Whiplash is an injury that most commonly happens during a car accident, however, it isn’t the only time that whiplash can occur. The way that whiplash happens is when there is a force that causes the head to move in one direction, and once it hits it’s limit, it forces the head back in the opposite direction, forcing the neck to make a whip-like movement. When this happens, depending on how much force is exerted, it will determine how much damage is done to the neck and surrounding structures, as it isn’t just the neck that is affected. This can range from very mild to no pain in the neck and there isn’t any limitations to the movements in the neck, all the way over to there being serious sprains and strains in the neck, jaw pain, difficulty breathing, headaches, and a few other symptoms can also be present. Sometimes when it is this bad, there is a chance that surgery may be needed to help with the stability of the neck. However, there is still some difficulty with explaining this type of condition, because there isn’t always just that whip-like movement in the neck to create a whiplash condition. This includes when pilots of fighter jets are catapulted into the air. In this case, the neck is only forced backward really quickly, and with a major force, but there is no force countering this action. This can still cause the same sprains and strains into the neck.
In either of these cases there can be several different muscle groups that are affected, again depending on the severity of the injury, where the first force came from (in a car accident it will depend on if you were rear-ended, hit from the side or head-on collision) as well as the position of your head when the whiplash happened (were you looking to the side or were you looking straight ahead). Depending on the severity of the whiplash, how soon you get treatment, any pre-existing conditions in the neck, and even your health before the whiplash, all affect how long you might be feeling symptoms.
There are a few different articles that categorize how long one might feel the symptoms from whiplash. Sadly they don’t all agree, so this makes it hard to give a real answer as to how long you can feel this pain. For the ones that don’t feel any pain, they will more than likely not come for massage, so I won’t be using that group as an example, however for those who do have pain, or other symptoms of whiplash may find that their condition goes away after about a week, whereas very severe cases, some of the symptoms may never go away. In these cases, massage is only used to help manage the pain and side effects caused by the whiplash.
Depending on the severity of the whiplash, massage can be performed the day after the accident. However, if it is very severe whiplash, and surgery or a neck collar is needed, it is best to have your doctor approve you for a massage before booking. It is usually better to have treatment sooner rather than later. This is because a lot of times when there is neck pain, we tend to try not to move our necks at all. Now unless you have the neck collar on, you don’t want to keep the neck in one position. You want to keep moving your neck to keep the muscles from seizing up. If this happens it makes it a lot more difficult to be able to get back the range of motion in the neck as well as to help with the symptoms that you are experiencing. I do want to mention that when you are doing a range of motion for your neck you never want to cause pain, so you are only moving your neck in all directions just before there is pain, not to the point of pain.
When treatment is started it will depend on what symptoms you are experiencing, as everyone can experience something different, even if they are at the same grade level for the injury itself. So rather than going through an entire treatment plan, which can change a lot from person to person, or even from treatment to treatment, I will discuss what may be worked on and some of the techniques that could be used for each region of the body. Also to note before going into the different areas, when the whiplash is in an acute state, muscle spasms are worked on, however, the therapist will not get rid of them completely. This is because they are called protective muscle spasms, and a certain amount of this type of spasm is needed to protect the structures in the neck so it doesn’t get injured even worse.
Torso: During some whiplash injuries the chest can be affected, especially in car accidents since you have the force from the airbag going off, as well as the pressure from the seatbelt, keeping you back against your seat as much as possible. Both of these can cause bruising, contractions into the breathing muscles, and also because you are feeling pain, very often we tend to curl inward to try to make ourselves feel better. Sadly this changes our posture, which can make it harder for you to breathe since you will only be able to take more short, and shallow breaths. Plus with being in this position, especially more in the upper chest/shoulder area, this can cause there to be more stretching into the upper back, again causing more pain. Depending on if you have bruising or not, as well as how your pain levels are, the diaphragm (major breathing muscle found just under the ribs), pectoralis muscles (2 chest muscles that lay over the front of the rib cage), and serratus anterior (breathing muscle that lays on the sides of the ribcage just below the armpit). All will be treated for trigger points, fascial restrictions, spasms, and lymphatic drainage if there is any swelling present.
