Whiplash Injuries:
Changing Perspectives

Motor vehicles have been humanity’s primary methodology of transportation for only about a hundred years. Neck injuries from motor vehicle collisions are commonly referred to as “whiplash injuries.”

Technically, “whiplash” would only pertain to the mechanism of injury rather than the type of injury. However, such a distinction is blurred by the public, by healthcare providers, the insurance industry, and attorneys.

Prior to automobiles, the precursor to “whiplash injury” was “railway spine.” The syndrome of “railway spine” was diagnosed in persons injured in train accidents in the nineteenth century (1).

The first substantial medical study of “railway spine” was by John Eric Erichsen, in On Railway and Other Injuries of the Nervous System, published in 1864. Dr. Erichsen was a Professor of Surgery at University College in London. Erichsen took the view that (2):

“Minor injuries of the head and spine could result in severe disability due to ‘molecular disarrangement’ or anemia of the spinal cord.”

Erichsen’s second book on the subject was published in 1882, titled On Concussion of the Spine: Nerve Shock and Other Obscure Injuries of the Nervous System in the Clinical and Medico-Legal Aspects (3):

“Erichsen and other physicians considered that the symptoms in the spine were due to the excessive speeds of the trains and that the human body could not cope with speeds.” (1)

•••••

During World War I (1914-1918), a whiplash mechanism injury was recognized in test pilots for the US Navy. Planes were launched from the decks of battle ships and cruisers by the catapult method, and these planes did not have head restraints (1):

“The violent force on the cervical spine in catapulting was great enough to cause a blackout for a few seconds and accidents occurred that were undoubtedly due to the whiplash effect.”

•••••

By 1919, cases of neck injuries following mild or low impact automobile accidents were increasing. X-rays, when taken, noted the cervical spine to be “normal.” Recommended treatment during this era was to use “orthopaedic supports, manipulation, exercises and physical therapy.” (1)

The term “whiplash” was first used in 1928 to “describe the effects of sudden acceleration-deceleration forces in motor vehicle accidents which resulted in injuries to the cervical spine,” at the symposium of the Western Orthopaedic Association in San Francisco. The presenter, orthopedic surgeon Harold Crowe, MD, reported on eight cases of neck pain caused by motor vehicle collisions. The 1928 symposium proceedings were not published, and the first published use of the term “whiplash” occurred in 1945 by American orthopedist surgeon Arthur E. Davis, MD (1, 4). Dr. Davis’s publication appeared in the Journal of the American Medical Association (5).

By 1953 it was observed that a rear-end collision resulted in the majority of these whiplash injuries (6). Initial thoughts were that the vehicle collisions resulted in cervical spine hyperflexion, followed by rebound hyperextension inertial injuries of the joints and tissues of the cervical spine (6). However, this would discount Newton’s 1687 Laws of Inertia; surprisingly, these early whiplash clinicians did not seem to understand Newton’s Laws.

Drs. Gay and Abbott were quickly rebutted, and the mechanisms of rear-end collision inertia were corrected. Physician Kirk Cammack, MD, noted in his 1957 publication that earlier whiplash publications seemed to be unfamiliar with Newton’s laws of motion when they believed that the first phase of a rear-end collision was cervical spine flexion. Dr. Cammack clearly notes that the first phase of a rear-end collision is cervical spine extension. He also criticized other early studies that appear to have gotten it incorrect (7).

Soon, the best reference texts pertaining to rear-end motor vehicle collisions also corrected the earlier error: the first phase of a rear-end motor vehicle collision is extension/hyperextension of the struck vehicle’s occupant’s head (8, 9, 10, 11, 12).

•••••

The understanding of whiplash biomechanics was forever changed in 1997. Researchers from Yale University School of Medicine performed a series of rear-end collisions on human cadavers while imaging their biomechanics with cineradiography (13). The results established that during the earliest phase of collision mechanics, the cervical spine forms an “S” shaped configuration, with flexion of the upper cervical spine and simultaneous significant hyperextension of the lower cervical spine. The tissue distortion noted during this “S” configuration of the cervical spine was of a magnitude that is injurious, especially in the lower cervical spine. As the subjects used in this initial assessment were cadavers, skepticism as to the relevance to live humans in real life collisions remained. This skepticism was mitigated within a few years with follow-up studies.

