Neck injuries that don’t include a whiplash component are uncommon (though neck pain and associated headaches are very common).
So it is convenient to refer to most if not all neck injuries as variants of whiplash because a) two important groups of muscles are nearly always found to be weak and in need of re-training (upper cervical flexors and lower cervical extensors), and b) there is frequently an element of ‘shock’ involved when the head is moved suddenly on the body and the neck muscles are unable fully to ‘brace’ against the movement.
The most common problem, then, is either strain to muscles that tried in vain to brace the neck against the injurious movement, or the effects of shock on the nervous system that tried to initiate the self-defence mechanisms. Commonly both.
Occasionally, the joints themselves will be injured, together with the ligaments that bind them together, though this only becomes a common finding in high-impact sporting injuries. Injuries that cause fractures in the neck do not necessarily cause worse long term symptoms than muscular strains – as long as the spinal cord itself is not injured.
Proper assessment and management of neck injuries and whiplash, then, must include not only muscles, joints, ligaments, tendons and bony structures, but also the nervous system that controls movement and which may have been shocked and braced, together with the blood supply to all these systems. Attention is also paid to how the neck is used – that is, postural and occupational elements. And last but not least, the patient’s general state of health, including sleep, stress and energy levels.
Whiplash injuries are notorious for taking months if not years to resolve. Unfortunately there has been a common belief that this is often related to legal action taken after road traffic accidents. In fact, there is much good scientific evidence to suggest that the real problem with whiplash is misdiagnosis; most so-called whiplash injuries are not, as is commonly believed, caused by structural damage to nervous tissue or muscular tissue, but are in fact caused by long term bracing – that is, splinting of the neck as a result of a disturbance in the levels of nervous control of neck muscles. This is a ‘shock’ effect, and it is necessary to retrain the levels of power developed by neck muscles in order to resolve the problem.