In Pakistan, whiplash Injury is managed by physical medicine & rehabilitations. Whiplash injury is a soft-tissue neck injury caused by rapid forced hyperextension followed by flexion of the cervical spine, most often during a rear-end motor vehicle collision. Incidence in motorised countries is roughly 300-600 per 100,000 person-years and the condition accounts for the largest share of soft-tissue injury claims after road traffic collisions.
Whiplash injury (ICD-10: S13.4, S13.9), formally Whiplash-Associated Disorder (WAD), describes a constellation of neck symptoms produced by a sudden acceleration-deceleration mechanism transferring energy to the cervical spine, most often during a rear-end or side-impact motor vehicle collision but also during sports, falls, and amusement-park rides. The forces stretch and partially tear capsular ligaments of the facet joints (C5-C6 and C6-C7 are most often affected), strain paraspinal muscles, and may injure the cervical intervertebral discs. The Quebec Task Force on Whiplash-Associated Disorders (Spitzer 1995) graded severity from 0 (no symptoms or signs) through I (pain, stiffness, no clinical signs), II (musculoskeletal signs), III (neurological signs), to IV (fracture or dislocation). Grades I-II represent the soft-tissue whiplash typically managed in primary care and rehabilitation, while grades III-IV require orthopaedic or neurosurgical assessment.
The key symptoms of Whiplash Injury are: Neck pain and stiffness developing 6-48 hours after a rear-end or side-impact collision, often described as worse on waking the day after., Reduced cervical range of motion, especially with rotation and extension, with paraspinal muscle spasm tender to palpation., Occipital and upper-thoracic radiating pain reaching the shoulders, scapulae, and base of the skull (cervicogenic headache)., Headache, most commonly tension-type or cervicogenic, present in 50-70% of patients in the first month., Jaw pain, clicking, or temporomandibular dysfunction in up to 25% of patients, particularly after high-energy impacts., Dizziness, vertigo, or unsteadiness without true vestibular signs, often reflecting cervicogenic dizziness or autonomic involvement., Tinnitus, hyperacusis, or sensation of fullness in the ears reported in 10-15% of patients..
Diagnosis is clinical. The history pinpoints the mechanism (rear-end, side-impact, fall), head position at impact, presence of seat-belt and headrest, immediate versus delayed symptom onset, and the trajectory of pain over the first 24-72 hours. Examination assesses cervical range of motion (active and passive), tenderness over the facet joints and paraspinal muscles, neurological status (myotomes, dermatomes, reflexes, Hoffmann sign, gait), and the temporomandibular and shoulder girdles. The Canadian C-spine Rule is the most widely validated tool for deciding which alert, stable adults need radiography after blunt cervical trauma: any high-risk factor (age above 65, dangerous mechanism, paraesthesia) mandates imaging; low-risk factors (simple rear-end collision, sitting in emergency department, ambulatory, delayed onset of pain, no midline tenderness) allow safe range-of-motion testing. Plain radiographs in three views suffice for most low-risk patients; CT cervical spine is preferred in older adults, severe trauma, and high-risk mechanism; MRI is reserved for neurological signs, persistent radicular symptoms, or planned intervention. Routine MRI in uncomplicated grade I-II WAD is not recommended. The Neck Disability Index (NDI) and a 0-10 numeric pain rating scale at baseline guide prognosis and treatment intensity. Psychological screening for catastrophising, hyperarousal, and post-traumatic stress is increasingly recommended where access permits.
Around 50% of patients with WAD grade I-II recover fully within 3-6 months, and 70-75% by 12 months. Persistent symptoms beyond 12 months occur in 25-30% and define chronic WAD, a major cause of long-term neck pain and disability. The strongest predictors of chronic disability are high initial pain intensity (above 6/10), high Neck Disability Index (above 30/100) at baseline, post-traumatic stress symptoms, pre-existing psychological distress, and pre-collision neck pain. Mechanical factors such as collision speed and imaging findings have weaker prognostic value once initial neurological status is accounted for. Early reassurance, active rehabilitation, and avoidance of collars are associated with better outcomes. Multidisciplinary programmes addressing pain, psychological distress, and graded return to activity improve outcomes in 40-60% of those with established chronic WAD.
Most whiplash injuries are managed in primary care and physiotherapy. Specialist referral to physical medicine and rehabilitation or sports medicine is warranted for persistent symptoms beyond 6-12 weeks, suspected facet-joint pain, neurological signs, or chronic post-traumatic stress symptoms. Orthopaedic or neurosurgical referral is needed for WAD grade IV, persistent radicular signs, or imaging evidence of significant injury.
Find specialists →Acute pain peaks within 24-72 hours, then improves over 2-4 weeks in most patients. Range of motion returns by 4-6 weeks. Most patients return to normal work and leisure activities within 4-8 weeks. Residual symptoms at 12 weeks predict chronic outcomes; multidisciplinary rehabilitation is recommended at this point. Patients with chronic WAD often have variable courses with partial recovery over 6-18 months on structured programmes.
Begin gentle cervical range-of-motion exercises within 24-72 hours of injury — slow rotation, flexion, extension, and lateral flexion to the limits of comfort, 10 repetitions three times daily. Progress over 2-4 weeks to deep cervical flexor activation (chin tucks), scapular retraction, and resistance band exercises. Resume aerobic activity (walking, cycling, swimming) at low intensity in the first week and build up over 4-6 weeks. Avoid contact sports until pain is settled, range of motion is full, and strength is restored.
Choose a physiotherapist with experience in cervical spine rehabilitation and graded activity programmes. For persistent symptoms, look for a rehabilitation physician or pain specialist who offers diagnostic medial-branch blocks and cognitive behavioural therapy in a multidisciplinary setting. Ask whether the clinic uses validated outcome measures (Neck Disability Index, numeric pain rating scale).
Medically reviewed by AIHealz Medical Editorial Board · May 13, 2026
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