Whiplash associated disorder

What is whiplash associated disorder?

Whiplash associated disorder (WAD) is the term for the collection of symptoms that can follow a sudden, forceful back-and-forth movement of your neck, most often from a car accident. It ranges from mild, short-lived neck pain to longer-lasting symptoms affecting your neck, shoulders and back.

What are the symptoms of whiplash associated disorder?

Common symptoms of whiplash associated disorder include:

• neck pain and stiffness
• pain that spreads into your shoulder or arm
• muscle spasms
• persistent headaches
• pins and needles or numbness in your arm
• dizziness, fatigue or nausea (less common).

Symptoms often take a few hours, or even a day, to appear after the injury, and can be surprisingly severe even when scans and examinations don't find any specific damage. If symptoms persist for more than six months, this is sometimes called late whiplash syndrome.

What causes whiplash associated disorder, and who is at risk?

Whiplash associated disorder happens when a sudden acceleration-deceleration force is transferred to your neck, most commonly from a rear-end or side-impact car accident. Your head and neck are forced backwards and then rapidly forwards, which can strain the soft tissues and joints of your neck.

Whiplash can also be caused by:

• a sporting accident, such as in rugby or diving
• a fall
• a physical assault.

Within the UK, it's estimated that around 500 people in every 100,000 are affected by whiplash associated disorder each year. Around half of people recover within the first three months, but a significant minority go on to experience longer-term pain and disability.

Are there different types of whiplash associated disorder?

Doctors often grade the severity of whiplash associated disorder using the Quebec Task Force classification:

• Grade 0: No neck pain or physical signs
• Grade I: Neck pain, stiffness or tenderness only, with no other physical signs
• Grade 2: Neck pain plus musculoskeletal signs, such as reduced movement or tenderness to touch
• Grade 3: Neck pain plus neurological signs, such as reduced reflexes, weakness or altered sensation
• Grade 4: Neck pain with a fracture or dislocation.

How is whiplash associated disorder diagnosed?

A doctor or healthcare professional will usually diagnose whiplash associated disorder by asking about your symptoms and how the injury happened, then examining your neck's range of movement and strength.

Occasionally, you may need further examination or imaging to rule out other possible causes, such as a fracture, particularly if you have severe pain, neurological symptoms, or the injury involved a lot of force.

How is whiplash associated disorder treated?

Most cases of whiplash associated disorder improve gradually with the right advice and self-management, though this can take a number of months.

The following can help your recovery:

• Staying active: Continue with your everyday activities and normal routine as much as you can
• Pain relief: Such as paracetamol or anti-inflammatory painkillers, to help you move more comfortably
• Range-of-movement exercises: Often starting within the first few days once your symptoms allow
• Physiotherapy: This can help strengthen your neck muscles and reduce pain
• Ice followed by heat: This can help reduce swelling and ease pain in the early stages
• Electrotherapy or acupuncture: Some people find this helpful for reducing muscle spasm and pain
• Spinal manipulation from an osteopath or chiropractor: This is sometimes considered if symptoms continue beyond four weeks.

A neck collar or brace is not usually recommended, as it doesn't help and can make your symptoms worse by causing your neck muscles to stiffen. If you're advised to use one, it should only be for a short time.

If your pain becomes long-lasting, underlying stress or emotional difficulties can sometimes make it harder to recover, and psychological support or cognitive behavioural therapy (CBT) may help alongside physical treatment.

Surgery is not part of treatment for most cases of whiplash associated disorder. In the rare cases where there's a fracture or dislocation of the neck (grade IV), you'll need specialist assessment and treatment for that specific injury.

When should I see a doctor?

Speak to a healthcare professional if your whiplash symptoms haven't improved within 6 weeks of following self-management advice, or if your symptoms get worse at any point.

Get medical advice urgently if you have a sudden 'electric shock' feeling in your neck or back, which may also spread into your arms and legs, as this could be a sign of nerve damage.

Contact 111 or seek emergency care for severe symptoms such as major weakness, loss of bladder or bowel control, or if the injury involved significant force.