whiplash

Whiplash occurs when a person’s head moves backward and then forward suddenly with great force. This injury is most common following a rear-end car collision. It can also result from physical abuse, sports injuries, or amusement park rides.

Whiplash results when the soft tissues (the muscles and ligaments) of your neck extend beyond their typical range of motion. Your symptoms might not appear for a while, so it’s important to pay attention to any physical changes for a few days following any accident.

Whiplash is thought of as a relatively mild condition, but it can cause long-term pain and discomfort. How do whiplash injuries occur?

Whiplash occurs when the muscles in your neck suffer a strain because of a rapid movement backward and then forward. The sudden motion causes your neck’s tendons and ligaments to stretch and tear, resulting in whiplash.

Some things that can cause whiplash include:

car accidents
physical abuse, such as being punched or shaken
contact sports such as football, boxing, and karate
horseback riding
cycling accidents
falls in which the head violently jerks backward
blows to the head with a heavy object

What does whiplash feel like?

Symptoms usually appear within 24 hours after the incident that caused the whiplash. Sometimes, symptoms may develop after a few days. They can last for several weeks.

Common symptoms include:

neck pain and stiffness
headaches, specifically at the base of the skull
dizziness
blurred vision
constant weariness

Less common symptoms associated with chronic whiplash include:

problems with concentration and memory
ringing in the ears
inability to sleep well
irritability
chronic pain in the neck, shoulders, or head

You should follow up with your doctor immediately if:

your symptoms spread to your shoulders or arms
moving your head is painful
you have numbness or weakness in your arms

How is whiplash diagnosed?

Most mild to moderate cases of whiplash can be treated at home using over-the-counter (OTC) drugs, ice, and other remedies. However, you should seek medical help if you have the following symptoms:

pain or stiffness in the neck that goes away and then returns
severe neck pain
pain, numbness, or tingling in your shoulders, arms, or legs
any issues with your bladder or bowels
localized weakness in an arm or leg

Your doctor will normally ask you questions about your injury, such as how it occurred, where you feel pain, and whether the pain is dull, shooting, or sharp. They may also do a physical exam to check your range of motion and look for areas of tenderness.

Your doctor might order an X-ray to ensure your pain isn’t connected to any other type of injury or degenerative disease such as arthritis.

Other tests, such as CT scans and MRI, will allow your doctor to assess any damage or inflammation in the soft tissues, spinal cord, or nerves. Certain imaging studies, such as diffuse tensor imaging (DTI) or positron emission tomography (PET scan), may be helpful, especially when there may be a brain injury. These tests will help localize and measure the extent of an injury to the brain or other areas.

Treatment for whiplash

The treatments for whiplash are relatively simple. Doctors will often prescribe an OTC pain medication like Tylenol or aspirin. More severe injuries may require prescription painkillers and muscle relaxants to reduce muscle spasms.

In addition to medication, physical therapy plays a crucial role in recovery. You may want to apply ice or heat to the injured area and practice simple exercises to build strength and flexibility in your neck. Practice good posture and learn relaxation techniques to keep your neck muscles from straining and to help with recovery.

You might also be given a foam collar to keep your neck stable. Collars should not be worn for more than three hours at a time. They should only be used the first couple of days after your injury, as well.

Complications associated with whiplash

Some people with whiplash do experience chronic pain or headaches for years following their accident. Doctors may be able to trace this pain to damaged neck joints, disks, and ligaments. But chronic pain following a whiplash injury typically has no medical explanation.

However, very few people have any long-term complications from whiplash. Usually, recovery time is anywhere from a few days to several weeks. According to the National Institute of Neurological Disorders and Stroke, most people recover fully within three months.

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Do You Have a Stiff Neck? Try These Simple Remedies

With so many of us gazing into computers or staring down at our smart phones most of the day, it’s no wonder data from the Centers for Disease Control and Prevention reports that nearly 20 percent of us have experienced neck pain within the past three months.

A stiff neck typically is the result of muscles weakening over time from poor posture or misuse, says chiropractor Andrew Bang, DC, of Cleveland Clinic’s Center for Integrative Medicine.

