Neck pain after a car accident is a common occurrence, with neck injuries accounting for 90% of car accident-associated injuries yearly in the United States. Most of the time, that pain resolves quickly, but in some cases, it can persist for quite a while, even years. The amount of time it takes to recover from neck soreness after a car accident injury depends on the type of injury and the treatment provided. This is why seeking the care of an experienced and knowledgeable car accident doctor is critical to ensuring optimal outcomes.
Do You Have Whiplash?
Whiplash is a term most people recognize as meaning a neck injury or pain after a car accident. This form of car accident injury encompasses several injuries to the soft tissues and bones of the neck. These injuries can be mild and resolve quickly or be severe and result in chronic pain and disability. Symptoms can vary from person to person, but all result in some amount of neck soreness following a car accident. Collectively, these symptoms are termed Whiplash Associated Disorder (WAD).
Many people think of whiplash as merely soreness after an accident, but it can be much more complicated than that. Whiplash is categorized based on the structures that were injured and the symptoms produced by that injury. These result in a classification that was developed by the Quebec Task Force, called a WAD Grade.
WHIPLASH ASSOCIATED DISORDERS Grades
- You have symptoms of pain, stiffness, etc., but no measurable or objective signs of injury on assessment or imaging.
- You have symptoms of pain, and the doctor can objectively measure signs of injury on assessment, such as decreased range of motion.
- You have symptoms of pain, etc., and the doctor can objectively detect signs of neurological involvement, such as weakness or decreased tendon responses.
- You have symptoms of pain, etc., and there is a broken or dislocated bone on imaging.
Anatomy of the Neck
The neck is one of the most complex parts of the body, with a myriad of blood vessels, ligaments and tendons, muscles, bones, nerves, organs, and other structures. The bones of the neck are the seven cervical vertebrae. The first of which, the C1, is called the atlas. The C2 is called the axis. These two bones create a junction with the back of the skull that allows the head to pivot and turn easily.
Each cervical vertebrae has a bony spike, called a spinous process, that allows it to connect to the vertebra below it while still moving and stretching. The main part of the vertebra, called the body, is topped with a canal that the spinal cord runs through. From the spinal cord comes smaller nerves, called spinal nerves, that are responsible for controlling and sensing structures at that level of the body. For example, the C1 has spinal nerves that are responsible for operating and feeling in the neck and clavicles (collarbones).
Between each vertebra is a cartilaginous disc that cushions the bones and absorbs the impact of our motions. Attached to each vertebra are muscles and tendons that support and move the bones, creating the ability to turn and rotate the head and neck. Many blood vessels pass through the neck on the way to the brain and supply blood to the organs and tissues of the neck itself. The thyroid gland, esophagus, and trachea are also in the neck. This complexity means that any injury to the neck can have significant ramifications.
How Do Neck Injuries Occur in a Car Accident?
90% of car accident injuries in the United States are neck injuries. In most cases, neck injuries occur in rear-end or side collisions that occur at a low rate of speed. When the car is impacted from behind, the body continues to move forward at the same rate of speed the vehicle was traveling. The seat belt, or steering wheel, stops the body from continuing on its forward trajectory. The head, being unrestrained, continues to move, though, which can force the bones and tissues of the neck to initially hyperextend, starting at the lower cervical vertebrae. The head and neck then rebound, causing a hyperflexion of the neck that can force that part of the spine into an abnormal curve. This motion essentially pulls the vertebrae apart and then pushes them back together abruptly, like an accordion.
The neck allows for multiple forms of movement, from flexion and extension (contraction and expansion, respectively) to axial torsion (the twisting motion that allows for turning the head). The extensive range of motion in the neck relies on the complex musculature of the area. The muscles can be strained or torn in car accidents, causing pain and injury. The same applies to the ligaments and tendons, which can also be torn or sprained.
Signs and Symptoms of Whiplash Associated Disorder
- Pain in the neck, arms, or chest that may take 24 hours or more to appear after an accident
- Impaired movement of the head and neck
- Stiffness in the neck
- Radiating pain in the arms and chest
- Numbness and tingling in the arms and chest
- Difficulty concentrating and thinking
- Distressing memories or dreams about the event
- Headache
- Visual changes
How Does the Doctor Evaluate Neck Soreness?
