Injury type: Acute/ Chronic

Category: Medical Options

Rating: Not effective

What is it?

Botulinum toxin is a neurotoxin protein which is produced by the bacterium Clostridium Botulinum. It is one the most poisonous naturally occurring substances in the world and is considered to be the most toxic protein. Although this is a highly toxic substance, it is used to treat muscle spasms and for cosmetic reasons. It is commonly referred to as Botox and Dysport in the cosmetic industry.

How does it work?

Botulinum toxin is used to treat a variety of neurological disorders which are caused by pathological increases in muscle tone. When injected in minute quantities into the overactive muscles, Botulinum toxin type A decreases muscle activity by blocking the release of acetylcholine (a neurotransmitter) from the nerve which normally signals the muscle to contract. This ensures that the muscle is unable to contract for a period of up to six months.

Is it effective?

A clinical practice guideline1 which was developed based on systematic reviews of high-quality studies suggested that clinicians should not offer botulinum toxin injections for patients with chronic grades I-II neck pain and associated disorders (including whiplash).

A narrative review2 found no significant difference between the study subjects who received botulinum toxin A and those who received saline injections. However, this conclusion was only supported by a single included randomised controlled trial in this review. In a recently published systematic review3, the effectiveness of botulinum toxin A was used to compare with local anaesthetic on pain intensity in patients with myofascial pain attributed to conditions such as whiplash. This review concluded that botulinum toxin A injections are less effective than local anaesthetic injections at mitigating pain intensity.

Are there any disadvantages?

There can be potential side effects as a result of Botulinum toxin injections. This could be in the form of paralysis of the wrong muscle group leading to loss of muscle function and allergic reaction. It has also been noted that bruising at the site of injection can occur if inappropriately administered.

Where do you get it?

Botulinum toxin for whiplash patients can only be administered by registered health professional, most likely a medical specialist (i.e. Neurologist). As this is an emerging area of intervention, it may not be widely available.


Based on current evidence, Botulinum toxin cannot be recommended as routine treatment for patients with acute or chronic whiplash who are experiencing neck pain and other associated symptoms. More research is required before concrete recommendations can be made.