Whiplash injury may extend far beyond the neck, and may involve even the soft tissues of the pelvis. For permanent recovery, all the
injuries must be evaluated and treated together. When impact from the rear snaps the head back and then forward, posterior subluxations in the cervical spine cause anterior-posterior narrowing of the intervertebral foramina, which may result in injury to the cervical nerve roots. Impact at the front, causing hyperflexion followed by hyperextension, has a similar effect although usually not as severe. Resulting symptoms may not appear until two or three weeks later, when irritative lesions have developed because of
hemorrhage or swelling. Mild or progressive degenerative changes may cause no symptoms but may predispose the affected area to injury following some slight
trauma. Capsular ligaments of the lateral intervertebral joints are especially liable to
whiplash injury which may give rise to
scars and adhesions that compress spinal nerves. Sympathetic system involvement may cause reflex and
referred pain. Detailed neurologic, roentgen and electromyographic studies may be necessary for proper evaluation of
injuries. Seemingly psychosomatic
pain or disability is likely to have some physical basis in
whiplash injuries. In 33 patients with
whiplash injury, some recently injured and some chronically disabled with persistent symptoms, good results were observed following hydromassage, hot packs, joint mobilization exercises and, in a few, cervical or pelvic
traction.