Condition
Whiplash
Whiplash is the search people use after a rear-end on I-95, Route 1, or a parking-lot tap at Christiana. The neck was taken through a range it was not ready for. Ligaments, joints, and muscles then spend days announcing it.
Dr. Richardson in Middletown focuses on auto and personal injury, including extremities. Dr. Johnson in Wilmington has personal-injury and MRI coursework. Computerized range of motion is how we stop “it feels a little better” from being the entire file.
Pair this page with auto accidents and work injuries for the broader PIP and workers’ compensation path. Pair it with neck pain and headaches if the crash was months ago and the stiffness never left. Sudden neurological change after trauma is emergency care first.
The injury mechanism explains a great deal about why whiplash behaves the way it does. In a rear-end collision the seat pushes the torso forward before the head begins to move, so for roughly the first hundred milliseconds the neck is forced into an S-shape — the lower cervical segments extending sharply while the upper ones remain flexed. No voluntary movement produces that shape, and the facet joint capsules at the lower cervical levels are loaded in a way they never normally experience. Those capsules are richly innervated, and they are the single most common pain source in persistent whiplash.
This is also why occupant injury correlates so poorly with vehicle damage. A modern bumper absorbing energy through deformation reduces the force transmitted to occupants; a stiff bumper that survives a collision intact transmits more. Head restraint position matters far more than closing speed — one set too low acts as a fulcrum rather than a support. Being unaware the collision was coming matters too, because the neck musculature has no time to brace.
Symptoms extend well beyond neck pain and patients are often relieved to hear the list is expected rather than alarming. Headache, usually starting at the base of the skull. Reduced neck rotation. Pain across the shoulders and between the shoulder blades. Jaw pain. Dizziness and unsteadiness from disturbed upper cervical position sense. Difficulty concentrating and disturbed sleep in the first weeks. Arm pain or pins and needles where a nerve root is irritated, which we examine for specifically.
Our examination establishes both the clinical picture and the record. Detailed mechanism history, neurological screening, orthopaedic testing, and computerised range-of-motion measurement that produces repeatable numbers rather than descriptions. Objective measurement matters more here than almost anywhere else, because a whiplash file that says only that the patient feels somewhat better is worth very little to anyone six months on, including the patient.
Treatment follows the evidence toward early, gradual, active care. The first phase settles protective spasm and restores motion within tolerance — soft-tissue work, gentle mobilisation, electrical muscle stimulation, and early range-of-motion exercise. As irritability drops we progress to specific adjusting where indicated, deep neck flexor and scapular strengthening, and proprioceptive retraining for the position sense the injury disturbed. Reassurance is a legitimate part of the treatment: patients told the injury is understood and expected to improve do better than those left to assume the worst.
The cases we send elsewhere immediately: any neurological deficit that is progressing, midline spinal tenderness with a mechanism meeting imaging criteria, severe headache unlike any before, difficulty swallowing or speaking, visual disturbance, or a patient who cannot rotate the neck forty-five degrees in each direction after a high-risk mechanism. Those are emergency-department findings, and getting that call right is more important than anything else we do on the first visit.
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Doctors to start with
Patients from Bear, Glasgow, and Pike Creek typically use Newark. Brandywine Hundred, Claymont, and Hockessin use Wilmington. Capital-area patients use Camden/Dover. Smyrna covers Route 13 and Saturday mornings.
FAQ
I felt fine at the scene. Should I still get checked?
Yes. Adrenaline hides injuries. Stiffness, headache, and arm symptoms often arrive on day two or three.
Do advertised $78 exams apply after a crash?
No. Personal injury and workers’ compensation use a different billing path. You are still welcome. Use the motor-vehicle forms on the new-patients page.
Will you document findings for my claim?
We record history, exam, and computerized range of motion. We are not your attorney. We treat the injury and write what we find.
Why does whiplash hurt more two days later?
The mechanical damage occurs in the first fraction of a second, but the inflammatory response that follows it takes one to three days to build. Adrenaline suppresses pain at the scene, and protective muscle spasm — which is a large part of what people experience as whiplash stiffness — develops as the body splints the injured segments. Feeling fine at the roadside and stiff on Wednesday is the expected course, not an unusual one.
What is a whiplash grade?
The Quebec classification is what most clinicians use. Grade 0 is no complaint and no physical sign. Grade 1 is neck complaint with no physical sign. Grade 2 is neck complaint with musculoskeletal signs such as reduced range of motion and point tenderness — this is the large majority of cases we see. Grade 3 adds neurological signs. Grade 4 involves fracture or dislocation and is a hospital case, not a clinic one.
Do I need an X-ray or scan?
Not usually, and imaging every crash is not good practice. Validated decision rules — the Canadian C-Spine Rule and NEXUS criteria — identify who needs imaging based on age, mechanism, neurological findings, midline tenderness, and the ability to rotate the neck. Where those criteria are met we refer for imaging. Where they are not, a scan typically shows pre-existing degenerative change that was there before the crash and adds nothing except worry.
Should I wear a collar?
No, in almost all cases. Soft collars were standard for decades and the evidence went firmly the other way: immobilisation prolongs recovery and increases the likelihood of persistent symptoms compared with early gentle movement. The exception is a genuine unstable injury, which is a hospital-managed situation rather than something we would be treating.
What makes some people not recover?
Higher initial pain intensity, early widespread pain rather than pain confined to the neck, and psychological distress in the first weeks are the factors that consistently predict a slower course — considerably more than the speed of the collision or the damage to the vehicle. That is a strong argument for early, active treatment and for taking the injury seriously rather than being told to walk it off.