Back: In this area, a lot of the muscles along the spine are worked on. Many of these are very small muscles, they include multifidus, rotatories, which link between each of the vertebrae, then you have the long Erector spinae muscle, which is the full length of the spine. Some of the other muscles that are affected by a whiplash injury are, rhomboids (muscles between the shoulder blades), intercostals (the muscles between each of the ribs), and levator scapula (helps raise the shoulder blade towards the head). All of these will be treated for trigger points, fascial restrictions, spasms, and lymphatic drainage if there is any swelling present. These may also have techniques used that can help calm the nervous system. For the rhomboid muscles, they may also have a stimulatory type techniques used on them to help counter the postural issue that the Pectoralis muscles in the chest area causing, as these muscles help bring your shoulders straight back, but become overstretched when the pectoralis muscles are too tight.
Head: This area is treated more for some of the side effects that can happen from the whiplash, including jaw pain and headaches. For the headaches, the muscles that are worked on will depend on where you are feeling the headache, as a headache can be the sign of trigger points in other muscles, that are referring pain to the area that you are feeling the pain, rather than the sight of pain being the actual issue. Some of these muscles that can cause you to feel like you have a headache are not always just in the head itself, you can also get referral pain into the head from some of the muscles in the neck as well. As for the jaw pain, some of it can be coming from the muscles in the front of the neck, but can also be caused by the muscles in the jaw, and temple areas. All of these are checked and trigger points and any swelling are treated. Sometimes this can also mean that massage inside of the mouth will be necessary to be able to get to all the muscles that affect the jaw.
Front of the neck: These are the muscles that are in the front of the neck, which can be showing signs of spasm and trigger pints. Some of these muscles are harder to get to and there must be lots of communication between the therapist and the patient as this can cause discomfort. These muscles include the muscles that are on the inside of the cervical spine, which can be reached by gently moving over the trachea (breathing tube in the throat), scalenes (breathing muscles) which do wrap around the back of the neck but attach just behind the collar bone on the first and second rib, Sternocleidomastoid, platysma, very thin muscle that is used when shaving the face, and the muscles attached to the hyoid bone (help you to swallow). All of these muscles will be treated for muscular spasms, trigger points, fascial restrictions, and lymphatic drainage if swelling is present.
Back of the neck: these include the suboccipitals (the muscles at the base of the skull, which can cause lots of headaches if they are present), upper trapezius (this muscle has 3 sections, the upper portion is the one that covers most of the cervical spine), semispinalis cervicis and longissimus cervicis. Others do attach into the back of the neck but have been explained in other sections as they connect into those sections as well. Usually, the client is face-up when working on these muscles to allow gravity to help with the treatment and to keep from forcing the clients to face down into the headrest. This work can be done face down, but like I said it can be uncomfortable for some due to the added downward pressure. Again these muscles are treated for muscle spasms, trigger points, fascial restrictions, and lymphatic drainage if swelling is present.
Other structures can be affected when there is a whiplash injury, other than just the muscles. These include the nervous system, lymphatic system, skeletal system and the ligaments which can be sprained or have a rupture in the ligament itself.
To be able to treat the nervous system, a lot of relaxation techniques are used since the nerves become more excitable from the injury. This is because the brain knows that something is wrong and because the neck is a very important structure of the body, it wants you to be aware of everything that happens to it. This is because if we damage our necks too much it can affect the spinal cord, which can be life-threatening. Sadly this excitability can sometimes occur during chronic stages of a whiplash injury, or even in the lower grades of injury. In this case, the relaxation techniques are used to calm the nervous system so you feel less pain, and the brain also relearns that touch on or around the neck is safe. Sometimes this can take a long time to be able to achieve.
As for the lymphatic system, lymphatic drainage is used to help unblock any lymph nodes that are in the neck or chest area, then the rest of the tissues are drained. This can cause you to need to urinate more often if there is a lot of swelling in the tissues.
As for the skeletal system if there are any fractures in the area they will be treated the same way as described in the Fractures article. This is also true for the ligaments under the Sprains article.