The head, with no force acting upon it, remains static in space, resulting in forced extension of the neck as the shoulders travel anteriorly under the head. Following extension, the inertia of the head is overcome, and it is also accelerated forward. The neck then acts as a lever to increase the forward acceleration of the head and force the neck into flexion. Injury results because the neck is unable to compensate adequately for the rapidity of head and torso movement resulting from the acceleration forces generated at the time of impact. Although the mechanism is well undersood, the actual pathology is not well defined.
Most experts agree that injuries occur to the neck muscles.
As well, there may be straining or cartilagous injuries to supporting structures of facet and apophyseal joints. Injury can occur to anterior and posterior longitudinal ligaments. Esophogeal and laryngeal damage has been reported. There are alleged injuries to the brain. This is controversial and far from certain.