Hyperextension of the neck is more commonly known as whiplash. This injury is caused by the sudden backward and forward motion of the neck, or from strenuous overuse.
Hyperextension of the neck causes injury in the soft tissues and the neck joints, which are called cervical facets and are located in the cervical portion of the spine.
The soft tissues include tendons, ligaments, and muscles surrounding the neck and cervical facets.
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Causes of Whiplash
Whiplash injury is most common in road traffic accidents, but may also be caused by sports injuries, falls, assault, or chronic neck strain. What may be most surprising is that whiplash can be caused by automobile impact accidents at relatively low speeds, as reported by this scientific journal.
There are some exercises that can cause hyperextension of the neck over time, and lead to pain or immobility. This type of injury may also be classified as whiplash by a medical professional. These exercises include full neck circles, the plough, inverted shoulder stand, inverted bicycle, and sit-ups performed with hands behind the neck- all which can cause undue strain to the cervical tissue.
Symptoms of Whiplash
There are a number of symptoms that indicate hyperextension of the neck though it is generally characterized by neck pain. This pain is felt along either side of the spine at the back of the neck and when the neck is used for motion (moving the head). Some other common symptoms include:
- Stiff Neck
- 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 any damage has occurred to the neck or spine.
Hyperextension of the neck is diagnosed via a physical examination of the neck, 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 (backwards motion) the neck then snaps into flexion (forward motion) and whiplash occurs.
- 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 (dislocation) resulting in whiplash. Hyperextension may also 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 other physical signs.
- Grade 2: indicates neck complaints and musculoskeletal abnormality.
- Grade 3: neck complaints and neurological abnormality.
- Grade 4: neck complaints and fracture/dislocation:
- Most cervical spine fractures occur predominantly at two levels – at the level of C2 or at C6 and C7.
- Most severe cervical spine injuries occur in upper cervical levels, at either of the cranio-cervical junctions (C1 and C2). These are known as Atlas Fractures.
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 exercises may be 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 mobilization exercises designed to increase and preserve flexibility.
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 can cause the damaged tissue to heal in a shortened position that renders them less flexible.
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.
- Apply 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 methods include using a warm towel or bathing in warm water. Be cautious if choosing to use a heating pad or commercial hot pack in case of accidental burns.
- Alternate hot and cold therapies to maximize the benefits. Each therapy should be applied to the affected area no longer than 15 minutes per method.
- 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 recommended by a doctor.
- Steroid injections at the site of injury have shown to reduce inflammation and alleviate pain associated with WAD.
Physical therapy can be useful to help strengthen muscles and reduce painful motions. Occupational therapy can be used to help return the patient to the work environment. Other treatments, like ultrasound and massage, may be used as complimentary therapies. This study shows a combination of noninvasive therapies may be most beneficial when recovering from whiplash.
In more severe cases of whiplash, regenerative therapies such as Platelet Rich Plasma(PRP) injections should be considered.
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 Medicine produces clinical outcomes that repeatedly outperform not only conventional approaches but also chiropractic care for neck pain.
Patients begin seeing improvement after a few days, with the best results observed 1 month post injection. Some patients have the PRP repeated after three months if the pain returns. Patients can experience up to 80% reduction in pain and improved range of motion and functionality.
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.