In 1999, similar cineradiography studies were performed on live human volunteers (14). The results were the same as those of the cadaver studies, solidifying the concept that the cervical spine undergoes an “S” configuration during a rear-end motor vehicle collision, primarily injuring structures of the lower cervical spine. Essentially all articles published after 1999 regarding whiplash biomechanics cite these studies, noting that the pathology of whiplash primarily occurs during this “S” configuration. A representative article from 2007 states (15):

“The forward acceleration of the torso deforms the cervical spine into a non-physiologic S-shaped curve, with extension developing between the lower segments and flexion developing between the uppermost segments. Most of the whiplash injury occurs during this deformation phase.”

“The cervical facet joint is the most common source of chronic neck pain after whiplash injury.”

Injury to the facet joints and their capsular ligaments as a consequence of the “S” configuration is emphasized in other publications, including (14):

“The zygapophysial joint is the suspected origin of neck pain after rear-end car collision.”

“Most whiplash injuries occur during low-speed rear-end collisions and rarely produce morphologic changes such as fracture of the joint. The zygapophysial joint is a synovial joint and has a synovial fold (meniscus), between the articular facets that is innervated with nociceptive receptors. Thus, we hypothesize that facet collisions are likely to impinge on and inflame the synovial folds in the zygapophysial joints, causing neck pain (facet synovial fold impingement syndrome).”

Other studies support the premise of whiplash-mechanism facet joint injury and pain (16, 17, 18, 18, 20, 21, 22, 23, 24).

•••••

In 1995, the understanding of whiplash injuries was greatly updated with the publication of (25):

Scientific Monograph of the Quebec Task Force
on Whiplash-Associated Disorders:
Redefining “Whiplash” and its Management

In this comprehensive review of the literature, the authors evaluated more than 10,000 articles. The authors categorized whiplash signs/symptoms as follows:

• Grade O: No complaints about the neck, no physical signs
• Grade I: Neck complaints of pain, stiffness, or tenderness only; no physical signs
• Grade II: Neck complaint AND musculoskeletal signs (decreased range of motion and point tenderness)
• Grade III: Neck complaint AND neurological signs (decreased or absent deep tendon reflexes, weakness, and sensory deficits)
• Grade IV: Neck complaint AND fracture or dislocation

Symptoms and disorders that can be manifest in all Quebec grades include deafness, dizziness, tinnitus (ringing in the ears), headache, memory loss, dysphagia (difficulty swallowing), and temporomandibular joint pain.

The authors noted that the most common presenting symptoms after whiplash-type injury are:

• Neck pain (88 – 100%)
• Headache (54 – 66%)

•••••

The entire December 1, 2011 supplement of the journal Spine is dedicated to whiplash trauma (21). The issue contains 27 articles by the world’s foremost authorities on whiplash biomechanics, pathology and outcomes, including the physician/clinical anatomist, Nikoli Bogduk, from Australia. Dr. Bogduk’s article in this issue of Spine is titled, “On Cervical Zygapophysial Joint Pain After Whiplash” (21).

Dr. Bogduk cites 72 references while summarizing the evidence that implicates the cervical zygapophysial joints (facets) as the leading source of chronic neck pain after whiplash trauma. He states that the pathoanatomic basis for neck pain after whiplash is not elusive, but rather well documented and well known. Dr. Bogduk notes that there is convergent validity from:

• Whiplash postmortem studies
• Whiplash biomechanics studies
• Whiplash clinical studies

These studies and diverse methods of investigation indicate that the primary source of chronic whiplash pain is injury to the cervical zygapophysial (facet) joints. Dr. Bogduk states:

“Collectively, these various biomechanics studies, in normal volunteers and in cadavers, predict or produce the same spectrum of lesions as that identified in postmortem studies. In particular, they indicate that the zygapophysial joints can be injured.”