Looking down at your computer monitor all day can cause the muscles around the neck joints to tire and become overstretched. Driving for long periods of time or looking at your smart phone can have the same effect. If you’re doing this day after day, it can add up and can displace your neck joints.

“When your neck muscles become weak and you try to turn your head, the joint no longer moves smoothly because it’s now out of place,” Dr. Bang says. “Often the joint catches on something, either pulling a muscle or hitting the nerve irregularly, or maybe both. Then you’ll have instant pain and your body has a protective spasm. Your body doesn’t want you to get hurt more, so it will clench, causing you to feel like you can’t even move — and leaving you wondering what you did to injure yourself.”
Stretching can keep pain at bay

Putting your monitor at eye level, sitting up straight and avoiding tilting and twisting your head down or to the side while you’re on the computer can help you avoid neck pain. When you’re driving or looking at your smart phone, be sure to take frequent breaks and avoid having your neck bent forward for long periods of time, Dr. Bang says.

The key to relief for a stiff neck is proper stretching and manipulation, Dr. Bang says. Here are some stretches you can try at your desk or in the car that may help you to avoid a stiff neck:

Roll your shoulders backwards and down 10 times
Squeeze your shoulder blades together 10 times
Push your head backwards into your car head rest or hands and hold for 30 seconds
Bring your ear to your shoulder 10 times on each side

Take care when you sleep

Dr. Bang says if your neck is bothering you, you also should pay attention to your sleep positions. Sleep only on your side or on your back – never on your stomach, he says.

“When you sleep on your stomach, often you will end up twisting your head one way or the other for hours at a time,” Dr. Bang says. “Sleeping on your stomach also can affect your low back because your belly sinks in to the bed if you don’t have enough support.”

For minor, common causes of neck pain, try these simple remedies:

Apply heat or ice to the painful area. Use ice for the first 48 to 72 hours, then use heat after that. Heat may be applied with warm showers, hot compresses or a heating pad. Be sure not to fall asleep with a heating pad or ice bag in place to avoid skin injuries.
Take over-the-counter pain relievers such as ibuprofen or acetaminophen.
Keep moving, but avoid jerking or painful activities. This helps calm your symptoms and reduce inflammation.
Do slow range-of-motion exercises, up and down, side to side, and from ear to ear. This helps to gently stretch the neck muscles.
Have a partner gently massage the sore or painful areas.
Try sleeping on a firm mattress without a pillow or with a special neck pillow.
Ask your health care provider about using a soft neck collar to relieve discomfort. Do not use the collar for a long time. Doing so can make your neck muscles weaker.

If the pain gets in the way of your daily activities, Dr. Bang says to call your doctor.

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Neck pain

Overview

Neck pain is a common complaint. Neck muscles can be strained from poor posture — whether it's leaning over your computer or hunching over your workbench. Osteoarthritis also is a common cause of neck pain.

Rarely, neck pain can be a symptom of a more serious problem. Seek medical care if your neck pain is accompanied by numbness or loss of strength in your arms or hands or if you have shooting pain into your shoulder or down your arm. Symptoms

Signs and symptoms include:

Pain that's often worsened by holding your head in one place for long periods, such as when driving or working at a computer
Muscle tightness and spasms
Decreased ability to move your head
Headache

When to see a doctor

Most neck pain improves gradually with home treatment. If not, see your doctor.

Seek immediate care if severe neck pain results from an injury, such as a motor vehicle accident, diving accident or fall.

