Whiplash associated disorder

General

Grade	Description
0	No complaints, no signsᵃ
1	Neck pain or stiffness or tenderness, no signs
2	Above symptoms with reduced range of motion or point tenderness
3	Above symptoms with weakness, sensory deficit, or absent deep tendon reflexes
4	Above symptoms with fracture or dislocationᵃ

Keep in mind that conditions such as occipital neuralgia may occasionally follow whiplash-type injuries and should be treated appropriately

Grade	Evaluation guidelines
Grade 1	Patients with normal mental status and physical exam do not require plain radiographs on presentation.
Grade 2 & 3	C-spine X-rays, possibly with flexion-extension views. Special imaging studies (MRI, CT, myelography...) are not indicated.
Grade 3 & 4	These patients should be managed as suspected spinal cord injury; see initial management of spinal cord injury and sections that follow.

Whiplash is usually a benign condition requiring little treatment and usually resolves in days to a few weeks in most cases.

Recommendation	Grade 1	Grade 2	Grade 3
Range of motion exercises	Should be started immediately for all	Should be started immediately for all	Should be started immediately for all
Encourage early return to regular activities	Immediately	ASAP	ASAP
Cervical collars and restᵃ	No	Not for > 72 hrs	Not for > 96 hrs
Passive modality therapies: heat, ice, massage, TENS, ultrasound, relaxation techniques, acupuncture, and work alteration	No	Optional if symptoms last > 3 wks	Optional if symptoms last > 3 wks
Medications: optional use of NSAIDs and non-narcotic analgesics? (recommended for ≤ 3 wks)	No	Yes	Yes; limited narcotics may also occasionally be needed
Surgery	No	No	Only for progressive neurologic deficit or persisting arm pain

Not Recommended: cervical pillows, soft collars, bed rest, spray and stretch exercises, muscle relaxants medication, TENS, reflexology, magnetic necklaces, herbal remedies, homeopathy, OTC medications (except NSAIDs, see above), and intra-articular, intrathecal, or trigger point steroid injections.
Excluding patients with #, dislocations, or spinal cord injuries.
ᵃsoft foam collars are generally discouraged; if they are to be used, the narrow part should be placed in front to avoid neck extension.

In a study of 117 patients < 56 years of age having WAD due to automobile accidents (excluding those with cervical fractures, dislocations, or injuries elsewhere in the body) conducted in Switzerland (where all medical costs were paid by the state and there was no opportunity for litigation and no compensation for pain and suffering, although there was the possibility of permanent disability)

Of the 21 patients with continued symptoms at 2 yrs, only 5 were restricted with respect to work (3 reduced to part-time work, 2 on disability).
Patients with persistent symptoms were

Older,
Had more varied complaints on initial exam,
Had a more rotated or inclined head position at the time of impact,
Had a higher incidence of pretraumatic headaches,
Had a higher incidence of certain pre-existing findings (such as radiologic evidence of cervical osteoarthritis).

The amount of damage to the automobile and the speed of the cars had little relationship to the degree of injury, and outcome was not influenced by gender, vocation, or psychological factors.