Whiplash can be a very painful and complicated syndrome from which to recover. Whiplash occurs when there is a sudden acceleration-deceleration force. This commonly occurs in car accidents when the car is struck causing the head to fall rapidly into flexion, then snap back into extension. This can also happen when struck from the side.
As a result of this injury, bone, soft tissue, and even the brain can be damaged.
In the case of soft tissue, all of the muscles in the front, back and sides of the spine are stretched beyond their normal length and will have microscopic tears. This can be very painful and cause swelling and scarring. Immediately after an injury, the normal response of the body is to increase muscle tone to reduce excessive movement, effectively splinting the neck for protection. With normal healing, the increased tone will reduce within a few days and allow slow return to normal movement. Rest is just as important as movement during this time. As you might guess, when you ask an injured muscle to work harder, it will fatigue and fail, and in most cases become more painful.
In some cases, muscle tone will stay high and one will start to develop a compensatory movement strategy and prolong the healing process. An example of a compensatory movement strategy is when one holds their head down and forward secondary to pain. They may even avoid all cervical motions in the fear that they may further injure their neck. The deep cervical flexor muscles that are already injured are at a mechanical disadvantage for stabilizing the neck and stop working. Superficial cervical muscles, that are also injured, step up to the challenge, but are also not in the best position to work. The end result is painful muscles that are working too hard to hold the weight of the head. They will fatigue quickly and lead to further dysfunction. Pain that lasts longer than 3 months is considered chronic pain. During that time, compensatory movement patterns become ingrained and cause more symptoms, such as headache, jaw pain, low back pain, tingling in the arms, and/or deep pain between the shoulder blades.
Physical therapy can help a person return to healthy movement by first reducing muscle tone through manual therapy of the neck and upper back, soft tissue massage, the application of heat or cold, stretching, and the use of external splinting such as a cervical collar. A physical therapist will provide education on correct positioning to allow the injured muscles to stay relaxed and not overused. When a person can achieve good posture, strain on the muscles is reduced and healing can proceed. A physical therapist will be knowledgeable on how fast to prescribe the best progression of exercises for someone with whiplash to avoid further injury while returning to normal function as efficiently as possible.