Whiplash-associated disorder (WAD) is a term used to describe the constellation of physical and psychosocial symptoms that can follow the sudden acceleration–deceleration of the head and neck, most commonly from a motor vehicle collision. Although many patients recover quickly, up to half may go on to experience chronic pain and other symptoms for months or even years. Given the substantial burden WAD can cause individuals and society, research has focused on identifying why some patients recover and others do not so that those at higher risk can receive more comprehensive, early interventions in hopes of avoiding chronicity. One important factor is central sensitization.

Central sensitization is a process in which the central nervous system becomes hypersensitive and amplifies pain signals, sometimes making normally non-painful stimuli feel painful. This can occur after injury to tissues that send sensory input (the cervical facet joints and capsules, neck muscles, intervertebral disks and their ligaments, nerve roots and dorsal root ganglia, and the dura mater, for example), direct injury to the spinal cord, or neuroplastic changes in the brain in response to ongoing pain.

In WAD patients, direct spinal cord injury is rare, but soft-tissue injury in the neck is common. Persistent pain and stress after the injury may also contribute to changes in brain processing. This is why prompt care is so important — not only to help tissues heal but also to reduce the risk that ongoing pain will lead to long-term sensitization. Estimates suggest that about one-third of acute WAD patients show signs of central sensitization, which can appear as early as one day and up to two weeks post-accident. Interestingly, a February 2023 study found that these symptoms tend to appear faster after rear-end collisions than front-end collisions.

Chiropractic care for WAD often involves a multimodal approach including spinal manipulation and mobilization, soft tissue therapy, trigger point release, and physiotherapy exercises to help restore neck mobility, reduce pain, and decrease painful nerve signaling. Chiropractors also encourage patients to remain active within pain tolerances; advise on ice, heat, anti-inflammatory supplements, and/or dietary modifications; and prescribe exercises to improve posture and strength. When necessary, a doctor of chiropractic will collaborate with medical physicians or specialists to ensure the patient receives the most appropriate care to support as full a recovery as possible.