Short answer
Clinical practice guidelines for whiplash recommend staying active, starting gentle neck exercises early, and, for many people, combining exercise with hands-on care such as spinal manipulation or mobilization. In the early phases of healing, we also use passive care such as electrical muscle stimulation, heat and massage to calm pain and muscle spasm, always alongside adjustments and rehab. Resting in a soft neck collar is not recommended. Most people improve, but some still have neck pain a year later, so getting examined and following a plan matters.
What whiplash is
Whiplash is a neck injury caused by a sudden back-and-forth movement of the head, most often in a rear-end car crash. The muscles, ligaments, joints and discs of the neck can all be strained. Symptoms often include neck pain and stiffness, headaches, shoulder or upper back pain, and sometimes dizziness or tingling in the arms. They commonly build over the first day or two.
Our doctors grade whiplash injuries with the Croft grading scale, the system used in our chart notes (Croft, 1993):
| Grade | Severity | What it means |
|---|---|---|
| I | Minimal | No loss of motion, no ligament injury, no neurological findings |
| II | Slight | Loss of motion, no ligament injury, no neurological findings |
| III | Moderate | Loss of motion, some ligament injury, neurological findings may be present |
| IV | Moderate to severe | Loss of motion, ligament instability, neurological findings, fracture or disc injury |
| V | Severe | Needs surgical treatment or stabilization; chiropractic care follows surgery |
Grade V, and any fracture or dislocation, is treated first by a surgeon or in a hospital.
First, rule out a serious injury
Go to an emergency room or call 911 first if you have severe head or neck pain, weakness or numbness on one side, confusion, repeated vomiting, loss of consciousness, or loss of bladder or bowel control. A whiplash exam should also include concussion screening, because the same crash forces that strain the neck can injure the brain.
Every auto-injury exam at our Oregon City, Milwaukie and Troutdale clinics includes concussion screening.
What helps, according to the research
- Stay active and keep moving. In a randomized trial of 97 people with whiplash after car crashes, those taught frequent, gentle neck rotation exercises had less pain and less time off work than those told to rest and wear a soft collar, and the difference held at three years (Rosenfeld et al., 2003).
- Neck exercises. For whiplash in the first three months, the Ontario Protocol for Traffic Injury Management (OPTIMa) guideline recommends range-of-motion exercises with patient education, and supervised strengthening exercises when there are neurological signs (Côté et al., 2016).
- Exercise combined with hands-on care. The same guideline and a chiropractic guideline from the Canadian Chiropractic Guideline Initiative both suggest multimodal care: exercise combined with manipulation or mobilization (Côté et al., 2016; Bussières et al., 2016).
- Clinical massage, not just relaxation massage. A systematic review for the OPTIMa collaboration found mobilization, manipulation and clinical massage effective for neck pain, while relaxation massage was not (Wong et al., 2016).
- Education and reassurance. Guidelines advise explaining the usual course of recovery and the importance of staying active, together with exercise rather than education alone (Côté et al., 2016).
- Passive care in the acute and subacute phases (our approach). While tissues are inflamed and starting to repair, our doctors use electrical muscle stimulation, heat and therapeutic massage to calm pain and muscle spasm, so you can move, tolerate adjustments and start your exercises. Passive care is one part of the plan, used alongside adjustments and rehab, and it tapers off as you move into the active strengthening phase.
What the research says to skip
- Soft neck collars. The OPTIMa guideline advises against a cervical collar (Côté et al., 2016).
- Passive treatments on their own. Heat, electrical stimulation and similar treatments used alone, without adjustments or rehab, did not hold up in research reviews (Wong et al., 2016). That is why we use them only as part of a full plan.
- Long rest. Rest and a collar did worse than early active care over three years (Rosenfeld et al., 2003).
How long whiplash treatment takes
Our doctors use the Croft treatment guidelines to set how often and how long you are seen. The guidelines give the upper limits for each grade (Croft, 1993):
| Grade | Visits per week, in order | Up to (total time) | Up to (total visits) |
|---|---|---|---|
| I, minimal | Daily for 1 week; 3 a week for 1 to 2 weeks; 2 a week for 2 to 3 weeks; once a week for up to 4 weeks | about 11 weeks | 21 |
| II, slight | Daily for 1 week; 3 a week, 2 a week and once a week for up to 4 weeks each; then monthly for up to 4 months | 29 weeks | 33 |
| III, moderate | Daily for 1 to 2 weeks; 3 a week, 2 a week and once a week for up to 10 weeks each; then monthly for up to 6 months | 56 weeks | 76 |
| IV, moderate to severe | Daily for 2 to 3 weeks; 3 a week for up to 16 weeks; 2 a week for up to 12 weeks; once a week for up to 20 weeks; may need ongoing monthly or as-needed care | as needed | as needed |
| V, severe | Surgical stabilization first; chiropractic care follows surgery |
These are maximums, not a fixed prescription. Dr. Croft’s guidelines state they are not meant as set treatment plans: many patients need fewer visits, some with complicating factors need more, and care stops when you are back to your pre-injury condition or further care no longer helps. We re-examine you along the way and release you from care when you are ready.
