What is Whiplash?

Despite having the third safest roads in the world, with 2.9 vehicle deaths per 100,000 people per year, just behind Sweden (2^nd) but ahead of countries such as Switzerland (4^th) and the Netherlands (5^th), the UK has been dubbed the whiplash capital of the world. It was reported by the Association of British Insurers (ABI) that there are more than 1,500 whiplash claims made in the UK every day, which cost the insurance industry a significant amount – estimated at more than £2 billion per year.

The UK government introduced new rules on whiplash claims which came into force on 31^st May 2021. The changes were designed to reduce the unacceptably high number of whiplash claims made each year, with more than 550,000 in 2019/20 alone.

These “whiplash reforms”, which form part of the Civil Liability Act 2018, are a package of measures designed to reduce insurance costs for ordinary motorists and tackle the continuing high number of whiplash claims, with half of all car crashes in England resulting in a whiplash injury (Source Association of Personal Injury Lawyers).

As part of the reforms, the Ministry of Justice (MoJ) commissioned the Motor Insurers’ Bureau (MIB) to develop an online portal for managing low-value road traffic accident (RTA) claims. The intention is that the portal will be suitable for individuals to manage their own claims rather than needing to rely on legal representatives, which increased the costs of a claim.

What is whiplash?

A legal definition of what constitutes a “whiplash” injury is contained in the Civil Liabilities Act. It is defined as an “injury of soft tissue in the neck, back or shoulder that is a sprain, strain, tear, rupture or lesser damage of a muscle, tendon or ligament in the neck, back or shoulder, or an injury of soft tissue associated with a muscle, tendon or ligament in the neck, back or shoulder”.

When your neck is forced beyond its usual range of movement, the soft tissues, tendons, muscles and ligaments may be overstretched or sprained. This causes pain and discomfort in your neck and shoulders and may also cause back pain.

The earliest medical reports that mention whiplash, refer to it as “railway spine”. This term was used in the 19^th century to describe the persistent pain and other “subjective symptoms” that railway passengers and personnel reported following minor railway crashes. Whiplash became a more common injury in the early 20^th century when cars become more widely owned and motor traffic increased.

What causes whiplash?

Whiplash injury is typically the result of an acceleration-deceleration injury. The head is effectively thrown backwards and then forwards in relation to the shoulders. Most often this is the consequence of rear-end or side-impact motor vehicle collisions.

It is a common injury for both drivers and passengers, and it doesn’t take much force, as many whiplash injuries occur in low-speed collisions of between 5 mph and 10 mph. But the injury does not only happen during driving accidents; other incidents can cause whiplash injuries.

Such as:

• Physical abuse, such as being struck or shaken.
• Contact sports, such as football, boxing and some martial arts.
• Horseback riding.
• Cycling collisions or falls.
• Trip, slip or falling accidents, in which the head violently jerks backwards.
• Blows to the head with a heavy object.

Women are more at risk of whiplash injury than men and this is possibly due to the fact that women’s necks tend to have less muscle development and are long and slender. The typical patient with a neck injury is a middle-aged woman who has worn a seat belt when involved in a low-speed crash.

What are the signs and symptoms of whiplash?

Whiplash is thought of as a relatively mild condition, but it can cause long-term pain and discomfort. Symptoms usually appear within 24 hours after the incident that caused the whiplash. Sometimes, symptoms may develop after a few days and they can last for several weeks.

Some of the most common signs and symptoms include:

• Pain in both or one side of the neck and/or upper back.
• Stiffness and loss of movement in the neck and upper back.
• Headaches, coming from the increased tension in the muscles of the neck.
• Pain and bruising along the path of the seat belt.
• Possible radiating pain into the arms/hands.
• Dizziness.
• Blurred vision.
• Constant tiredness.

Some of the less common symptoms associated with chronic whiplash include:

• Problems with concentration and memory.
• Ringing in the ears (tinnitus).
• Inability to sleep well.
• Irritability.
• Chronic pain in the neck, shoulders or head.

