Fatty Infiltration in the Cervical Extensor Muscles in Persistent Whiplash-Associated Disorders: A Magnetic Resonance Imaging Analysis
Spine 2006 (Oct 15); 31 (22): E847–755
The WAD subjects had significantly larger amounts of fatty infiltrate for all of the cervical extensor muscles compared with healthy control subjects. In addition, the amount of fatty infiltrate varied by both cervical level and muscle, with the rectus capitis minor/major and multifidi at C3 having the largest amount of fatty infiltrate. Intramuscular fat was independent of age, self-reported pain/disability, compensation status, body mass index, and duration of symptoms.
Multiplanar Cervical Spine Injury Due to Head-Turned Rear Impact
Spine 2006 (Feb 15); 31 (4): 420—429
Epidemiologically and clinically, head-turned rear impact is associated with increased injury severity and symptom duration, as compared to forward facing. To our knowledge, no biomechanical data exist to explain this finding. Six human cervical spine specimens (C0-T1) with head-turned and muscle force replication were rear impacted at 3.5, 5, 6.5, and 8 g, and flexibility tests were performed before and after each impact. Head-turned rear impact caused significantly greater injury at C0-C1 and C5-C6, as compared to head-forward rear and frontal impacts, and resulted in multiplanar injuries at C5-C6 and C7-T1.
The Use of Flexion and Extension MR in the Evaluation of Cervical Spine Trauma: Initial Experience in 100 Trauma Patients Compared with 100 Normal Subjects
Emerg Radiol 2002 (Nov); 9 (5): 249—253
The cervical spines of 100 consecutive uninjured normal asymptomatic adults and 100 adult accident victims following rear low-impact motor vehicle accidents were evaluated using rapid T2-weighted MRI. Injured subjects were evaluated during the subacute period, at 12 to 14 weeks after injury. The "normal subjects" showed: Loss of normal cervical lordosis (hypolordosis) in 4% (4 of 100) patients: Range of motion of 50° flexion, and 60° extension; and asymptomatic disk herniations were observed in 2% (2 of 100) patients. In the subacute post-traumatic subjects, there was a loss of the normal segmental motion pattern, with hypolordosis in 98% (98 of 100) patients. Range of motion was restricted, quantified as 25° flexion and 35°; and disk herniations were observed in 28% of the patients. The authors conclude that flexion and extension MR can be a valuable adjunct examination in the evaluation of patients in the clinical setting of subacute cervical spine trauma.
Cervical Spine Lesions After Road Traffic Accidents: A Systematic Review
Spine Journal 2002 (Sep 1); 27 (17): 1934—1941
Previous investigations have examined pathoanatomical conditions of the cervical spine of road traffic fatalities. However, different methods of investigation have been used, and results of studies are conflicting. Hence, potential pathoanatomical conditions in fatalities and survivors remain a controversial issue. Twenty-seven articles of which three fulfilled the quality criteria were reviewed. In these studies, subtle pathoanatomical lesions were found in the cervical intervertebral discs, cartilaginous endplates, and the articular surfaces and capsules of the zygapophysial joints. The lesions were found exclusively in the traumatized patients and in none of the patients in the control group.
Effects of Abnormal Posture on Capsular Ligament Elongations in a Computational Model Subjected to Whiplash Loading
J Biomech 2005 (Jun); 38 (6): 1313—1323
Although considerable biomechanical investigations have been conducted to understand the response of the cervical spine under whiplash (rear impact-induced postero-anterior loading to the thorax), studies delineating the effects of initial spinal curvature are limited. Results from the present study, while providing quantified level- and region-specific kinematic data, concur with clinical findings that abnormal spinal curvatures enhance the likelihood of whiplash injury and may have long-term clinical and biomechanical implications.
Onset of Neck Pain After a Motor Vehicle Accident:
A Case-control Study
J Rheumatol 2005 (Aug); 32 (8): 1576—1583
In total, 26% of drivers reported post-accident neck pain. Women, younger individuals, and those with a history of neck pain were more likely to report neck pain following their accident. In addition, a number of accident related and psychosocial factors were independently associated with reporting post-accident neck pain: collision from behind; vehicle stationary at impact; collision severity; not being at fault; and monotonous work. Based on these 8 factors, the likelihood of having neck pain increased from 7% with < 2 risk factors to 62% with > 5.
Chiropractic Management of Intractable Chronic Whiplash Syndrome
Clinical Chiropractic 2004 (Mar): 7 (1): 16—23
The management protocol in this case consisted of chiropractic spinal manipulative therapy, soft tissue work and post-isometric relaxation (PIR) techniques to address biomechanical somatic dysfunction. In addition, active rehabilitation exercises, self-stretches and proprioceptive exercises were utilised to address postural and muscle imbalance. On the seventh treatment, the patient reported no neck pain, no headaches and unrestricted cervical spine range of motion. At 4 months follow-up, the patient continued to be free of headaches and neck stiffness and reported only mild, intermittent neck pain.