Whiplash can also linger: a 2019 review in PM&R reported that prognosis studies indicate about half of people injured in a crash still have neck pain a year later (Nolet et al., 2019).
What whiplash treatment looks like at our clinics
- Exam: history, neck and nerve testing, concussion screening, and imaging only if your exam calls for it.
- Written plan: your Croft grade, your goals, the visit schedule for your grade, and how we will measure progress.
- Hands-on care: chiropractic adjustments or gentler mobilization, and soft-tissue work or clinical massage when it fits your injury, with electrical muscle stimulation and heat in the early phases to calm pain and spasm.
- Home exercises from day one: neck and whiplash home exercises, as your provider directs.
- Re-exams: we track your progress and adjust the plan, refer you to a medical doctor if anything worsens or new symptoms appear, and discharge you when you have recovered.
When to see a medical doctor
See a physician promptly if your symptoms are getting worse, if new numbness, weakness or other neurological symptoms appear, or if neurological signs continue more than three months after the crash (Côté et al., 2016). We refer when your exam calls for it.
Paying for whiplash treatment in Oregon
Oregon PIP pays reasonable and necessary medical expenses from your own auto policy, at least $15,000 per person, for care within two years of the crash (ORS 742.524(1)(a)).
How Oregon PIP pays for your care
Auto Injury Chiropractic
Get care near you
Oregon City
1404 Molalla Ave
Oregon City, OR 97045
Mon to Thu 9:00am to 6:00pm
Fri 9:00am to 1:00pm
Milwaukie
13152 SE Rusk Rd
Milwaukie, OR 97222
Mon to Thu 9:00am to 6:00pm
Fri 9:00am to 1:00pm
Troutdale
233 E Columbia River Hwy
Troutdale, OR 97060
Mon to Thu 9:00am to 6:00pm
Fri 9:00am to 1:00pm
Return to a pain-free life.
Common questions
Does chiropractic help whiplash?
Guidelines suggest combining exercise with manipulation or mobilization for many people with whiplash (Côté et al., 2016; Bussières et al., 2016). Your exam decides which approach fits your injury.
Should I wear a neck brace?
Usually not. Guidelines advise against a soft collar, and early gentle movement led to better long-term results than rest and a collar (Côté et al., 2016; Rosenfeld et al., 2003).
Should I use ice or heat?
In the early phases, we often use heat in the clinic, along with electrical muscle stimulation and massage, to ease pain and spasm before adjustments and exercise. At home, use whichever eases stiffness enough to keep you moving.
How soon should I start treatment?
As soon as serious injury has been ruled out. Early active care is what the research supports, and an exam soon after the crash also documents your injuries.
How many visits will I need?
It depends on your Croft grade and how you respond. For a minimal (grade I) injury, the guidelines allow up to about 21 visits over about 11 weeks; for a moderate (grade III) injury, up to 76 visits over 56 weeks. Most people need fewer than the maximum, and we re-examine you along the way.
References
- Côté P, Wong JJ, Sutton D, et al. Management of neck pain and associated disorders: a clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J. 2016;25(7):2000-2022. https://doi.org/10.1007/s00586-016-4467-7
- Bussières AE, Stewart G, Al-Zoubi F, et al. The treatment of neck pain-associated disorders and whiplash-associated disorders: a clinical practice guideline. J Manipulative Physiol Ther. 2016;39(8):523-564.e27. https://doi.org/10.1016/j.jmpt.2016.08.007
- Wong JJ, Shearer HM, Mior S, et al. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. Spine J. 2016;16(12):1598-1630. https://doi.org/10.1016/j.spinee.2015.08.024
- Rosenfeld M, Seferiadis A, Carlsson J, Gunnarsson R. Active intervention in patients with whiplash-associated disorders improves long-term prognosis: a randomized controlled clinical trial. Spine. 2003;28(22):2491-2498. https://doi.org/10.1097/01.BRS.0000090822.96814.13
- Nolet PS, Emary PC, Kristman VL, et al. Exposure to a motor vehicle collision and the risk of future neck pain: a systematic review and meta-analysis. PM R. 2019;11(11):1228-1239. https://doi.org/10.1002/pmrj.12173
- Croft AC. Treatment paradigm for cervical acceleration/deceleration injuries (whiplash). ACA J Chiropr. 1993;30(1):41-45. Also published in Foreman SM, Croft AC, eds. Whiplash Injuries: The Cervical Acceleration/Deceleration Syndrome. 2nd ed. Williams & Wilkins; 1995.