Contact a doctor if your neck pain:

Is severe
Persists for several days without relief
Spreads down arms or legs
Is accompanied by headache, numbness, weakness or tingling

Causes

Your neck is flexible and supports the weight of your head, so it can be vulnerable to injuries and conditions that cause pain and restrict motion. Neck pain causes include:

Muscle strains. Overuse, such as too many hours hunched over your computer or smartphone, often triggers muscle strains. Even minor things, such as reading in bed or gritting your teeth, can strain neck muscles.
Worn joints. Just like the other joints in your body, your neck joints tend to wear down with age. Osteoarthritis causes the cushions (cartilage) between your bones (vertebrae) to deteriorate. Your body then forms bone spurs that affect joint motion and cause pain.
Nerve compression. Herniated disks or bone spurs in the vertebrae of your neck can press on the nerves branching out from the spinal cord.
Injuries. Rear-end auto collisions often result in whiplash injury, which occurs when the head is jerked backward and then forward, straining the soft tissues of the neck.
Diseases. Certain diseases, such as rheumatoid arthritis, meningitis or cancer, can cause neck pain.

Prevention

Most neck pain is associated with poor posture combined with age-related wear and tear. To help prevent neck pain, keep your head centered over your spine. Some simple changes in your daily routine may help. Consider trying to:

Use good posture. When standing and sitting, be sure your shoulders are in a straight line over your hips and your ears are directly over your shoulders.
Take frequent breaks. If you travel long distances or work long hours at your computer, get up, move around and stretch your neck and shoulders.
Adjust your desk, chair and computer so that the monitor is at eye level. Knees should be slightly lower than hips. Use your chair's armrests.
Avoid tucking the phone between your ear and shoulder when you talk. Use a headset or speakerphone instead.
If you smoke, quit. Smoking can put you at higher risk of developing neck pain.
Avoid carrying heavy bags with straps over your shoulder. The weight can strain your neck.
Sleep in a good position. Your head and neck should be aligned with your body. Use a small pillow under your neck.
Try sleeping on your back with your thighs elevated on pillows, which will flatten your spinal muscles.

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What rehabilitation or support options are available for patients with head and neck cancers?

The goal of treatment for head and neck cancers is to control the disease, but doctors are also concerned about preserving the function of the affected areas as much as they can and helping the patient return to normal activities as soon as possible after treatment. Rehabilitation is a very important part of this process. The goals of rehabilitation depend on the extent of the disease and the treatment that a patient has received.

Depending on the location of the cancer and the type of treatment, rehabilitation may include physical therapy, dietary counseling, speech therapy, and/or learning how to care for a stoma. A stoma is an opening into the windpipe through which a patient breathes after a laryngectomy, which is surgery to remove the larynx.

Sometimes, especially with cancer of the oral cavity, a patient may need reconstructive and plastic surgery to rebuild bones or tissues. However, reconstructive surgery may not always be possible because of damage to the remaining tissue from the original surgery or from radiation therapy. If reconstructive surgery is not possible, a prosthodontist may be able to make a prosthesis (an artificial dental and/or facial part) to restore satisfactory swallowing, speech, and appearance. Patients will receive special training on how to use the device.

Patients who have trouble speaking after treatment may need speech therapy. Often, a speech-language pathologist will visit the patient in the hospital to plan therapy and teach speech exercises or alternative methods of speaking. Speech therapy usually continues after the patient returns home.

Eating may be difficult after treatment for head and neck cancer. Some patients receive nutrients directly into a vein after surgery or need a feeding tube until they can eat on their own. A feeding tube is a flexible plastic tube that is passed into the stomach through the nose or an incision in the abdomen. A nurse or speech-language pathologist can help patients learn how to swallow again after surgery.

Is follow-up treatment necessary? What does it involve?

Regular follow-up care is very important after treatment for head and neck cancer to make sure that the cancer has not returned, or that a second primary (new) cancer has not developed. Depending on the type of cancer, medical checkups could include exams of the stoma, if one has been created, and of the mouth, neck, and throat. Regular dental exams may also be necessary.

From time to time, the doctor may perform a complete physical exam, blood tests, x-rays, and computed tomography (CT), positron emission tomography (PET), or magnetic resonance imaging (MRI) scans. The doctor may monitor thyroid and pituitary gland function, especially if the head or neck was treated with radiation. Also, the doctor is likely to counsel patients to stop smoking. Research has shown that continued smoking by a patient with head and neck cancer may reduce the effectiveness of treatment and increase the chance of a second primary cancer.

How can people who have had head and neck cancer reduce their risk of developing a second primary (new) cancer?

