Whiplash and the cervical spine

Whiplash-associated disorders are presented as a complex condition with often incomplete recovery and a substantially increased risk of future neck pain. Symptoms can vary widely and may appear immediately or be delayed for up to 12–15 hours. A key point is that injury severity is linked more to head acceleration than vehicle speed, while being prepared for impact and having the head in a neutral position are associated with better outcomes. The main suspected pain source is the facet joints, whereas ligament injury and routine MRI findings appear less useful than previously thought. Poor prognosis is linked to age over 35, high Neck Disability Index scores above 40%, and signs of post-traumatic stress, especially hyperarousal. Fatty infiltration of the deep cervical extensors on MRI may also predict worse recovery. Assessment should also consider visual symptoms, impaired standing balance, dizziness, concussion, and possible fracture using the Canadian C-spine rule. Rehabilitation emphasizes reassurance, staying active, strengthening, sensorimotor and vestibular exercises, and addressing psychosocial factors.