Treating Whiplash: How to Treat a Hyperextended Neck?

By Last updated on October 13th, 2020 Last updated on October 13th, 2020 No Comments

Hyperextension of the neck is more commonly known as whiplash and is an injury that is caused by the sudden backward and forward motion of the neck.

Hyperextension of the neck causes injury in the soft tissues and the neck joints, which are also known as the cervical vertebrae.

The soft tissues include tendons, ligaments, and muscles.

Causes of Whiplash

Whiplash injury is common in road traffic accidents and may also be caused by sports injuries, falls, assaults, or chronic neck strain. Most cases of a whiplash injury occur as the result of rear-end vehicle collisions at speeds of less than 14 miles per hour.

Patients may suffer from neck pain and stiffness, occipital headache, thoracic back pain and/or lumbar back pain, and upper-limb pain and paraesthesia. There are some exercises that can cause hyperextension of the neck over time. These include full neck circles, the plough, inverted shoulder stand, inverted bicycle, and sit-ups performed with hands behind the neck.

Symptoms of Whiplash

There are a number of symptoms that indicate hyperextension of the neck. The first of these is neck pain. This pain is generally felt along either side of the spine at the back of the neck, although there is also pain whenever the neck is moved. Some other common symptoms include:

  • Stiff Neck
  • Headache
  • Muscle Spasms
  • Tenderness along the back of the neck
  • Tingling or numbness in the upper body
  • Shooting pain from the neck into the shoulder and down the arm

If you experience any of these symptoms of whiplash following a car crash or any traumatic impact, see a doctor as soon as possible. A full diagnosis will show if there is any damage that can make the situation worse.


Hyperextension of the neck is usually diagnosed via a physical examination of the neck and a medical history, including details of the accident that caused the injury. X-rays may be taken if fracture is suspected. It is best to seek medical attention immediately after an accident if there is any concern of possible neck injury.

There are two types of injury:

  • Typical Cervical Hyperextension injuries occur in drivers/passengers of a stationary or slow-moving vehicle that is struck from behind. The person’s body is thrown forward but the head lags, resulting in hyperextension of the neck. When the head and neck have reached maximum extension, the neck then snaps into flexion.
  • Rapid Deceleration injury throws the head forward and flexes the cervical spine. The chin limits forward flexion but the forward movement may be sufficient to cause longitudinal distraction and neurological damage. Hyperextension may occur in the subsequent recoil.

Whiplash-associated disorders (WAD) can be classified by the severity of signs and symptoms:

  • Grade 0: no complaints or physical signs.
  • Grade 1: indicates neck complaints but no physical signs.
  • Grade 2: indicates neck complaints and musculoskeletal signs.
  • Grade 3: neck complaints and neurological signs.
  • Grade 4: neck complaints and fracture/dislocation:
    • Most cervical spine fractures occur predominantly at two levels – at the level of C2 or at C6 or C7.
    • Most fatal cervical spine injuries occur in upper cervical levels, either at the cranio-cervical junction C1, or at C2.

The most important issue in the management of whiplash is optimal education of the patient about their injury. This includes information on the cause, potential treatments, and likely outcomes. Patients should understand that this is a real injury, but that nearly all patients have the ability to fully recover. Patients that do not receive this information are much more likely to develop the more chronic “whiplash associated disorder.”

In the past, the initial treatment for whiplash was often a soft cervical collar for several weeks. The goal of the collar was intended to reduce the range of motion of the neck and to prevent any additional injuries. More recent studies have shown that this prolonged immobilization actually slows the healing process.

If there is no evidence of abnormal spinal alignment, early range of motion is advised. Patients involved in early range of motion exercises have been shown to have a more reliable and rapid improvement in their symptoms. This treatment typically involves rotational exercises performed 10 times per hour as soon as symptoms allow within the first four days of the accident.

It seems that excessive rest and immobilization have been shown to have greater chances of chronic symptoms. This is explained by loss of range of motion leading to increased pain and stiffness. Immobilization also causes muscle atrophy (muscle wasting), decreased blood flow to the injured soft tissues, and healing of damaged muscles in a shortened position that renders them less flexible.

Physical therapy can be useful in helping to wean a patient from a cervical collar as well as to help strengthen muscles and reduce painful motions. Occupational therapy can be used to help return the patient to the work environment.

To help with recovery, you should also consider the following actions:

  • Ice the neck to reduce pain and swelling as soon as possible after the injury. Do it for 15 minutes every 3-4 hours for 2-3 days. Wrap the ice in a thin towel or cloth to prevent injury to the skin.
  • Take painkillers or other drugs, if recommended by your doctor. Non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil, Motrin) or naproxen (Aleve), will help with pain and swelling. However, these medicines can have side effects. Never use them regularly unless recommended by a doctor. Check with a medical professional before taking them if you take other medicines or have any medical problems. If over the counter medications do not work, prescription painkillers and muscle relaxants may be necessary.
  • Apply moist heat to the neck — but only after 2-3 days of icing it first. Use heat on the neck only after the initial swelling has gone down. Some preferred methods include using a  warm, wet towel or taking a warm bath.
  • Other treatments, like ultrasound and massage, may also help.

In more severe cases of whiplash, regenerative therapies such as Platelet-Rich-Plasma(PRP) injections should be considered.

PRP Treatments

PRP injection treatment involves taking a sample of the patient’s own blood and centrifuging it to extract the platelets from the other components of the blood. Once the platelets are extracted and concentrated, they then can be injected into the damaged structures of the neck. This comprehensive approach to pain allows the body to heal from the damages sustained during the whiplash.

The PRP injections treat the damaged ligaments and tendons that were stressed and micro damaged from the force of the injury while strengthening all the supporting structures of the neck. This type of Regenerative Naturopathic Medicine produces clinical outcomes that repeatedly outperform not only conventional approaches but also chiropractic care for neck pain.

Patients begin seeing improvement immediately, with the best results observed 1 month post injection. After a series of 3 platelet rich plasma treatments have been completed, patients experience over an 80% reduction in pain. Complete range of motion and functionality are also restored.

Which Treatment to Choose?

Depending on the severity of the neck hyperextension it may be necessary to explore different treatment options. Be sure to consult a physician to best identify the proper treatment.

Dr. Pouya Mohajer

Dr. Pouya Mohajer

Director of Regenerative Interventional Spine Medicine
Board certification in Anesthesiology and Interventional Pain Medicine
Fellowship-trained from Harvard University
UCLA Alumni