Psychiatry of Whiplash Neck Injury
Br J Psychiatry 2002 (May); 180: 441-448 ~ FULL TEXT
This paper helps to dispell the inaccurate conclusion that compensation drives outcomes in whiplash cases (
NEJM 2000 (Apr 20); 342 (16): 1179–1186) by eliminating insurer's bias. This paper comes to radically different conclusions by focusing on all of those injured in MVAs (rather than just the whiplash cases) and defining the similarities between those with soft-tissue and boney injuries. They found that: (1) Claiming compensation was not a predictor of psychological outcome in any of the injury groups; (2) That whiplash is more likely to be litigated because of the unpleasantness of the acute symptoms, that the sufferer is an innocent victim, and that the liability of the other driver will not be disputed; (3) and that the anger associated with being an innocent victim, and (being trapped within a) slowly progressing litigation is one of several social variables influencing overall quality of life following the accident.
Dizziness and Unsteadiness Following Whiplash Injury: Characteristic Features and Relationship With Cervical Joint Position Error
J Rehabil Med 2003 (Jan); 35 (1): 36–43
Dizziness and/or unsteadiness are common symptoms of chronic whiplash-associated disorders. This study aimed to report the characteristics of these symptoms and determine whether there was any relationship to cervical joint position error. Joint position error, the accuracy to return to the natural head posture following extension and rotation, was measured in 102 subjects with persistent whiplash-associated disorder and 44 control subjects.
A Proposed New Classification System for Whiplash Associated Disorders-Implications for Assessment and Management
Manual Therapy 2004 (May); 9 (2): 60–70
Recent evidence is emerging that demonstrates differences in physical and psychological impairments between individuals who recover from the injury and those who develop persistent pain and disability. Motor dysfunction, local cervical mechanical hyperalgesia and psychological distress are present soon after injury in all whiplash injured persons irrespective of recovery.
Impairment in the Cervical Flexors: A Comparison of Whiplash and Insidious Onset Neck Pain Patients
Manual Therapy 2004 (May); 9 (2): 89–94
The results indicated that both the insidious onset neck pain and whiplash groups had higher measures of EMG signal amplitude (normalized root mean square) in the sternocleidomastoid during each stage of the test compared to the control subjects (all P<0.05) and had significantly greater shortfalls from the pressure targets in the test stages (P<0.05). No significant differences were evident between the neck pain groups in either parameter indicating that this physical impairment in the neck flexor synergy is common to neck pain of both whiplash and insidious origin.
A Symptomatic Classification of Whiplash Injury and the Implications
for Treatment
Journal of Orthopaedic Medicine 1999; 21 (1): 22–25
Whiplash injuries are common. Chiropractic is the only proven effective treatment in chronic cases. Our study enables patients to be classified at initial assessment in order to target those patients who will benefit from such treatment. You may also enjoy this review
of this article.
Whiplash Update:
New Research About Chiropractic Utilization in America
Lawrence Nordhoff, DC, QME
It is important for the chiropractic profession to stay current with claim behavior in the United States, including treatment costs, number of office visits, types of injuries, and use of diagnostic procedures. This is particularly true with respect to motor vehicle collision injuries. This information lets doctors of chiropractic evaluate their practice profiles and determine how national figures apply to their practices.
The Possibility to Use Simple Validated Questionnaires to Predict Long-term Health Problems After Whiplash Injury
Spine 2004 (Feb 1); 29 (3): E47–51
The subjective experience of a notably decreased level of activity because of the neck pain when supplemented by the enhanced score of Neck Disability Index questionnaire predicts well poor outcome in long-term follow-up and can be used as a tool to identify persons who are at risk to suffer long-term health problems after whiplash injury.
Cervical Spine Curvature During Simulated Whiplash
Clin Biomech (Bristol, Avon) 2004 (Jan); 19 (1): 1–9
Average peak lower cervical spine extension first exceeded the physiological limits (P<0.05) at a horizontal T1 acceleration of 5 g. Average peak upper cervical spine extension exceeded the physiological limit at 8 g, while peak upper cervical spine flexion never exceeded the physiological limit. In the S-shape phase, lower cervical spine extension reached 84% of peak extension during whiplash. Both the upper and lower cervical spine are at risk for extension injury during rear-impact. Flexion injury is unlikely.
Cervical Spine Geometry Correlated to Cervical Degenerative Disease in a Symptomatic Group
J Manipulative Physiol Ther 2003 (Jul); 26 (6): 341–346
We identified 5 geometric variables from the lateral cervical spine that were predictive 79% of the time for cervical degenerative joint disease. There were discrete age, sex, and symptom groups, which demonstrated an increased incidence of degenerative joint disease.
Cervical Spine Lesions After Road Traffic Accidents:
A Systematic Review
Spine 2002 (Sep 1); 27 (17): 1934–1941
Occult pathoanatomical lesions in the cervical intervertebral disc and zygapophysial joints after fatal road traffic trauma may exist. Present imaging methods, especially conventional radiography, do not visualize these subtle lesions; hence, underreporting of pathoanatomical lesions during standard autopsy is probably common. These findings may have clinical relevance in the management of road traffic trauma survivors with potentially similar pathoanatomy.