“The zygapophysial joints are the single, most common source of pain in patients with chronic neck pain after whiplash.”

There is an extensive amount of evidence indicating that post-whiplash pain syndrome is attributed to injury to the cervical facet joints; no other explanation for whiplash pain has more evidence.

•••••

Effective Clinical Approach

The whiplash injury is considered to be a “soft tissue injury” because fracture of bone is rare. For many decades, publications have advocated early mobilization, soft tissue work, exercise, and even manipulation (a form of passive mobilization) for the optimum management of injured soft tissues (27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41). This includes an article published earlier this year (2026), in the journal Scientific American, titled (42):

Heal Injuries Faster:
Toss Out the Old Advice that
Rest is the Best Recovery Strategy

This article notes:

“In most cases, limiting motion does not promote healing. In fact, immobilization causes muscles to weaken and lose stability. An injured body part that is immobilized for too long is more likely to move from acute to chronic pain.”

“Instead of rest, ‘motion is the potion,’ and it is important to move far sooner than many imagine.”

“Injured tissue sends signals to the brain. Which is where we perceive pain.”

•••••

Over the decades, published studies have also specifically assessed the outcomes of chiropractic spinal adjusting (specific line-of-drive manipulation) for the management of the whiplash-injured patient and for the management of neck pain in general. The outcomes have been very good, especially when considering that many of the patients had already failed to respond to other types of management, including drugs and physical therapy. A few of these studies are present below.

•••

In 1996, clinicians from the University Department of Orthopaedic Surgery, Bristol, United Kingdom, published a study in the journal Injury, titled (43):

Chiropractic Treatment
of Chronic ‘Whiplash’ Injuries

The authors note, “the whiplash syndrome is a cause of long-term symptoms for which conventional medicine has failed to discover an effective treatment.” They note that 43% of patients will suffer long-term symptoms following ‘whiplash’ injury, for which no conventional treatment has proven to be effective. Consequently, they performed a retrospective study to determine the effects of chiropractic spinal manipulation in a group of 28 patients who were suffering with chronic ‘whiplash’ syndrome.

The 28 patients in this study had initially been treated with anti-inflammatory drugs, soft collars, and physiotherapy. These patients had all become chronic and were referred for chiropractic at an average of 15.5 months (range was 3–44 months) after their initial injury. At the initial evaluation and prior to chiropractic treatment, 27/28 (96%) of the patients suffered from intrusive or disabling symptoms. Following the chiropractic care, 93% of the patients had improved. The authors concluded:

“The encouraging results from this retrospective study merit the instigation of a prospective randomized controlled trial to compare conventional with chiropractic treatment in chronic ‘whiplash’ injury.”

“The results of this retrospective study would suggest that benefits can occur in over 90% of patients undergoing chiropractic treatment for chronic whiplash injury.”

•••

In 1999, the same group of clinicians from the University Department of Orthopaedic Surgery, Bristol, United Kingdom, published a study in the Journal of Orthopaedic Medicine, titled (44):

A Symptomatic Classification of Whiplash Injury
and the Implications for Treatment

The study was a retrospective review involving 93 consecutive chronic whiplash-injured patients. The authors note:

“Conventional treatment of patients with whiplash symptoms is disappointing.”

“In chronic cases, no conventional treatment has proved successful.”

All patients underwent chiropractic spinal manipulation, defined as a “high velocity, low amplitude thrust to a specific vertebral segment.” Patients underwent a mean of 19.3 treatments (range 1-53), over a period of 4.1 months.

The authors note that their results “confirm the efficacy of chiropractic, with 69 of our 93 patients (74%) improving following treatment.” The authors concluded:

“The results from this study provide further evidence that chiropractic is an effective treatment for chronic whiplash symptoms.”

“Chiropractic is the only proven effective treatment in chronic [whiplash] cases.”