People who have been treated for head and neck cancers have an increased chance of developing a new cancer, usually in the head, neck, esophagus, or lungs. The chance of a second primary cancer varies depending on the site of the original cancer, but it is higher for people who use tobacco and drink alcohol.

Especially because patients who smoke have a higher risk of a second primary cancer, doctors encourage patients who use tobacco to quit. The federal government's main resource to help people quit using tobacco is BeTobaccoFree.gov. The government also sponsors Smokefree Women, a website to help women quit using tobacco, and Smokefree Teen, which is designed to help teens understand the decisions they make and how those decisions fit into their lives. The toll-free number 1-800-QUIT-NOW (1-800-784-8669) also serves as a single point of access to state-based telephone quitlines.

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How common are head and neck cancers?

Head and neck cancers account for approximately 4% of all cancers in the United States. These cancers are more than twice as common among men as they are among women. Head and neck cancers are also diagnosed more often among people over age 50 than they are among younger people.

Researchers estimated that more than 65,000 men and women in this country would be diagnosed with head and neck cancers in 2017.

How can I reduce my risk of developing head and neck cancers?

People who are at risk of head and neck cancers -- particularly those who use tobacco -- should talk with their doctor about ways that they may be able to reduce their risk. They should also discuss with their doctor how often to have checkups. In addition, ongoing clinical trials are testing the effectiveness of various medications in preventing head and neck cancers in people who have a high risk of developing these diseases.

Avoiding oral HPV infection may reduce the risk of HPV-associated head and neck cancers. However, it is not yet known whether the Food and Drug Administration-approved HPV vaccines Gardasil®, Gardasil 9®, and Cervarix® prevent HPV infection of the oral cavity, and none of these vaccines has yet been approved for the prevention of oropharyngeal cancer.

How are head and neck cancers diagnosed?

To find the cause of the signs or symptoms of a problem in the head and neck area, a doctor evaluates a person's medical history, performs a physical examination, and orders diagnostic tests. The exams and tests may vary depending on the symptoms. Examination of a sample of tissue under a microscope is always necessary to confirm a diagnosis of cancer.

If the diagnosis is cancer, the doctor will want to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Staging may involve an examination under anesthesia (in an operating room), x-rays and other imaging procedures, and laboratory tests. Knowing the stage of the disease helps the doctor plan treatment.

How are head and neck cancers treated?

The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage of the cancer, and the person's age and general health. Treatment for head and neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of treatments.

People who are diagnosed with HPV-positive oropharyngeal cancer may be treated differently than people with oropharyngeal cancers that are HPV-negative. Recent research has shown that patients with HPV-positive oropharyngeal tumors have a better prognosis and may do just as well on less intense treatment. An ongoing clinical trial is investigating this question.

The patient and the doctor should consider treatment options carefully. They should discuss each type of treatment and how it might change the way the patient looks, talks, eats, or breathes.

What are the side effects of treatment?

Surgery for head and neck cancers often changes the patient's ability to chew, swallow, or talk. The patient may look different after surgery, and the face and neck may be swollen. The swelling usually goes away within a few weeks. However, if lymph nodes are removed, the flow of lymph in the area where they were removed may be slower and lymph could collect in the tissues, causing additional swelling; this swelling may last for a long time.

After a laryngectomy (surgery to remove the larynx) or other surgery in the neck, parts of the neck and throat may feel numb because nerves have been cut. If lymph nodes in the neck were removed, the shoulder and neck may become weak and stiff.

Patients who receive radiation to the head and neck may experience redness, irritation, and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing; changes in taste; or nausea. Other problems that may occur during treatment are loss of taste, which may decrease appetite and affect nutrition, and earaches (caused by the hardening of ear wax). Patients may also notice some swelling or drooping of the skin under the chin and changes in the texture of the skin. The jaw may feel stiff, and patients may not be able to open their mouth as wide as before treatment.

Patients should report any side effects to their doctor or nurse, and discuss how to deal with them.

Where can I find more information about clinical trials for patients with head and neck cancers?

