Neck pain is very common, even without an accident or injury. With busy roads, about 1 in 200 people now have a minor neck injury or whiplash each year. Fortunately serious or permanent damage is rare.
There is a great deal of research surrounding the management of whiplash, but patients remain confused regarding its management. They frequently receive conflicting advice about the best way to handle it.
The aim of this article is to show you how to get better as quickly as possible, including giving you an idea of how to react to the situation you find yourself in.
A road traffic accident is certainly a disturbing and frightening experience. Even a minor whiplash injury can be very painful and generate feelings of dread and fear as to the long term outlook.
Although these feelings of dread are common, it is important to see the positive side of things. The facts are:-
1. Permanent damage is rare and the long term outlook is good.
2. Most whiplash injuries are not serious and there is usually no damage to the bones, discs or nerves in the spine.
3. Serious injuries are nearly always detected early.
4. Some people only develop pain a day or two after the accident. This is a good sign, because it usually means that the damage to the neck is not serious.
5. Everyone knows that whiplash causes neck pain but some people also suffer low back pain.
6. It is not uncommon to generate headaches after whiplash from the tension of the muscles which run up the neck to the base of the skull. Other people get symptoms such as arm pain, jaw pain or dizziness.Usually, these symptoms resolve as the neck pain improves.
7. The acute pain usually improves within the first few days or weeks, at least enough to return to a relatively normal life.
8. In some cases the problem can persist for quite a long time after injury. Even then, it does not mean the problem is serious. It is just difficult to resolve. The pain usually settles eventually, if you have a positive outlook combined with, exercises, postural care and treatment.
9. What you do in the early stages after a whiplash injury is very important. Rest for more than a day or two usually does not help. It may result in your neck becoming stiff. Recent research has shown that to keep generally active, within the limits of your pain, and to keep the neck moving is the best way forward.
10. The people who cope best with whiplash are those who stay active, exercise their neck, and get on with life. These people are commonly described as “doers and copers”.
The Anatomy of Whiplash
Your spine, and that includes your neck as well as your back, is one of the strongest parts of your body. It is made of solid bony blocks joined by discs to give it strength and flexibility. It is reinforced by strong ligaments and surrounded by large powerful muscles that protect it. It is surprisingly strong and therefore serious damage to the structure of your neck is rare although sprains and strains of the tissues around your neck are common.
If you have a violent accident and your neck is very painful you should go to Accident & Emergency, or see your doctor. This is to make sure there is no serious damage, although this is rare. It is particularly important if you have:
1. Been unconscious.
2. Disturbed vision.
3. Severe muscle pain or your neck is in an abnormal posture.
4. Pins and needles, numbness or weakness in your arms or legs.
5. Any difficulty with walking or balance.
These features are rare, but if you do suffer them you should be examined professionally.
How to Manage Whiplash
Nobody would pretend that whiplash can be simply dismissed. Of course you might be limited in how much you can do for the first few days, if the pain is severe, but generally only for a few days. This is to allow the worst of the spasm and inflammation to subside. After this the most important thing is to get moving and active as soon as you can.
Your body must stay active to stay healthy. It works better through use and regular physical activity:
1. Gives you strong bones.
2. Develops fit and active muscles.
3. Keeps you supple.
4. Makes you fit.
5. Makes you feel good.
6. Releases natural chemicals that reduce the pain.
Even when you are sore you can start without putting too much stress on your neck and there are many forms of exercises that can help with whiplash such as:
1. Simple neck exercises.
2. Any form of aerobic exercise.
3. Keep fit exercises.
4. General Pilates.
6. Most daily activities and hobbies.
Different exercises suit different people and you must find for yourself what best suits you and your neck. Then try to re-arrange your life to get regular physical activity at some time every day.
If you have to have sedentary periods in your life, for example, sitting at the computer at work or driving for long periods, try and look after your posture. You may also need advice on this from an Osteopath or Physiotherapist. Andrew Gilmour can help with this
The Control of Whiplash Pain
There are some treatments that could help to control the pain so that you can things get moving and active.
1. Painkillers:-You can use painkillers to help manage your pain and it is quite alright to do this. Paracetamol is the simplest to take as a painkiller, or you can use anti-inflammatory tablets like Ibuprofen. It is important to take them regularly. Every 4-6 hours as they build up in effect. You can take painkillers for a few days, but you may also need to take them for as much as a week or two. Take them regularly and do not wait until the pain is out of control. Do not take either Ibuprofen or aspirin if you are pregnant, or if you have asthma, indigestion or an ulcer.
