Whiplash Causes, Symptoms, Treatment, Ayurveda Concept

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Whiplash is a neck injury. It is caused due to movement of the neck like the cracking of a whip. Herein there is forceful and rapid back and forth movement of the neck leading to the neck injury. Other names – Neck sprain, Strain
Note – these terms include other types of neck injuries.
Read – Stiff Neck Causes, Ayurvedic Treatment And Remedies

Causes

Mechanism of whiplash – This condition usually occurs when the head is thrown backward and forwards, forcefully and quickly. This may eventually lead to injury of bones in the spine, inter-vertebral discs, muscles, ligaments, nerves and other tissues of the neck.

Important causes of whiplash –
Rear-end car accidents (most common cause)
Auto / car accidents especially rear-end collisions
Physical abuse / assault – It may occur when one is punched or shaken. It is a commonly seen injury in shaken baby syndrome.
Contact sports / sports accident like football tackles
Other types of traumas, falls etc
Read – Cervical Spondylosis: Ayurvedic Treatment

Prognosis

The pain and other symptoms of whiplash start getting better in people suffering from this condition. The relief starts few weeks after following the treatment plan. Interventions include medications for pain relief and exercise. Some people may land up with chronic neck pain and complications which run a long course.

Symptoms

Signs and symptoms usually develop within few days of the injury.

• Pain in the neck
• Stiffness in the neck
• Movements of the neck worsens the pain
• Loss of range of motion / movements in the neck
• Headaches (usually starts at the base of the neck / base of the skull)
• Pain or tenderness in the upper back, shoulder or arms
• Numbness / tingling in the arms
• Fatigue
• Dizziness

Additional symptoms are also noted in some people –

• Tinnitus – ringing in the ears
• Blurring of vision
• Sleep disturbances
• Irritability
• Depression
• Problems related to memory
• Difficulty in concentrating

When to consult doctor?

Below mentioned conditions of the whiplash should alert you to consult doctor immediately –
Symptoms / neck pain occurring after a car accident, sports injury or other traumatic injury. This condition should be promptly and accurately diagnosed and damages around the neck or broken bones shall be ruled out.

Complications

Usually within a few weeks following injury many people who have whiplash start feeling better. They also don’t seem to have any lasting symptoms from the whiplash injury. Some people continue having pain for several months or years following the injury. It is difficult to predict the period and nature of recovery in whiplash injuries since this varies from person to person. Chronic pain is more likely to occur if the symptoms at the onset of whiplash were intense and have rapidly started. It may also occur if the initial symptoms of whiplash include severe pain in the neck, excessively limited range of movements and pain radiating towards the arm.

Bad prognosis of whiplash are associated with –
Having previous history of whiplash
Old age
High speed injury
Existing neck pain or low back pain
Read – Low Back Pain – Ayurveda View Point And Treatment

Diagnosis

Diagnosis of whiplash is usually done through a thorough examination. Case history and narration of events leading to the symptoms will help the physician to diagnose this condition. Your doctor may palpate your head, neck and arms while asking you to perform some activities to access the range of movements / motion in neck and shoulders, intensity of pain, degree of motion which causes or worsens the pain, tenderness in your neck and also in the back and shoulders, sensation and strength in limbs and reflexes therein. Some imaging tests too will be required in spite of injuries related to whiplash not being apparent on imaging tests. S rays, CT scan or MRI scan may be advised to rule out the other conditions which are similar to whiplash or would be masking the whiplash pain.

Prevention

Prevention of whiplash and related symptoms consists of being cautious with or avoiding the causes which leads to the same. One needs to be cautious while driving or playing sports and also should keep away from abuse and assault. One should take safety measures related to driving and sports seriously.

Other suggestions include – purchasing a car with highly rated head rest and then adjusting the head restraint properly. Airbags, seat belts, properly designed seats and adjusted head restraint will protect one from sustaining a whiplash injury in a rear-end collision.

A 2002 Canadian study – showed that only about 14% of headrests evaluated were properly adjusted. It was 28% in the UK. That meant 72% of front seat occupants failed to properly adjust their head restraints or they had improperly adjusted head restraints. Amongst remaining 28% who had head restraint in proper position, 11% had a fixed / non-adjustable one piece design and the protection was also limited to only a shorter person. One should also wear a safety belt while driving and sit upright.
Read – How to save your neck in a rear end crash?

Treatment

Pain control will be the primary goal of whiplash treatment. The other goals will be to improve and restore normal range of movements / motion in the neck and get the ailing person back to normal activities. Pain management shall be achieved through rest, heat or cold application, pain medications and injections and muscle relaxants.

Exercises as essential part of intervention
Some stretching and movement exercises shall be advised. These exercises shall be done at home. Helps in achieving pain relief and other motives of the treatment mentioned above. Exercises are skillfully combined with a treatment plan. Exercise will yield better results if moist heat or warm shower is taken over the painful area before doing the exercise.

Common exercises advised –
Rotation of neck, in both directions
Tilting of head from one side to the other
Bending of neck towards the chest
Rolling of shoulders
Read – Exercise Timing, Benefits, Side Effects, Ayurvedic Management

Physical Therapy

Physical therapy will help those who have ongoing pain related to whiplash or those who need help in terms of exercises which would help in improving range of motion. This will help people with whiplash to feel better and prevent further injury. Physical therapy would include exercises which help in strengthening the muscles, improve one’s posture and restore normal movement.
TENS (Transcutaneous Electrical Nerve Stimulation) is a procedure in which mild electric current is applied to the skin. This ease neck pain and also help in improving muscle strength temporarily as per certain research works.