Clinical trials are research studies conducted with people who volunteer to take part. Participation in clinical trials is an option for many patients with head and neck cancer. Ongoing clinical trials are testing the effectiveness of treatments for head and neck cancers.

People interested in taking part in a clinical trial should talk with their doctor.

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What causes head and neck cancers?

Alcohol and tobacco use (including smokeless tobacco, sometimes called "chewing tobacco" or "snuff") are the two most important risk factors for head and neck cancers, especially cancers of the oral cavity, oropharynx, hypopharynx, and larynx. At least 75% of head and neck cancers are caused by tobacco and alcohol use. People who use both tobacco and alcohol are at greater risk of developing these cancers than people who use either tobacco or alcohol alone. Tobacco and alcohol use are not risk factors for salivary gland cancers.

Infection with cancer-causing types of human papillomavirus (HPV), especially HPV type 16, is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue. In the United States, the incidence of oropharyngeal cancers caused by HPV infection is increasing, while the incidence of oropharyngeal cancers related to other causes is falling.

Other risk factors for cancers of the head and neck include the following:

Paan (betel quid). Immigrants from Southeast Asia who use paan (betel quid) in the mouth should be aware that this habit has been strongly associated with an increased risk of oral cancer.

Preserved or salted foods. Consumption of certain preserved or salted foods during childhood is a risk factor for nasopharyngeal cancer.

Oral health. Poor oral hygiene and missing teeth may be weak risk factors for cancers of the oral cavity. Use of mouthwash that has a high alcohol content is a possible, but not proven, risk factor for cancers of the oral cavity.

Occupational exposure. Occupational exposure to wood dust is a risk factor for nasopharyngeal cancer. Certain industrial exposures, including exposures to asbestos and synthetic fibers, have been associated with cancer of the larynx, but the increase in risk remains controversial. People working in certain jobs in the construction, metal, textile, ceramic, logging, and food industries may have an increased risk of cancer of the larynx. Industrial exposure to wood or nickel dust or formaldehyde is a risk factor for cancers of the paranasal sinuses and nasal cavity.

Radiation exposure. Radiation to the head and neck, for noncancerous conditions or cancer, is a risk factor for cancer of the salivary glands.

Epstein-Barr virus infection. Infection with the Epstein-Barr virus is a risk factor for nasopharyngeal cancer and cancer of the salivary glands.

Ancestry. Asian ancestry, particularly Chinese ancestry, is a risk factor for nasopharyngeal cancer.

What are common symptoms of head and neck cancers?

The symptoms of head and neck cancers may include a lump or a sore that does not heal, a sore throat that does not go away, difficulty in swallowing, and a change or hoarseness in the voice. These symptoms may also be caused by other, less serious conditions. It is important to check with a doctor or dentist about any of these symptoms. Symptoms that may affect specific areas of the head and neck include the following:

Oral cavity. A white or red patch on the gums, the tongue, or the lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth.

Pharynx. Trouble breathing or speaking; pain when swallowing; pain in the neck or the throat that does not go away; frequent headaches, pain, or ringing in the ears; or trouble hearing.

Larynx. Pain when swallowing or ear pain.

Paranasal sinuses and nasal cavity. Sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; bleeding through the nose; frequent headaches, swelling or other trouble with the eyes; pain in the upper teeth; or problems with dentures.

Salivary glands. Swelling under the chin or around the jawbone, numbness or paralysis of the muscles in the face, or pain in the face, the chin, or the neck that does not go away.

