Define Whiplash-Associated Disorder. Describe its clinical features and grading.

Definition

Whiplash-associated disorder is a soft-tissue (musculoligamentous) injury of the cervical spine caused by a sudden acceleration–deceleration (‘whiplash’) movement of the neck, classically in a rear-end road-traffic collision. There is no fracture or dislocation, but the neck is hyperextended then flexed, straining the muscles, ligaments and facet joints.

Clinical Features

Symptoms are often delayed by hours and include neck pain and stiffness, occipital headache, reduced range of movement, and referred pain to the shoulders and interscapular region. Dizziness, paraesthesiae and difficulty concentrating may occur. The examination excludes a true neurological deficit or bony injury (the Quebec classification grades severity 0–IV).

Investigations & Management

Radiographs (or CT where the Canadian C-spine rule/nexus indicate) are performed to exclude a fracture or dislocation; imaging is normal in whiplash apart from possible loss of the cervical lordosis from muscle spasm. Management is conservative and emphasises reassurance, early mobilisation and return to normal activity, simple analgesia and physiotherapy. Prolonged collar immobilisation is discouraged as it delays recovery and fosters stiffness. Patients are reassured that the great majority recover fully, and are encouraged to keep the neck moving within the limits of pain and to resume work and driving as symptoms allow.

Grading and Prognosis

The Quebec Task Force grades whiplash from 0 (no complaint) through I (pain only), II (pain with musculoskeletal signs) and III (pain with neurological signs) to IV (fracture or dislocation). Most patients in grades I and II recover within a few weeks to months with active management. A minority develop a chronic whiplash syndrome with persistent pain and disability; recognised risk factors include high initial pain intensity, pre-existing neck symptoms and psychosocial stressors. Setting realistic expectations and encouraging early return to normal activity measurably improve outcome.

Collars are avoided — early movement gives better outcomes.

• Soft-tissue acceleration–deceleration injury of the neck (rear-end collision); no fracture.
• Delayed neck pain/stiffness, headache, reduced movement.
• Image to exclude fracture/dislocation; films otherwise normal (± lost lordosis).
• Treat conservatively: reassurance, analgesia, early mobilisation; avoid prolonged collar.