Foam collars

Long back soft foam cervical collars used commonly to ease the injuries related to whiplash and also to hold the neck and head still. Studies have shown that the muscle strength might decrease if the neck is kept still for long period of time. This will also interfere with recovery from whiplash. Even nowadays these collars are used to limit movement and help to reduce pain soon after the injury. This also help the people to sleep well at night.

Alternative Medicine

Acupuncture, chiropractic care, massage and mind-body therapies are also useful in treating whiplash but they are not supported by research evidence.
Read – History of Acupuncture Treatment

Ayurveda Concept of Whiplash

Whiplash cannot be compared to any one condition explained in Ayurveda treatises. Below mentioned are the hypothetical understanding of whiplash in Ayurveda language due to the resemblance in manifestation of disease, symptoms and treatment in managing both these conditions.

• Vata aggravation – In Ayurveda, abhighata vis-à-vis injury is one of the main causes of vata aggravation. This aggravated vata causes pain and other symptoms of whiplash.
• Vatarakta – Travel history, varying and abnormal postures in travel, trauma etc are mentioned under etiological factors of Vatarakta. Similar etiologies are the cause of whiplash. So, whiplash can be considered under vatarakta for treatment purpose.
• Greeva shula / Manyastambha – Greeva shula means neck pain. Manyastambha means pain in the nape of the neck / neck stiffness.
  Read – Stiff Neck Causes, Ayurvedic Treatment And Remedies

Ayurveda treatment

Whiplash may be treated on the below said lines of treatment –
Vata Chikitsa – treatment prescribed for aggravated vata
Vatarakta Chikitsa – treatment prescribed for vatarakta vis-à-vis gouty arthritis / peripheral vascular disease
Greeva Shula / Manyastambha Chikitsa – treatment prescribed for neck pain and ‘neck nape treatment’

Other interventions

Mamsagata Vata Chikitsa – treatment for aggravation of vata in the muscles located in the neck region
Asthigata Vata Chikitsa – treatment for aggravation of vata in the bones located in the neck region
Sandhigata Vata Chikitsa – treatment for aggravation of vata in the joints of the neck region
Snayugata Vata Chikitsa – treatment for aggravation of vata in the ligaments and tendons of the neck region
Read – Charaka Vatavyadhi Chikitsa 28th Chapter

Treatment according to symptoms –

Therapies, Panchakarma Treatments

Snehana and Swedana
Oleation and sudation are actually not considered amongst Panchakarma therapies. They are preparatory procedures for these five specialized treatments.

External oleation –

a. Abhyanga – herbal oil massage
b. Snehadhara – pouring / showering of medicated oils and ghee on the neck
c. Greeva vasti – oil pooling on the neck

Ksheerabala Taila, Mahamasha Taila, Mahanarayana Taila, Prasarini Taila, Balashwagandha Taila, Lakshadi Taila etc shall be used for the above said treatments.

Internal oleation –
a. Snehapana – drinking of medicated (disease specific) ghee / oil in metered dosage
b. Nitya snehapana – oral consumption of small quantities of medicated fats (ghee / oil)
Guggulutiktaka Ghrta, Rasnadi Ghrta, Maharajaprasarini Tailam, Bala Tailam, Masha / Mahamasha Taila etc shall be used for this purpose.

Sudation therapy – this is usually done in combination with external oleation therapy. The below mentioned sudation therapies shall be preferred in the treatment of whiplash –Patrapinda sweda – bolus sudation prepared with herbal leaves
Shashtika shali pinda sweda – bolus sudation prepared with special rice (paddy grown in 60 days) processed with milk prepared with herbal decoctions

Nasya –
Nasal instillation of medicated ghee / oil is the best treatment for whiplash.
Brmhana Nasya i.e. nourishing errhine therapy is ideal in this case. In chronic cases and recurring symptoms
Pratimarsha Nasya daily instillation of small quantity of medicated ghee / oil in the form of drops shall be used. The below mentioned medicines shall be used for this purpose –
Ksheerabala Taila 101
Masha Taila
Maharajaprasarani Taila
Read – How To Do Nasya? Procedure, Types, Benefits, Precautions, Side Effects

Vasti
Vasti – medicated enemas, especially anuvasana vasti, matra vasti – small quantity of unctuous enema and brmhana vasti – nourishing enemas are helpful in chronic cases of whiplash and in presence of severe symptoms. Below mentioned medicines may be used for this purpose –Guggulutiktakam Ghrtam, Sahacharadi Tailam or Ksheerabala Tailam

Formulations

Mahayogaraja Guggulu
Rasnadi Guggulu
Maharasnadi Kashayam
Prasarinyadi Kashayam
Dashamula Kashayam
Maharajaprasarini Tailam
Rasonadi Kashayam
Mustadi Marma Kashayam
Kokilaksham Kashayam
Guluchyadi Kashayam
Guggulutiktakam Kashayam
Gandharvahastadi Kashayam
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