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# Whiplash (cervical sprain)

Whiplash is a neck sprain from a sudden jolt of the head, most often in a rear-end car crash; it causes neck pain, stiffness and headache.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Neck facet joints](https://durgical.com/en/anatomy/zygapophysial-joints/)
- [Nuchal ligament](https://durgical.com/en/anatomy/nuchal-ligament/)
- [Sternocleidomastoid](https://durgical.com/en/anatomy/sternocleidomastoid-muscle/)
- [Splenius](https://durgical.com/en/anatomy/splenius-capitis-muscle/)
- [C5 vertebra](https://durgical.com/en/anatomy/c5/)
- [C6 vertebra](https://durgical.com/en/anatomy/c6/)
- [Longus colli](https://durgical.com/en/anatomy/longus-colli-muscle/)
- [Trapezius](https://durgical.com/en/anatomy/trapezius-muscle/)
- [Semispinalis](https://durgical.com/en/anatomy/semispinalis-muscles/)
- [Suboccipital muscles](https://durgical.com/en/anatomy/rectus-posterior-major-capitis-muscle/)

## What it is

Soft-tissue injury of the neck from sudden acceleration and deceleration, most often in a rear-end car crash. Its range of symptoms is called whiplash-associated disorder.

## Who gets it

Very common after road traffic crashes, a leading cause of injury in Colombia and Latin America. Most patients are young or middle-aged adults; women report it more often.

## Causes

- Rear-end vehicle collision (the classic mechanism)
- Side or front collisions
- Contact sports, falls and diving

## Risk factors

- Female sex
- Head turned at the moment of impact or unprepared for the impact
- Previous neck pain or injury
- High initial pain and disability, psychological distress or catastrophising (predict slow recovery)

## Pathophysiology

On impact the lower neck extends while the upper neck flexes, forming an S-shaped curve before the whole neck extends. This strains the facet joint capsules, ligaments, discs and muscles. Most injuries are soft-tissue sprains and strains; altered pain processing contributes to persistent symptoms.

## Classification

- Quebec Task Force grade 0: no neck complaints or signs
- Grade I: neck pain, stiffness or tenderness only, with no physical signs
- Grade II: neck complaints plus musculoskeletal signs (reduced range of motion, point tenderness)
- Grade III: neck complaints plus neurological signs (reduced reflexes, weakness, sensory loss)
- Grade IV: neck complaints with fracture or dislocation

## Symptoms and signs

- Neck pain and stiffness, often starting hours after the crash
- Headache, usually at the [base of the skull](https://durgical.com/en/anatomy/occipital-bone/)
- Pain in the shoulders and between the shoulder blades
- Dizziness, tinnitus, poor concentration or sleep problems
- Arm tingling or numbness in some patients

## Red flags

- Midline tenderness of the cervical spine, focal neurological deficit or reduced consciousness: suspect fracture or cord injury
- Severe headache, vomiting or confusion: consider brain injury or vertebral or carotid artery dissection
- Progressive weakness or numbness in the arms or legs

## Diagnosis

**Clinical**
History of the mechanism and a focused exam of range of motion, tenderness and neurology to assign a Quebec grade. Validated decision rules (Canadian C- [spine](https://durgical.com/en/anatomy/region/spine/) rule, NEXUS) decide who needs imaging.

**Imaging**
No imaging for low-risk grade I–II patients who meet the decision rules. CT is the first study when fracture is suspected; MRI if there are neurological signs or suspected ligament or cord injury.

## Differential diagnosis

- Cervical spine fracture or dislocation
- Cervical radiculopathy
- Vertebral or carotid artery dissection
- Concussion
- Muscle strain without a crash mechanism

## Goal of treatment

Rule out serious injury, relieve pain, keep the patient active and prevent the move to chronic pain and disability.

## Treatment

**Acute**
Spine precautions and immobilisation in the emergency setting until the decision rules or imaging clear the neck.

**Conservative**
Reassurance and education about the usually good outcome; early return to normal activity. Prolonged soft collar use is discouraged.

**Medical**
Simple analgesics and NSAIDs for a short period; muscle relaxants are sometimes used.

**Rehabilitation**
Guided exercise and physiotherapy for range of motion, strength and posture, with attention to psychological factors when recovery is slow.

## Complications

- Chronic neck pain (chronic whiplash-associated disorder)
- Chronic headache
- Anxiety, depression or post-traumatic stress
- Work loss and medico-legal disputes

## Prognosis

Most patients improve within weeks to a few months, but a significant minority keep symptoms long term; reported proportions vary. High early pain, disability and distress predict a slower recovery.

## Prevention

- Head restraints adjusted to the height of the head
- Seat belt use and road safety measures

## Test yourself

Think of the answer, then tap the question to see it.

## What is the classic mechanism of whiplash injury?

Sudden acceleration-deceleration of the neck, typically in a rear-end car collision.

## What defines Quebec Task Force grade II whiplash?

Neck complaints plus musculoskeletal signs, such as reduced range of motion and point tenderness, without neurological signs.

## What distinguishes Quebec grade III from grade IV?

Grade III has neurological signs; grade IV has a fracture or dislocation.

## Which decision rules help decide who needs cervical spine imaging after trauma?

The Canadian C-spine rule and the NEXUS criteria.

## Is prolonged use of a soft collar recommended after whiplash?

No. Staying active and early return to normal activity are favoured; prolonged immobilisation may slow recovery.

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## Related conditions

- [Cervical radiculopathy](https://durgical.com/en/conditions/cervical-radiculopathy/)
- [Spinal cord injury](https://durgical.com/en/conditions/spinal-cord-injury/)
- [Traumatic brain injury](https://durgical.com/en/conditions/traumatic-brain-injury/)
- [Cervical Spondylosis](https://durgical.com/en/conditions/cervical-spondylosis/)
- [Torticollis](https://durgical.com/en/conditions/torticollis/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Cervical Sprain](https://www.ncbi.nlm.nih.gov/books/NBK541016/) (StatPearls (NCBI Bookshelf), 2026).

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Source: https://durgical.com/en/conditions/whiplash/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/whiplash/