2. Collars:- A collar is sometimes given for immediate support and relief but research shows that after the first few days it may delay recovery.
3. Heat and cold:- Local heat or cold can be used for short term relief of pain and to relax spasm. In the first 48 hours you can try a cold pack on the sore area 5-10 minutes at a time. A bag of frozen peas wrapped in a towel is sufficient for this.
4. Manipulation:- Most doctors now agree that manipulation or mobilisation can help and Osteopathic treatment is one way forward for this. It is probably most effective in the early stages, but your treatment plan will also highlight advice regarding postural exercises, staying active and general life planning.
5. Neck exercises:- There is no single exercise that is right for everyone so it is best to seek advice from Osteopaths or Physiotherapists who set you on the right track.
Anxiety, Stress and Muscle Tension
Anxiety and stress can increase the amount of pain we feel. Tension can cause muscle spasm and the muscles themselves can be painful.
It is normal to be anxious after whiplash, especially if it is not getting better as fast as you would like. You may get conflicting advice even from doctors and therapists or from family and friends which makes you uncertain of what best to do.
Stress can aggravate or prolong the pain. If stress is a problem, you need to recognise it at an early stage and try to do something about it. You can try and manage this yourself and reduce its effect by using controlled breathing, muscle relaxation and mental calming techniques. You may also need to seek the help of a Psychologist or Hypnotherapist.
The Risk of Chronic Pain
There has been a lot of research in recent years to identify people at risk of developing long term pain and disability. What may surprise you is, that most of the warning signs are about what we feel and do, rather than medical findings. Early warnings and signs of people at risk are:
1. Belief that you have a serious injury or damage and being unable to accept reassurance.
2. Belief that hurt means harm and that you will become disabled.
3. Avoiding movement or activity due to fear of doing damage.
4. Continued rest and avoiding normal activities instead of getting on with your life.
5. Waiting for someone to fix it rather than believing you can help recover yourself.
6. Unable to see an improvement after 1-2 weeks.
7. Becoming withdrawn and depressed.
If you are still off work after 3-6 weeks, you are at risk of developing long term problems and, there is a 10% risk that you will still be off work in a year’s time. It is important to be proactive before you reach that stage. If you feel you are falling down this route you should seek professional advice from a Pain management specialist, your Doctor, Psychologist, Hypnotherapist or Osteopath.
Keeping Active Within Reason
The idea is to strike a balance between being as active as you can and not putting too much strain on your neck or back. The basic rules are simple.
1. Keep moving.
2. Do not stay in one position for too long.
3. Move about before you stiffen up.
4. Move a little further and faster every day.
5. Don’t completely avoid things, just alter the way you do them. Examples might include:
i. Sitting. Choose a chair in a position that is comfortable for you and do experiment. Get up and stretch regularly and take advantage of TV adverts for a break.
ii. Deskwork. Adjust the height of your chair to suit your desk. Adjust your keyboard and VDU so that your neck and shoulders are comfortable and keep the mouse close. Get up and stretch regularly.
iii. Driving. Adjust your seat so that you can hold the steering wheel comfortably. Stop regularly for a few minutes break. Get out of the car, walk about and stretch. Make sure that your headrest is not at the top of your head and no more than 2 inches behind it.
iv. Carrying shopping. If you need to carry it all carry things hugged to your body or split the load between both hands and use a trolley.
v. Daily activities and hobbies. Do each activity for a short period. Keep changing activities. Use your arms at or below shoulder height.
vi. Sports. Continuing with your normal sports is fine if it is non-impact or non-contact. Reduce intensity e.g. walking or cycling instead of running or rugby. Swimming. Try a different stroke, back crawl, side stroke or crawl.
vii. Sleeping. Find what pillow is most comfortable for you. Higher or lower, softer or firmer. Experiment. Try the airstream pillow identified in the Andrew Gilmour’s Favoured Products of this site. Take painkillers an hour before you go to bed.
Overall It’s Your Neck
It can take a while to recover from whiplash and it is important to realise that there are two types of sufferer. One who avoids activity, the avoider, and one who copes, the coper.
1. The avoider gets frightened by pain and worries about the future. He or she is afraid that hurting always means further damage when it doesn’t. The avoider rests a lot, withdraws from life and just waits for the pain to get better.
2. Conversely the coper knows that the pain will get better and does not fear the future. The coper carries on as normally as possible and deals with the pain by being positive, staying active and getting on with life.
Hopefully the above will help you cope with your whiplash, but if you feel that you are falling into being an avoider then do seek professional advice. At Andrew Gilmour and associates we are here to help