Whiplash

We start with how it happened: the direction of the hit or the fall, whether you struck your head, and how your symptoms have changed since. Then we look at how far your head turns, tilts and nods, where the movement catches, and whether the muscles on either side are holding the neck rigid. We test the nerves to your arms, which a hard jolt can irritate. We also ask about headaches and dizziness.

After a car crash, a doctor or nurse practitioner should check you before physiotherapy starts, to rule out a broken bone or another injury needing medical care. We also screen for a concussion from the same crash or fall, and refer you on if we find signs of one.

A collar and bed rest tend to slow recovery, so gentle movement from early on is the approach we use. We pitch activity so your pain is no more than a little worse for it, then build from there. Treatment often includes:

• Early movement: small, frequent turns and nods within comfort, with the range growing as the sprain settles.
• Hands-on treatment: once the neck allows it, we mobilize the stiff joints of the neck and upper back and work the sore tissue around them. See manual therapy.
• Massage therapy: a registered massage therapist works on the tension and spasm in the muscles guarding the sprain, between physiotherapy visits. See massage therapy.
• Exercise: range first, then endurance for the deep neck muscles and the muscles between the shoulder blades, which hold your head up through a shift or a ride.
• Headaches and dizziness: treated as they come up: neck treatment when the headache starts in the neck, and head-movement and gaze exercises when the dizziness does.
• Driving and work: short drives before long ones, once your head turns fully both ways. At work, we plan around what the job asks of the neck: a shift on the lifts, making beds, or overhead work on site.

The neck has two jobs in sport: holding your head steady while you look where you are going, and taking the next jolt. Both come back in stages. On snow, that means groomed runs at an easy pace before bumps, trees or the park. On a bike, the Valley Trail comes before the bike park, where rough ground shakes the head on every rock.

Each stage adds speed, roughness or time on the hill. You move on when the current stage passes: full turning, a whole session with the head up, and a bump taken without the neck flaring. There is no set date. If a concussion was part of the same crash, its step-by-step return sets the pace.

Book an assessment if neck pain or stiffness has set in after a crash, a fall or a tackle, or is spreading into the shoulders or an arm. Come in too if an old whiplash injury still limits how far you turn your head, or for help planning your return to driving, work, study and sport. After a car crash, book once the medical check is done.

Go to the emergency department right away, or call 911, if any of these happen:

• numbness, tingling or weakness in the arms or legs
• a severe headache, or one that keeps getting worse
• trouble swallowing or speaking
• being knocked out, or confusion after the crash
• neck pain with a fever
• pain that keeps getting worse despite rest