Evaluating neck injuries requires a great deal of knowledge and experience. As with all assessments, the provider will collect a careful history of the events that led to the injury. This should include the kind of accident (car or otherwise), what type of impact occurred (rear, side, front end collision), were you the passenger or driver, were you wearing a seat belt, did you strike the steering wheel, etc. You will also need to inform the doctor of any pre-existing medical conditions and medications that you take.
The doctor will then perform a physical exam looking for any pain on touch or movement, reduced range of motion in the neck, obvious changes in the curvature of the neck, and impaired sensation in the arms and chest. They may ask you to walk to assess your gait, so be sure to wear comfortable shoes to your appointment. Tell the doctor immediately if any motion you are asked to do causes you pain.
Most diagnoses of whiplash are made based on clinical presentation alone since imaging doesn’t typically show injury right away. If there is a suspicion of serious injury, such as signs of nerve injury or broken bones, the doctor will order either a computed tomography (CT) scan or magnetic resonance imaging (MRI). It is important to remember that someone can have significant pain due to whiplash and still have a normal result on CT or MRI. This is because the injury occurs due to excessive motion in most cases, like in a sprain or strain, and does not result in overt tearing or breakage of structures except in severe instances. Tearing of soft tissues can be extremely hard to see on imaging, particularly at first. Once healed, the changes can be seen in the form of scarring that is more readily visible radiologically than the initial tear or fracture itself.
How Long Does It Take to Heal?
For most people, the pain of a neck injury following a car accident resolves within a few weeks. Symptoms generally go away within three months, but if they remain at that point, there is a high risk that they will persist long term. In 25-40% of patients, there may be some remaining symptoms after a year, and in some people, symptoms are present as long as seven years after an accident. It can be difficult to predict who will develop long-term Whiplash Associated Disorder, but in general, the more pain one has at the start, the incidence of other injuries in the body at the same time, a great deal of disability associated with the neck injury, post-traumatic stress disorder from the accident, and difficulty coping with the pain all increase the risk. Age and gender may play a role, with older women being more likely to experience chronic pain related to WAD. This may be due to the higher incidence of osteoporosis in this population.
Some people believe that whiplash is used to extort money in car accident legal cases or that patients are malingering for other reasons. There is no high-quality evidence of this on a large scale in clinical literature. In fact, few people show signs of improvement after a legal settlement is made, suggesting this is not a factor in the development of long-term Whiplash Associated Disorder. Rather, it could be that those who are more severely injured are more likely to seek out compensation that requires the legal system. It may also be that the expense of treatment, which includes clinical care, time off from work, medications, and more, puts those with a financial disadvantage behind the game in healing. Unfortunately, not getting treatment is even worse, resulting in a longer time out of work, being in pain, and an increased rate of complications. Seeking prompt medical care from an expert can alleviate some of these concerns by restoring your ability to function quickly and efficiently.
In those who participated in active therapeutic interventions as directed by their doctor, there was a significant reduction in pain and needed work leave at six months compared to those who did not have the same care. Those interventions may include medications, bracing, physical therapy, and more options that the car accident doctor can provide based on your particular situation and Whiplash Associated Disorders Grade. A Whiplash Associated Disorders Grade 1 or 2 will likely recover faster and with fewer long-term complications than someone with a Grade 3 or 4 injury.
The good news is that even in those people who develop chronic symptoms from a prior whiplash injury, there are treatment options that can reduce pain and disability. A resolution of symptoms can be achieved in many who continue to suffer from long-term Whiplash Associated Disorder. One study showed 70% improvement with certain treatments. Prevention
The best way to deal with whiplash is to avoid it altogether. A vehicle with automatic emergency braking systems, collision warning systems, and other advanced driver assistance systems can reduce the risk of car accidents significantly. The posture of the individual should be upright and, as shown in the vehicle’s user’s guide, for ideal safety. Keeping the seat upright, with a lower angle of reclining, can reduce the risk of head and neck injuries. The closer the head is to the headrest, the less movement the head will experience when a crash occurs. An adaptive restraint system, which adjusts seatbelt tension, airbag force, and headrest position in an accident according to sensors that detect information about the driver and passengers’ own body position, can significantly reduce head and neck injuries in a car accident.
Appropriate medical care makes a significant difference in recovery time and outcomes. Seeking out the care of a skilled and experienced provider is the first step to healing. The doctors at AICA Tucker are available now to schedule your appointment and get you on the road to healing.