Whiplash: symptoms, treatment and how long it takes to recover

The NHS lists neck pain, neck stiffness with difficulty moving the head, headaches, and pain and muscle spasms in the shoulders and arms. Symptoms can take several hours to start. Patient.info notes pain and stiffness often worsen the day after, with the pain first developing the next day in about half of cases. It also lists upper and lower back pain, and brief dizziness, blurred vision, jaw pain or unusual facial skin sensations, advising you to tell a doctor if any of these persist.

The Chartered Society of Physiotherapy adds that some people feel more jumpy, stressed or irritable after the injury. These reactions are common after a frightening event and are part of the picture to discuss, not something to hide.

Whiplash is a neck sprain that occurs when the head is suddenly jolted backwards and forwards, or forcibly rotated, in a whip-like movement. Patient.info explains that this can stretch neck muscles and ligaments more than normal. The Chartered Society of Physiotherapy says the most likely source of pain is strain of the small facet joints of the neck.

The commonest cause is a road traffic accident, particularly being hit from behind, but sides and front impacts can also cause it. The NHS lists slips, falls and sports injuries as other causes. Patient.info adds that even slow vehicle bumps can jerk the neck enough to cause symptoms, and that damage to the spine or spinal cord is uncommon but needs to be ruled out after severe accidents.

The NHS says whiplash usually gets better within 2 to 3 months, but some people may have symptoms for longer. The Chartered Society of Physiotherapy (CSP) says whiplash will improve over weeks and months, that it is not uncommon for recovery to take months, and that for some people it may limit working life and activities.

Patient.info is more optimistic. It says the outlook is very good in most cases, symptoms often begin to improve after a few days and most people make a full recovery within a few weeks, but that in a small number of people some symptoms persist long term.

The CSP says that if you are not seeing any recovery four to six weeks after your injury, it is important to consider whether how you feel about the trauma is preventing your recovery, and to talk to your GP or physiotherapist about psychological support if you have nightmares, intrusive thoughts or irritability.

The NHS advice is to take painkillers such as paracetamol or ibuprofen for pain, try to continue everyday activities even though it may hurt a little because it will speed up recovery, and avoid resting the neck for long periods. It specifically says not to use a neck brace or collar because this does not help. The Chartered Society of Physiotherapy agrees that adequate pain relief in the early stages matters because it allows you to move more freely.

Patient.info suggests that at first you may need to rest the neck for a day or so, but should gently exercise as soon as you are able, moving it in each direction every few hours, and that you will not cause damage by moving it. It also recommends good sitting posture, trying not to use more than one pillow, and notes that some people cannot take anti-inflammatory painkillers because of stomach ulcers, asthma, high blood pressure, or kidney or heart failure, so check with a pharmacist.

A GP may prescribe a stronger painkiller such as codeine, and the NHS says you should have check-ups every few weeks while you have whiplash. If symptoms do not improve, you may be referred to a physiotherapist, to a pain specialist or for psychological support. In many areas you can refer yourself to NHS community musculoskeletal (MSK) services without a GP referral, though the NHS notes physiotherapy may not be available locally and waiting times can be long, and you can also see a physiotherapist privately.

Patient.info mentions that occasionally a muscle relaxant such as diazepam is prescribed for a few days when neck muscles become very tense. Sedating medicines carry risks and are used only briefly, so this is for a clinician to judge rather than a first-line option.

Most whiplash is a soft-tissue sprain, but a neck injury can occasionally damage nerves. The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have injured your neck and have any of the following. It also says not to do anything that could be dangerous, such as driving or cycling, until you have spoken to a GP or NHS 111.

• Severe pain despite taking paracetamol or ibuprofen.

• Tingling or pins and needles on one or both sides of your body.

• Problems with walking or sitting upright.

• A sudden "electric shock" feeling in your neck and back, which may also go into your arms and legs.

• Weak hands, arms or legs.

The NHS says to see a GP if symptoms of whiplash have not improved after 1 week, if painkillers such as paracetamol or ibuprofen have not worked, or if you are worried about the pain. It says you should have check-ups with a GP every few weeks if you have whiplash.

Patient.info says to go back to a doctor if the pain becomes worse, if it persists beyond 4 to 6 weeks, or if other symptoms develop such as numbness, weakness or persistent pins and needles in part of an arm or hand, which may indicate irritation or pressure on a nerve.

Patient.info says modern vehicles are increasingly designed to minimise the impact of collisions on the neck, and that all vehicles include head restraints on seats which may prevent some whiplash sprains. It says the head restraint should be as high as the top of the head, and that up to 3 in 4 head restraints are not correctly adjusted.

First contact is usually a GP, pharmacist, NHS 111 or an emergency department after a significant accident. Self-referral MSK physiotherapy is common, but waits vary.

Private physiotherapy is widely available for people who want earlier treatment. Treatment decisions should rest on your symptoms and examination, not on any insurance or legal process, so it is reasonable to ask a provider for a clear plan, how many sessions are expected and how progress will be measured.