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 resulting clinical picture is termed a whiplash-associated disorder (WAD).
The commonest cause is a rear-impact road traffic collision (RTC), though side-impact crashes, sporting injuries, falls and assaults can all produce it.
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.
• 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 or emergency department |
Source: NICE · Quebec Task Force classification
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