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Head and neck cancer facts

Head and neck cancer facts by John P. Cunha, DO, FACOEP

Cancers of the head and neck are identified by the area in which they begin: the oral cavity, salivary glands, paranasal sinuses and nasal cavity, pharynx, larynx (voicebox), and lymph nodes in the neck. Cancers of the brain, eye, thyroid gland, scalp, skin, muscles, and bones of the head and neck are not usually grouped with cancers of the head and neck.
The main causes of head and neck cancers include tobacco (smoked or chewed), and alcohol. Other risk factors are sun exposure, human papillomavirus (HPV) infection, radiation to the head and neck, Asian ancestry, Epstein-Barr virus infection, exposure to wood dust or airborne asbestos, consumption of certain preservatives or salted foods, poor oral hygiene, and Plummer-Vinson (also called Paterson-Kelly) syndrome.
Common symptoms of several head and neck cancer sites include a lump or sore that does not heal, a sore throat that does not go away, difficulty swallowing, and a change or hoarseness in the voice. Symptoms may differ according to the part of the head or neck that is cancerous.
Exams and tests conducted to diagnose head and neck cancer vary depending on the symptoms and may include a biopsy, endoscopy, blood or urine tests, X-rays, CT scans, MRIs, and PET scans.
Treatment for head and neck cancers depends on the exact location of the tumor, the stage of the cancer, and the person's age and general health. Treatment options include surgery, radiation therapy, and chemotherapy. Depending on the location of the cancer and the type of treatment, rehabilitation may include physical therapy, dietary counseling, speech therapy, and/or learning how to care for a stoma after a laryngectomy. Some patients may need reconstructive and plastic surgery.

What are cancers of the head and neck?

Cancers that are known collectively as head and neck cancers usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck (for example, inside the mouth, the nose, and the throat). These squamous cell cancers are often referred to as squamous cell carcinomas of the head and neck. Head and neck cancers can also begin in the salivary glands, but salivary gland cancers are relatively uncommon. Salivary glands contain many different types of cells that can become cancerous, so there are many different types of salivary gland cancer.

Cancers of the head and neck are further categorized by the area of the head or neck in which they begin. These areas are described below and labeled in the image of head and neck cancer regions.

Oral cavity: Includes the lips, the front two-thirds of the tongue, the gums, the lining inside the cheeks and lips, the floor (bottom) of the mouth under the tongue, the hard palate (bony top of the mouth), and the small area of the gum behind the wisdom teeth.

Pharynx: The pharynx (throat) is a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus. It has three parts: the nasopharynx (the upper part of the pharynx, behind the nose); the oropharynx (the middle part of the pharynx, including the soft palate [the back of the mouth], the base of the tongue, and the tonsils); the hypopharynx (the lower part of the pharynx).

Larynx: The larynx, also called the voicebox, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords. It also has a small piece of tissue, called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages.

Paranasal sinuses and nasal cavity: The paranasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose.

Salivary glands: The major salivary glands are in the floor of the mouth and near the jawbone. The salivary glands produce saliva.

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Four simple stretches to relieve neck pain

Neck pain is something most of us feel at some point. Whether it’s from sleeping in an awkward position, sitting still for hours, or a niggling old injury, that painful ache never seems to stay away for too long. While a trip to the physio might be in order to fix the problem long term, there are simple exercises you can do yourself at home to offer relief and ease soreness. Physiotherapist Kusal Goonewardena says these four stretches will gradually increase your range of movement over time. Remember, it’s important when doing any of these exercises not to push through pain. Some discomfort is ok, but pain is not. Gently ease yourself into the stretch and hold it when you feel the resistance without the pain. Trapezius stretch Put your right arm behind your back, put your left arm on your head, and then with your left hand gently tilt your head to the left hand side. Hold for 30 seconds and repeat three times on one side before doing the other. Neck rotation with opposite pressure Turn the head as far as you can tolerate (do not push into pain) and then provide resistance with your hand to the direction you’re going. Hold for three seconds. Release. Continue five times and your range will increase. This activates the muscles in the direction you want to turn. Fist under chin exercise This helps to strengthen the neck and also improve a little traction (stretch to the back of the neck). Make a fist, with your little finger resting on your sternum, and your thumb and forefinger under your chin. Gently use your other hand to push your head forward. Hold for 10 seconds and repeat three times. This helps open up the joints in the neck, therefore reducing pain and increasing mobility. Self massage at the base of the skull Place fingers from both hand either side of your neck bone, right at the base of the skull. You can achieve loosening in the muscles without any equipment, just apply a firm, rotational self-massage for 30 seconds to 1 minute on each side of the skull.

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