Whiplash

A chronic neck pain & headache following rear-ending car accidents, whiplash is often due to widespread minor injuries to neck muscles & nerves. While each injury is negligible in isolation, the pain is severe and persistent because muscle, joint, and nerve pain reinforce each other. Whiplash requires comprehensive treatment with targeted interventions.

Whiplash injury

The sudden neck acceleration-deceleration in accidents leads to injuries of ligaments, joints, muscles, and nerves. While each injury is minor, because of the anatomic & neurologic connection, together they potentiate pain and initiate the chronic pain cycle. Amplified by catastrophizing & post-traumatic stress disorder (PTSD) that often develop after accidents, whiplash injury treatment requires a comprehensive approach.

Chronic pain cycle in whiplash

Spine joints

  • C5–6 cervical facet joints
  • C2–3 cervical facet joints

Muscles

  • Sternocladomastoid
  • Middle scalene
  • Posterior scalene
  • Levator scapulae
  • Semispinalis capitis
  • Trapezius
  • Rhomboids

Nerves

  • Lesser occipital nerve
  • Long thoracic nerve
  • Dorsal scapular nerve
  • Third occipital nerve
  • Greater occipital nerve
  • Spinal accessory nerve
  • Brachial plexus

Psychological

  • Catastrophizing
  • PTSD

Functional

  • Avoidance
  • Overuse injury

Testing

  • Physical examination
  • X-ray, CT, MRI imaging
  • Ensure no joint injury in rest of body (shoulder, hip)
  • Ensure that there is no chronic cerebrospinal fluid (CSF) leak, which is the chronic leakage of CSF from small tears in the dural sac. Reduced fluids that suspend the brain and spinal cord can cause a wide range of pain and neurologic symptoms.

Treatment

  • Nerve blocks with steroids can help reduce tissue inflammation, which is helpful can be followed by radiofrequency ablation for longer lasting relief
  • Botox injection into the muscles can reduce muscle tension so as to reduce nerve impingement. Botox may also be picked up on the involved nerve and reduce neurogenic inflammation.
  • Medial branch procedures to target facet joint pain
  • Comprehensive pain management including pain psychology, physical therapy, and complementary & alternative medicine (CAM)

Neck pain

Dr. Ming Kao View All →

Pain physician & PhD computational biologist @StanfordPain • Advanced pain interventions with CIPS & FIPP • Opinions mine & not medical advice

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