•••

In 2004, a group of physiotherapists, physicians, and professors from the Rey Juan Carlos University, Spain, published a study in the Journal of Whiplash & Related Disorders, titled (45):

Manipulative Treatment vs.
Conventional Physiotherapy Treatment
in Whiplash Injury:
A Randomized Controlled Trial

The authors note that the goal of joint manipulation is to restore maximal, pain-free movement of the musculoskeletal system. This study was a randomized controlled trial using 380 acute whiplash injury (less than 3 months duration) subjects. All subjects were Quebec Task Force classified as grades II and III. The authors note:

“Patients who had received manipulative treatment needed fewer sessions to complete the treatment than patients who had received physiotherapy treatment.”

“Patients of manipulative group needed an average of 9 sessions to complete the treatment, whereas physiotherapy group needed an average of 23 sessions.”

“Results showed that the manipulative group had more benefits than the physiotherapy group in the visual analog scale and cervical range of motion.”

“Our clinical experience with these [whiplash-injured] patients has demonstrated that manipulative treatment gives better results than conventional physiotherapy treatment.”

“This clinical trial has demonstrated that head and neck pain decrease with fewer treatment sessions in response to a manipulative treatment protocol as compared to a physiotherapy treatment protocol among patients diagnosed with acute whiplash injury.”

Manipulation is “effective in the management of whiplash injury.”

“Manipulative treatment is more effective in the management of whiplash injury than conventional physiotherapy treatment.”

••••

In 2015, researchers and clinicians from the Orthopedic University Hospital Balgrist, University of Zurich, Switzerland, published a study in the Journal of Manipulative and Physiological Therapeutics, titled (46):

Prognostic Factors for
Recurrences in Neck Pain Patients
Up to 1 Year After Chiropractic Care

This was a prospective cohort study assessing 545 neck pain patients. After a course of chiropractic spinal manipulation, they were followed up for one year regarding recurrence of their neck pain. The results of this study are impressive:

• Fifty-four (54) participants (11%) were identified as “recurrent.”
• Four hundred ninety-one (491) participants (89%) were not recurrent.

The authors state:

“89% of neck pain patients had recovered from their neck pain episode up to 1 year after receiving chiropractic care.”

“The results of this study suggest that recurrence of neck pain within 1 year after chiropractic intervention is low.”

•••

In 2024, a study was published in the Journal of Bodywork & Movement Therapies, titled (47):

The Symptom Profile of People
with Whiplash-Associated Disorder:
A Mixed-Method Systematic Review

The authors aimed to identify the symptoms, impairments, activity limitations, and participation restrictions of people with whiplash-associated disorder. They assessed 53 studies involving 102,943 people with whiplash injuries. The analysis identified 309 different symptoms, impairments, and activity limitations. The authors found:

“At one year, nearly half of the injured report neck pain and 10–25% experience a significant decline in functional capacity and health.”

Study findings include:

• 89% had neck pain
• 75% had shoulder pain
• 70% had headache
• 60% had lower and upper back pain
• The most common impairments were related to neck movements (72%) and sleeping (66%)

The authors concluded:

“The studies reporting the severity of symptoms, restrictions related to leisure activity, household tasks, education, and work were considered relatively significant.”

“Neck pain is the most common symptom and caused several activity limitations and participation restrictions, [yet] most people also experienced pain in other regions, such as the head, shoulders, and upper and lower back.”

“Healthcare professionals, colleagues, employers, people around, and insurance companies were perceived to underestimate the symptoms caused by a whiplash injury.”

Assuming that the majority of the 102,943 whiplash-injured subjects in this review were managed with traditional approaches, the high incidence of chronic pain and ongoing levels of impairments/disabilities speaks to the shortcomings of traditional management approaches. Evaluation of unconventional approaches, including chiropractic care, is necessary.

•••

In 2025, a study was published in the journal Pain, titled (48):

Evidence for Peripheral Neuroinflammation
after Acute Whiplash

The authors point out that Scientific Monograph of the Quebec Task Force on Whiplash-Associated Disorders from 1995 noted that (25):

Grade II: Neck complaint AND musculoskeletal signs.

