Whiplash

Also called Neck sprain, Whiplash-associated disorder

A neck sprain from sudden movement. Most settle within weeks, and the strongest predictor of a bad outcome is being told to rest.

What it is

A neck injury from a sudden forceful backward and forward movement, most often in a road traffic collision, sometimes from a fall or a sporting impact.

It is a soft tissue injury: muscles, ligaments and joint capsules. Scans are normal in the vast majority, which is correct and not evidence that nothing happened.

Most people recover substantially within a few weeks to three months. A minority have persistent symptoms, and the factors that predict that are well studied and mostly not about the crash: high initial pain, high initial distress, fear of movement, and expectations of a poor outcome.

That has a direct practical implication. Early reassurance, early movement and returning to normal activity produce better outcomes than rest, collars and waiting. Soft collars, once standard, delay recovery and are no longer recommended.

Symptoms typically start within 24 hours rather than immediately, which surprises people who felt fine at the scene.

Red flags need excluding: significant trauma, severe pain, neurological symptoms or midline bony tenderness need imaging to rule out fracture.

Signs you might notice

Neck pain and stiffness, usually starting within a day of the incident.

Headache, often from the base of the skull.

Pain and tenderness in the shoulders and upper back.

Reduced neck movement.

Dizziness, tiredness, difficulty concentrating, and irritability, all of which are common and often unmentioned.

Pins and needles or numbness in the arms.

999 or A and E: severe neck pain after significant trauma, midline bony tenderness, weakness or numbness in the arms or legs, problems with bladder or bowel control, difficulty walking, severe headache, or any loss of consciousness. See concussion.

How it can affect day-to-day life

The dizziness, poor concentration and irritability are the parts that surprise people, and they are frequently attributed to something else or hidden because they sound implausible.

Litigation and insurance change the experience, and not only in the cynical direction people assume: the process itself is prolonged, adversarial and stressful, and it can delay recovery by keeping the injury under continuous review.

Fear of movement is the central problem in the minority who do badly. Being told the neck is not damaged, and being shown what movement is safe, is a genuine treatment.

Sleep is disrupted early on, and pillow height and position matter more than any equipment sold for it.

For anyone with pre-existing cervical spondylosis, a scan will show degenerative change that predates the accident, and that finding needs explaining rather than presenting.

Supporting someone well

Keep the neck moving from the start, within comfort, and return to normal activity as soon as possible.

Do not use a soft collar. It delays recovery.

Take regular simple pain relief in the first days so that movement is possible, rather than taking it only when the pain is bad.

Stay at or return to work with adjustments rather than waiting to be pain free.

Get exercises from a physiotherapist; self-referral is available in most areas.

Expect improvement over weeks, and say so; expectation genuinely affects outcome.

Get red flag symptoms assessed urgently.

Watch for concussion symptoms alongside, particularly after a head impact.

Where to get help

A GP practice, urgent treatment centre, or self-referral to physiotherapy.

A and E for red flag symptoms after significant trauma.

Chartered Society of Physiotherapy publish self-management advice for neck pain.