The car was barely dented. Six months on, people are implying you exaggerate.

WHIPLASH

The car was barely damaged. Two days later you could not turn your head, and six months later people have started implying you are exaggerating.

What actually happens in the neck

In a rear impact the torso is pushed forward before the head follows, and for a fraction of a second the cervical spine is forced into an S-shape — the lower segments extending while the upper ones are still flexed. That transient shape is not a posture the neck can adopt voluntarily, and it loads the facet joints at the lower levels in a way nothing in normal life does.

This is why vehicle damage predicts injury so poorly. The energy that matters is the energy transmitted to the occupant through the seat, and a well-designed bumper that absorbs the impact without deforming transmits it efficiently.

Why the facet joints keep coming up

Because the biomechanics point at them and because the diagnostic evidence follows. In chronic pain after whiplash, cervical facet joints are the single most commonly identified source when the question is actually tested with controlled diagnostic blocks — and the reason they are so often missed is that they show nothing on imaging.

That is the central frustration of this condition. The structure most likely to be responsible is invisible to the test everybody orders, so a normal scan gets read as evidence that nothing is wrong.

The delay before symptoms, and why it is normal

Most people feel comparatively little at the scene and considerably more over the following twenty-four to seventy-two hours. That is ordinary inflammatory physiology, not an afterthought and not a sign of anything invented. It is also, unhelpfully, the pattern that makes people doubt themselves and makes others doubt them.

What we look for

• Segmental tenderness over the facet columns, side to side, level by level.
• Loss of rotation, and whether it is limited by pain or by a genuine end-feel.
• Rotation in flexion, which isolates C1-2 and is frequently restricted after whiplash.
• The sternocleidomastoid and the suboccipital muscles, both of which refer into the head.
• A neurological examination, because a root injury is a different problem from a joint injury.
• Where there is unsteadiness or visual disturbance, a vestibular assessment, which is a routine part of the workup here and rarely offered elsewhere.

The headache that comes with it

Post-traumatic headache after whiplash is frequently cervicogenic — generated by the upper cervical segments and referred into the head through the trigeminocervical convergence. It is side-locked, it starts at the back, and it responds poorly to migraine treatment because it is not migraine.

Treating the neck treats the headache in that group, and it is one of the more satisfying things to get right because the person has usually been cycling through headache medication for a year.

What treatment looks like

Movement early rather than a collar. Collars were standard for decades and the evidence went the other way — immobilization prolongs recovery. Where pain is limiting movement, treating the pain to enable the movement is the sequence, not the reverse.

Where pain persists past three months and the examination points at the facet joints, a diagnostic medial branch block answers the question directly, and a positive result opens the door to radiofrequency ablation, which gives months of relief and can be repeated.

On being believed

A large number of people with genuine post-whiplash pain have had the reality of it questioned, usually because the imaging is normal and the mechanism looked minor. Both of those are expected findings in this condition rather than evidence against it.

We test the structures that are testable and we document what we find. A positive diagnostic block is objective evidence of a pain source, and it exists precisely because this condition needed something better than an argument about credibility.

The vestibular part nobody checks

Dizziness, unsteadiness and visual disturbance after a collision are common and are usually attributed to anxiety or to the concussion that may or may not have happened. Some of it is cervicogenic — the neck contributes proprioceptive information to balance, and a neck that has been injured contributes distorted information.

Distinguishing a cervical contribution from a vestibular one from a central one requires testing rather than guessing, and we do that as part of the workup. It matters because the treatments differ completely and because untreated unsteadiness stops people driving.

Grading, and why it is not very useful

Whiplash-associated disorders are conventionally graded from neck complaint without physical signs through to fracture or dislocation. The grading is fine for research and it does very little for an individual patient, because the great majority sit in the middle grades and the grade does not name a structure.

What names a structure is the examination and, where indicated, a diagnostic block. That is the step that turns a whiplash label into a treatable diagnosis.

The three-month mark

Most recovery happens in the first three months. Somebody still in significant pain at that point is unlikely to resolve by waiting longer, and continuing to wait is the most common thing that happens to them.

That is the point at which the diagnostic question should be asked properly rather than deferred again. It is also, unhelpfully, the point at which many people are told to give it more time.

Returning to driving

Rotation is the limiting factor and it is worth measuring rather than estimating. If you cannot turn far enough to check a blind spot without pain forcing you to stop halfway, you are compensating with trunk rotation and your effective field of view is smaller than you think.

That is a practical problem before it is a clinical one, and it is one of the more common reasons people restrict their own lives after a collision without ever describing it as a symptom.

What we document

Range measured in degrees, strength graded by muscle, the segments that reproduce pain on palpation, and the response to any diagnostic block recorded hour by hour. That record exists because it is how treatment decisions get made, and it happens to also be the objective account of an injury that imaging does not show.

We do not write records to support a case and we do not write them to undermine one. We write what the examination found, which is the only version that is useful to anybody.

The upper cervical segments specifically

C1-2 and C2-3 take a disproportionate share of the load in the S-shaped phase of the injury, and they are the segments least examined afterward. Rotation measured in flexion isolates C1-2 and takes seconds; it is restricted often enough after whiplash to be worth doing on everybody.

Where it is restricted and the headache is occipital and side-locked, an atlantoaxial injection reaches a level nothing else on the list reaches.

What people ask after a collision

My car was barely dented. Can I really be injured?

Yes, and this is one of the most consistently misunderstood parts of it. Vehicle damage and occupant injury correlate poorly, because a bumper that does not deform transmits energy rather than absorbing it. How care works while a claim is open.

How long should this take to settle?

Most people improve substantially over six to twelve weeks. A meaningful minority do not, and that group deserves a diagnosis rather than more time. How long neck pain should take to settle.

Should I wear a collar?

No, other than very briefly in specific circumstances. Early movement produces better outcomes and prolonged immobilization produces worse ones. What the facet joints actually do. The collar is the first item on the list of things that slow this down.

My scan was normal. Does that mean nothing is wrong?

No. The structure most often responsible after whiplash is not visible on imaging. That is a limitation of the test, not a verdict on your pain. What a normal scan does and does not rule out.

Do I need a lawyer involved before I am seen?

No. The evaluation is a clinical one and it happens the same way regardless. Cervical facet syndrome, in full.

Related reading

• Cervical facet syndrome
• Cervical medial branch block
• Cervicogenic headache
• Vestibular testing
• Atlantoaxial injection
• Why your MRI does not explain it

If the collision that caused this is still an open claim, the treatment does not have to wait for it — see after a collision for how care is arranged and paid for while a case runs.