Whiplash occurs when the head suddenly accelerates and then rapidly decelerates, placing excessive strain on the soft tissues that support the neck. In addition to neck pain and stiffness, this motion can produce a variety of symptoms collectively known as whiplash-associated disorders (WAD). To better define and manage these injuries, the Quebec Task Force on Whiplash-Associated Disorders (1995) developed a classification system that grades whiplash severity from I to IV.

WAD I is characterized by neck pain and stiffness without any objective findings on physical examination. In other words, there is no loss of range of motion; no muscle spasm or guarding; no swelling, bruising, or deformity; no neurological deficit; and no imaging abnormalities. Approximately 15–25% of whiplash patients fall into this category.

In WAD II, neck symptoms are accompanied by physical examination findings such as decreased range of motion, localized tenderness in neck muscles, muscle spasm, and sometimes headache. However, there are no neurological deficits or abnormalities visible on diagnostic imaging. About two-thirds of whiplash patients are graded WAD II.

At the WAD III level, patients present with both musculoskeletal findings (as seen in WAD II) and neurological signs, which may include sensory loss (numbness or tingling), motor weakness (reduced strength in muscles supplied by affected cervical nerves), altered reflexes, or radiating arm pain. As with WAD I and II, the injury still involves soft tissues that typically do not appear on X-ray or advanced imaging. Approximately 5–10% of whiplash patients fall into this grade of WAD.

The classification of WAD IV is utilized when there is structural damage to the cervical spine that is present on diagnostic imaging and is usually associated with severe symptoms. Patients with WAD IV typically require emergency treatment to stabilize the spine. Fortunately, fewer than 1–2% of whiplash patients meet this criterion.

The good news is that WAD I, II, and III typically respond well to a multimodal chiropractic approach aimed at reducing pain and restoring function as quickly as possible. Manual therapies may include gentle, low-velocity, low-amplitude techniques; thrust manipulation (high-velocity, low-amplitude); facet gliding; long-axis cervical traction; passive range-of-motion exercises; massage; trigger-point therapy; dry needling; or acupuncture. Adjunctive physical therapy modalities such as electrical stimulation, therapeutic ultrasound, laser therapy, pulsed electromagnetic field (PEMF) therapy, in-office or home cervical traction, and others are also frequently utilized. Exercise training is a crucial component of care, as long-term improvement depends on patient self-management and reduces provider dependency that can sometimes arise. In the event a patient does not respond to care or if additional issues are present that fall outside the chiropractic scope, the case may be co-managed with an allied healthcare provider.