Physical therapy, gentle exercise can ease whiplash pain

DEAR DOCTOR K: I was in a car accident several months ago and got whiplash. I still have neck pain. Is this normal?

DEAR READER: The neck contains a stack of bones (vertebrae) with joints between them. The bones are attached to muscles and ligaments that hold them together, and that hold the neck upright, allowing it to move as your head moves.

Whiplash - the term used to describe a group of symptoms and also the typical accident that leads to them - can damage one or more of these delicate structures. Whiplash is most commonly caused by car crashes, particularly those in which another car plows into the back of your car.

We used to think that the initial impact of whiplash jerked the head and neck back and then forward. Now we know there is a critical moment or two before that back-and-forth. When your car is hit from behind, your torso is pushed forward while your chin is forced down. Seen from the side, your neck momentarily looks like an S, as the upper and lower areas are unnaturally forced in different directions. (I've put an illustration of this on my website, AskDoctorK.com.)

Researchers now believe that this "S phase" of whiplash is when injury is most likely to occur, as the muscles, ligaments and joints strain to hold the vertebrae.

Whiplash can cause a range of symptoms. They include stiffness, neck and shoulder pain; muscle spasms in the neck or upper shoulders; decreased range of motion; and tingling or weakness in the arms.

What's to be done? If you haven't already, begin gentle range-of-motion exercises and then neck-strengthening exercises. It's best to seek treatment from a physical therapist to get this started and to learn how to do these exercises properly. Strong neck muscles decrease the stress on other muscles, disks and vertebrae. This gives damaged tissue a chance to heal.

Various pills are sometimes prescribed - tricyclic medicines, SSRI medicines, gabapentin - but the evidence that they help is limited. Because of the muscle spasms that can develop with whiplash, the muscle-relaxing treatment called Botox (botulinum toxin) has been tried. However, there's little evidence that it helps in whiplash.

Facet joint injections may also help. Joints are places where two bones meet. Facet joints are one of the places where two vertebrae meet; the bone above meets the bone below in several different places, or joints. The facet joints provide stability and help guide motion. Facet joint injections help numb pain and reduce inflammation.

Less commonly, radiofrequency neurotomy may be used. This procedure uses heat to block nerves from conducting pain signals.

Whiplash damage to muscles and ligaments should heal within a few months. If your symptoms continue, talk with your doctor. He or she can check for injuries to the facet joints and disks. On very rare occasions, there may be a problem that can be corrected by surgery. But most people recover from whiplash through physical therapy and regular exercise.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.