Grade III: Neck complaint AND neurological signs.

The authors also note that:

“Most people are classified as having whiplash-associated disorder grade II, with neck complaints and musculoskeletal signs, in the absence of frank neurological signs.”

Yet, through meticulous investigations on 122 whiplash subjects and 43 healthy control subjects, chronicity was commonplace. They state:

“Prognosis remains poor with approximately 50% of people living with pain and disability 5 years after [whiplash] injury.”

The authors assessed the study subjects using MRIs, nerve mechanosensitivity, serum inflammatory mediators (cytokines), muscle strength, deep tendon reflexes, light touch, and vibration sensation. Their findings led them to believe that many Grade II patients actually have signs of the more complex Grade III injuries, suggesting that these patients are suffering from neuroinflammation. They also point out that neuroinflammation requires a different approach to management, stating:

Patients with WAD II and neuroinflammation “need to reconsider their management.”

“Clinicians should be mindful of the potential for nerve involvement in some patients presenting as WAD II and ensure a comprehensive examination of the nervous system.”

“The broad definition of WAD II has faced scrutiny because studies have identified sensory deficits [frank neurological signs] in people classified under WAD II, such as reduced vibration thresholds and thermal hypoesthesia.”

The authors advocate that the best management for WAD II patients with neuroinflammation would include the approach that chiropractors routinely use, stating:

“Exercise and joint mobilizations for pain relief .... may be the most appropriate for managing people with WAD II.”

•••

Recently, in 2025, a study was published in the BMJ Open, titled (49):

Effectiveness of Musculoskeletal Manipulations
in Patients with Neck Pain:
A Systematic Review and Network Meta-analysis

The authors systematically summarized the available evidence on musculoskeletal manipulations for neck pain and identified the most effective type of musculoskeletal manipulation. They assessed a total of 101 randomized controlled trials (RCTs) involving 7,633 subjects. The interventions included manual therapy (manipulation), soft tissue techniques, and mobilization. Multimodal treatment included combinations of these interventions. The authors note:

“Musculoskeletal manipulation includes a range of non-invasive physical treatment modalities applying targeted forces to articular structures and soft tissues, with the aim of facilitating immediate functional enhancement while promoting sustained tissue repair and remodeling.”

“Current reviews of randomized controlled trials have supported the effectiveness of musculoskeletal manipulations, making them widely adopted in clinical practice as the primary option.”

“Musculoskeletal manipulations are recommended as the first-line treatment for neck pain in clinical practice guidelines, valued for their non-invasive and cost-effectiveness.”

“Several non-invasive interventions are recommended for neck pain, such as exercise, acupuncture and musculoskeletal manipulations.”

The authors summarize the outcomes of their study by stating:

“Findings indicate that multimodal treatment, the soft tissue technique, manipulation, manual therapy, and mobilization effectively alleviate the intensity of neck pain and neck disability, with multimodal treatment being the optimal choice.”

“Multimodal treatment (the combined use of two or more musculoskeletal manipulations) is the most effective intervention for reducing both neck pain intensity and neck disability.”

SUMMARY

Whiplash injury is an inertial soft tissue injury. The best management for these injuries involves early, persistent controlled motion, including chiropractic spinal adjusting (specific joint manipulation). Chiropractic care has proven to help patients who have failed to improve with more traditional treatment approaches. Chiropractic spinal adjusting is both effective and safe for patients suffering with neck pain, including patients with neck pain initiated by a whiplash injury. The evidence supports spinal manipulation for both acute and chronic neck pain. The evidence also shows that spinal manipulation is not only effective, but the benefits are also long-lasting with only a small incidence of recurrence.

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“Authored by Dan Murphy, D.C. Published by ChiroTrust® – This publication is not meant to offer treatment advice or protocols. Cited material is not necessarily the opinion of the author or publisher.”