when there is significant inflammation present, application of ice over the injured area can help reduce pain associated with compression from inflammation. This is especially true in the joints, which have limited space to handle the fluid compression of inflammation.

Heat is effective for reducing muscle spasm and reducing stiffness but should be used sparingly. Following a whiplash injury, the body is already in an inflammatory state; heat increases that inflammation and may increase pain following treatment if applied too early. In general, it is best to avoid heat until instructed otherwise by your doctor.

Electric Muscle Stimulation (E-Stim or EMS)

Electrical treatments have long been used for muscle disorders. By applying a current to the muscle, EMS machines will stimulate the muscles to contract and relax. This results in what some patients describe as an “electric massage,” helping to relax the muscles and remove tension, thereby decreasing pain.

The effects are temporary but work excellent for controlling the early pains associated with whiplash injuries. And unlike muscle relaxers, EMS won’t leave you feeling tired and unable to function.

Note that EMS can’t be used over areas with metallic implants or in patients with a pacemaker. Treatment usually runs between 10-15 minutes per session and few side effects are observed if treatment is applied properly. This therapy is adjustable so it can be applied based on your tolerance.

Intersegmental Traction (Roller Table)

Another popular treatment is intersegmental traction. Although this typically targets the lower back, traction tables will roll as high as the upper back, helping to reduce tension and ease pain associated with the joints near the bottom of the neck.

Traction works through gravity; a roller beneath the back moves across the joints, subtly opening the joint spaces as your body presses against the roller. It also moves through the spinal muscles, acting similar to a massage by compressing the muscles and helping to push out inflammation. Many traction tables vibrate, which helps to override pain sensations by replacing them with vibration.

Most patients enjoy the traction table, but there are a few instances where it shouldn’t be used. Broken bones are highly sensitive to vibration, so the table should be avoided in those cases. Your doctor’s exam will determine whether traction is appropriate.

Rehabilitative Exercises

No treatment plan for whiplash is complete without exercises. Following whiplash, the ligaments have difficulty stabilizing the neck and injured muscles may become tight. Exercises targeted at the cervical muscles can help restore stability and promote flexibility in stiff muscles.

Rehab exercises should start as soon as you're able to perform them. Although some exercises may be mildly uncomfortable at first, proper use of this treatment helps reduce pain and prevents long term problems such as recurring headaches or loss of motion in the neck.

There are countless neck exercises available, and your doctor will help select the most appropriate for your specific injury. In most cases you will start with exercises in the office, and then learn how to perform exercises at home in addition to those you perform with the doctor.

Manual Therapy

Manual therapy is a wide category of techniques used specifically to treat muscles. It includes things such as massage, Graston technique, Active Release Technique, and kinesiotaping. In general, all these different techniques are aimed at relieving muscle tension, improving motion, and reducing pain.

Your doctor may be trained in several different types of manual therapy and will recommend what he or she thinks is best for your condition. In some cases, manual therapy is appropriate from day one, but other times you may need to wait a short time for pain to decrease before beginning manual therapy. Pressure used in manual therapy tends to be firm and may be difficult to apply immediately following an injury.

Medical Care

Occasionally, more severe symptoms may require medical intervention. Short term pain relief medications and muscle relaxers may be employed by a medical doctor (MD) or doctor of osteopathy (DO) to control symptoms during the early phases of pain. Combination steroid and lidocaine injections sometimes relieve inflammation in the disc when there is nerve compression but should be used sparingly as steroid injections gradually degrade the joint.

If there is risk of neurological damage or symptoms are unbearable, surgery is the final option. Surgery is rarely necessary for whiplash injuries and should be avoided in all but a few cases. Your doctor will refer you for orthopedic or neurosurgical consult in these cases.

The “No Treatment” Option

For every condition, the option not to pursue treatment always exists. In minor injuries, the body often has all it needs to recover. In most whiplash injuries, this is not the case: failure to pursue adequate treatment carries with it multiple risks.

Chronic headaches are among the most common long-term problems associated with incompletely treated whiplash injuries. They often recur and reduce the overall quality of life. Most often, these headaches come with the story “ever since the accident…”

Instability in the neck may also accelerate the process of arthritis, which is the body’s way of dealing with chronic instability of the soft tissue. In osteoarthritis, the body transforms damaged soft tissue into bony tissue by adding calcium to the area. This gradually results in stiffness, which in turn promotes pain.

In more serious whiplash injuries that involve the spinal cord, failure to seek treatment may lead to loss of feeling in the affected areas, muscle weakness, and ultimately atrophy of the impacted limb. While this only occurs in a minority of cases, it can become extremely debilitating.

If you or someone you know was the victim of a whiplash injury, don’t wait: give us a call to schedule your evaluation so we can get you on the road back to health. We look forward to meeting you!

About the Author

Dr. Brandon Orsino is a chiropractic physician specializing in treating injuries related to automobile accidents. Along with the other chiropractors at Dynamic Medical & Rehabilitation, he uses chiropractic techniques and physiotherapies to get patients feeling better and back to living their best lives.