Derived from a study of 100 patients by Ronnen, de Korte, Brink, van der Bijl, Tonino and Franke in 1996, it was found that the incidence of symptoms reported by these patients with an acute whiplash injury were:

• Pain and stiffness in the neck and interscapular region 99%.
• Headache (general) 96%.
• Headache in the occipital region 78%.
• Limitation in rotation 49%.
• Limitation in flexion and/or extension 42%.
• Loss of concentration 34%.
• Paraesthesia in the arms or hands 24%.
• Vertigo and dizziness 24%.
• General tiredness 19%.
• Short-term memory disturbances 6%.
• Personality changes 6%.
• Disturbances with word finding 5%.
• Neurological deficit 0%.
• Radicular symptoms 0%.

Recovery from a whiplash injury typically occurs within 6 weeks. However, in some cases, long-lasting symptoms arise, notably neck pain, neck stiffness and headaches.

Following a whiplash injury, if you are experiencing symptoms that have spread to your shoulders or arms, or moving your head becomes painful, or you have numbness or weakness in your arms, you should seek urgent medical assistance by contacting your GP or calling NHS 111 or by going to A & E.

How is whiplash diagnosed?

A doctor will normally ask you questions about your injury, such as:

• How it happened.
• Where you feel pain.
• Whether the pain is dull, shooting or sharp.

They may also do a physical examination to check your range of motion and look for areas of tenderness. In most cases, injuries are to the soft tissues such as the discs, muscles and ligaments, and cannot be seen on standard X-rays, so specialised imaging tests, such as CT scans or magnetic resonance imaging (MRI), may be required to diagnose damage to the discs, muscles or ligaments that could be causing the symptoms of whiplash.

Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. They might perform a series of physical tests as part of your assessment to rule out other possibilities and to gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.

How is whiplash treated?

It is recommended that anyone experiencing whiplash should try to continue doing everyday activities; although it might hurt a little, the movement will speed up recovery. At first, you may need to adapt how you move to take care of your neck. Then gradually build up to your normal activities as your neck improves.

You might need to adapt some of your work or recreational activities for a while to avoid unnecessary strain on your neck, for example, you could make more trips so you don’t have to carry too much shopping at once, cut down on housework or gardening, or if you are a cyclist, lift up the handlebars on your bike so you can change your posture.

Other treatments that may be recommended for individuals with whiplash might include:

• An ice pack – This can help to relieve swelling and pain. Apply this as soon as possible after the injury, for 15 to 20 minutes at a time, and wrap in a tea towel to prevent cold burns.
• Pain medications such as paracetamol or ibuprofen, to help with pain – A GP may prescribe a stronger painkiller such as codeine.
• Nonsteroidal anti-inflammatory drugs.
• Antidepressants.
• Muscle relaxants.
• A range of motion exercises.
• Additional heat applications may relieve muscle tension.
• Physiotherapy and cervical traction may also be prescribed.

Additionally, recovery treatments may include:

• Exercises to build strength and flexibility in your neck.
• Practising good posture.
• Learning relaxation techniques to keep your neck muscles from straining and to help with recovery.

Alternative remedies to help to treat the pain might include:

• Chiropractic care – This is a treatment where a chiropractor practitioner uses their hands to help relieve problems with the bones, muscles and joints.
• Massage – Which may relieve some of the tension in the neck muscles.
• Electrical nerve stimulation – Which involves a gentle electric current that may help reduce neck pain.
• Acupuncture – Though no studies confirm acupuncture’s ability to ease neck pain.

Whilst you should remain active following a whiplash injury, there are a number of activities that you should try to avoid.

These include:

• Heavy lifting.
• Pushing or pulling movements.
• Contact sports like rugby and boxing.
• Lifting, bending or carrying out repetitive twisting movements.

What are the complications of a whiplash injury?

In serious whiplash injuries, there may be damage to the nerves, or fracture or dislocation of the neck. Some people with whiplash experience chronic (long-term) pain or headaches for years after the event that caused the initial injury.

