GPAtlas🧭 When to suspect
Whiplash describes an acceleration–deceleration injury to the neck – a sudden hyperextension–flexion of the cervical spine, with or without rotation, that strains the soft tissues. The commonest cause is a rear-impact road traffic collision (RTC), though side-impact crashes, sporting injuries, falls and assaults can all produce it. The resulting clinical picture is termed a whiplash-associated disorder (WAD).
Typical features are neck pain and stiffness with reduced movement, often accompanied by occipital headache, interscapular or shoulder pain, dizziness, or jaw pain. Symptom onset is characteristically delayed – frequently developing the day after the collision – so a reassuring first review can be followed by worse symptoms 24–48 hours later.
Two clinical priorities run through every assessment: first, safely exclude a serious cervical injury (fracture, instability, cord compression, or vertebral artery dissection) using the Canadian C-spine rule; and second, reassure and mobilise, since the large majority recover within weeks to a few months. Imaging is not required when red flags are absent.
| WAD grade | Clinical features | Implication |
|---|---|---|
| 0 | No neck complaint, no physical signs | No specific treatment |
| I | Neck pain, stiffness or tenderness only; no physical signs | Reassure, mobilise, simple analgesia |
| II | Neck complaint plus musculoskeletal signs (reduced range of movement, point tenderness) | Reassure, mobilise, analgesia ± physiotherapy |
| III | Neck complaint plus neurological signs (weakness, sensory loss, reduced reflexes) | Assess for radiculopathy/myelopathy; specialist review |
| IV | Neck complaint plus fracture or dislocation | Emergency – immobilise, 999 / emergency department |
Source: NICE · Quebec Task Force classification
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