Neck (Cervical)
Whiplash / Cervical Sprain
편타성 손상 (목 삐임)
Injury from sudden impact causing the neck to whip forward and backward
- How common
- Common (following motor vehicle accidents)
- Typical age
- All ages
What is it?
A sudden impact causes rapid hyperextension-hyperflexion (whip motion) of the neck, injuring cervical ligaments, muscles, and joint capsules.
Commonly affected: Soft tissue injuries are most common at C4-5 and C5-6 levels
How it develops
- ImpactIn a rear-end collision, the body moves forward while the head hyperextends backward
- Hyperextension-hyperflexionThe head whips back and forth like a lash, injuring soft tissues
- Ligament/muscle injuryMicrotears occur in the anterior and posterior longitudinal ligaments and muscles
- Inflammatory responseInflammation and edema develop at the injured site, causing pain
Symptoms
- Neck painTends to worsen 12–24 hours after the accident rather than immediately
- Restricted neck motionDifficulty turning the neck due to pain
- HeadacheHeadache originating in the occipital region
- Shoulder/upper limb painShoulder and arm pain (without radicular pain)
- Dizziness/fatiguePresent in some patients
How it is examined
- Restricted cervical ROMMotion limited in all directions due to pain
- Muscle tendernessDiffuse tenderness of the paracervical muscles
- No neurological deficitNo radicular pain, numbness, or weakness (in simple sprains)
Imaging
X-ray is performed first to rule out fracture.
- Usually normal
- Loss of cervical lordosis (from muscle spasm)
- Fracture only in severe trauma
MRI evaluates ligament injury, disc injury, and nerve compression.
- Possible ligamentous edema
- Assessment of disc injury
- Near-normal when no nerve compression is present
Non-surgical care
- Early mobilization (avoid excessive rest)Unlike older practice, brief rest followed by early return to daily activity is now recommended
- AnalgesicsAcetaminophen or NSAIDs for acute pain control
- Physical therapyHeat, cold, and electrotherapy followed by cervical exercise therapy
- Patient education on natural courseEducate patients that over 90% recover naturally within a few months
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Only when accompanied by fracture, dislocation, or nerve injury
Procedures that may be discussed
- Fracture fixation (when applicable)
Outlook
Generally favorable. 80–90% improve within 6 months. A minority may develop chronic symptoms.