Doctors may be able to trace this pain to damaged neck joints, discs and ligaments, but chronic pain following a whiplash injury typically has no medical explanation.

A wide variety of psychosocial symptoms may also be associated with whiplash including depression, anger, fear, anxiety, PTSD and hypochondriasis.

How to prevent getting whiplash

Modern car design has improved the seating and head restraints in the front of a car to reduce the risk of whiplash; however, many car rear seats have less sophisticated head restraints than those in the front, and most have no head restraints at all in the centre rear seats.

It is, however, still important to adjust your car seat and headrest correctly to minimise your chances of a whiplash injury.

To work well, the top of the head restraint should reach at least as high as the top of your ears, and preferably the top of your head, and be relatively close, 4 inches or less, to the back of your head. A head restraint that is too low or too far back will not protect your head and neck in a crash.

Sit upright, the head restraint can’t help if you are leaning to one side should a crash occur. Adjustable head restraints are the most common type and they can be raised or lowered to the proper height, and many can be tilted toward or away from the head. But they are only effective if drivers and passengers take the time to adjust them properly, which many people don’t, and this increases their risk of serious injury.

For correct posture when driving, adjust your steering wheel so it is level with your chest, not your face. Keep your arms bent and your thumbs on the rim of the steering wheel. Have the seat upright so your back and shoulders have support and sit deep in the seat.

Always wear your safety belt and ensure that any passengers do the same; the seat belt helps you stay in position during a crash.

Always leave plenty of room between your car and the car in front, so that if the car in front of you stops suddenly, you won’t have to slam on your brakes, jolting you forward and surprising the driver behind you.

If you see a crash coming or hear the squeal of tyres behind you and you have time to react, position yourself for a crash – lean back so that your head is touching the head restraint and look straight ahead. This will help to minimise any whiplash effect.

What is the average amount of compensation for whiplash?

If the accident happened before 31^st May 2021 then the awards will be calculated in line with the Judicial College Guidelines.

As of 31^st May 2021, the way whiplash injuries are awarded has changed for road traffic accidents alone because of the Whiplash Reform Programme. These changes only apply to accidents on or after this date. There are numerous factors that need to be considered when compensation for a whiplash injury is being calculated. The Whiplash Injury Regulations 2021 detail the scope and damages for whiplash injuries.

The measures in the Whiplash Reform Programme act to reduce fraud. The ban on seeking or making offers to settle claims without medical evidence ensures that insurers can no longer choose to settle claims for financial reasons, without investigating and verifying that the claim is genuine.

Additionally, the increase in the small claims track limit reduces the costs associated with civil litigation, encouraging greater challenge to potentially fraudulent claims.

Under the new regulations, the minimum payout for whiplash in the UK is £240, with the maximum being £4,345. However, the average amount of compensation in the UK for a whiplash claim is between £1,000 and £3,000 for milder injuries where there is some discomfort and headaches lasting from a few days to a few weeks.

More severe whiplash injuries with longer-term symptoms can settle for up to almost £100,000 in the most serious cases.

In addition to compensation for the injury incurred, losses you may be able to recover under special damages can include the following:

• Loss of earnings due to having to take unpaid time off work while recovering from your whiplash injury.
• Costs of receiving medical treatment for your whiplash injury.
• Travel expenses that you have incurred when travelling to medical appointments, or the cost of public transport if you are unable to drive.

It is really important that you keep a record of anything that should be included in special damages – this can include bills and receipts for costs you have incurred. Without evidence, expenses won’t be able to be included.

Final thoughts

A whiplash injury can be very painful and may result in having to take time off work to recover, so if you have suffered a whiplash injury and are considering seeking compensation you can visit the Official Injury Claim website which hosts a breadth of resources including a Guide to Making a Claim and links to various guides on the OIC YouTube channel.

Official Injury Claim is an impartial, free-to-use service that has been developed by the Motor Insurers’ Bureau (MIB). It can be used to claim up to £5,000 for personal injury, rising to a total of £10,000 when financial losses are included as well.