Motion Analysis of Cervical Vertebrae During Whiplash Loading
Spine 1999 (Apr 15); 24 (8): 763–769
There were three distinct patterns of cervical spine motion after impact. In the flexion-extension group, C6 rotated backward before the upper vertebrae in the early phase; thus, the cervical spine showed a flexion position (initial flexion). After C6 reached its maximum rotational angle, C5 was induced to extend. As upper motion segments went into flexion, and the lower segments into extension, the cervical spine took an S-shaped position. In this position, the C5-C6 motion segments showed an open-book motion with an upward-shifted instantaneous axis of rotation.
Is the Sagittal Configuration of the Cervical Spine Changed in Women with Chronic Whiplash Syndrome? A Comparative Computer-assisted Radiographic Assessment
J Manipulative Physiol Ther 2002 (Nov); 25 (9): 550–555
The whiplash group showed a decreased ratio between the lower versus upper cervical spine but comparisons between groups were not statistically significant. The whiplash group was in a significantly more flexed position at the C4-C5 level compared with the asymptomatic group (P =.007). The reliability measures have to be strengthened to render these results definitely conclusive.
Responses to a Clinical Test of Mechanical Provocation of Nerve Tissue in Whiplash Associated Disorder
Manual Therapy 2002 (May); 7 (2): 89–94
Only the whiplash subjects whose arm pain was
reproduced by the BPPT demonstrated differences between the symptomatic and asymptomatic sides. These generalized hyperalgesic responses to the BPPT support the hypothesis of central nervous system hypersensitivity as contributing to persistent pain experienced by WAD patients.
Contribution of Central Neuroplasticity to Pathological Pain:
Review of Clinical and Experimental Evidence
Pain 1993 (Mar); 52 (3): 259–285
Peripheral tissue damage or nerve injury often leads to pathological pain processes, such as spontaneous pain, hyperalgesia and allodynia, that persist for years or decades after all possible tissue healing has occurred. Although peripheral neural mechanisms, such as nociceptor sensitization and neuroma formation, contribute to these pathological pain processes, recent evidence indicates that changes in central neural function may also play a significant role.
The Risk of Injury for Children Exposed to Whiplash Trauma
Arthur C. Croft, DC, MS, FACO
Less than two percent of the literature about whiplash is devoted to children. When I wrote the first edition of my textbook in 1988,1 I cited an older German study placing the risk for children at approximately one-sixth the risk of adults. By the time the second edition was published in 1995, a Swedish study had since been published putting the risk proportion in children closer to two-thirds that of adults.2
Whiplash Associated Disorders: Redefining Whiplash and Its Management by the Quebec Task Force: A Critical Evaluation
SPINE 1998 (May 1); 23 (9): 1043–1049 ~ FULL TEXT
The validity of the conclusions and recommendations of the Quebec Task Force regarding the natural course and epidemiology of whiplash injuries is questionable. This lack of validity stems from the presence of bias, the use of unconventional terminology, and conclusions that are not concurrent with the literature the Task Force accepted for review. Although the Task Force set out to redefine whiplash and its management, striving for the desirable goal of clarification of the numerous contentious issues surrounding the injury, its publications instead have confused the subject further. You may review the original
Quebec Task Force Report on Whiplash-Associated Disorders (WAD) document right here.
Chiropractic Treatment of Chronic 'Whiplash' Injuries
Injury 1996 (Nov); 27 (9): 643–645
Twenty-six (93 per cent) patients improved following chiropractic treatment (U = 34, P < 0.001). The encouraging results from this retrospective study merit the instigation of a prospective randomized controlled trial to compare conventional with chiropractic treatment in chronic 'whiplash' injury.
The Rate of Recovery Following Whiplash Injury
Eur Spine J. 1994; 3 (3): 162–164
Fifty consecutive patients with soft-tissue neck injuries following rear end collisions were studied prospectively to assess their rate of recovery. Patients were seen within 5 days of the accident, after 3 months, 1 year and 2 years, and their symptoms were classified into one of four groups (A, asymptomatic; B, nuisance; C, intrusive; D, disabling). Fourteen of 15 patients (93%) who were asymptomatic after 3 months remained symptom-free after 2 years. Of 35 patients with symptoms after 3 months, 30 (86%) remained symptomatic after 2 years.
Conservative Management of Mechanical Neck Pain: Systematic Overview and Meta-analysis
British Medical Journal 1996 (Nov 23); 313 (7068): 1291–1296
Twenty four randomised clinical trials met the selection criteria and were categorised by type of intervention: nine used manual treatments; 12 physical medicine methods; four drug treatment; and three education of patients (four trials investigated more than one form of intervention).
Long–Term Consequences of Whiplash: Allergy; Breathing, Digestive and Cardiovascular Disorders; Hypertension and Low Back Pain
Arthur C. Croft, DC, MS, FACO, FACFE
Dynamic Chiropractic – October 16, 2000
A recent paper out of Canada takes an intriguing look into what may be some of the less recognized features of the long–term consequences of whiplash trauma – a condition perhaps more rightfully referred to as cervical acceleration/deceleration (CAD) trauma. The authors, using data obtained by health surveys, attempted to correlate a history of neck injury from motor vehicle crashes (MVC) with chronic neck pain.
Long-term Outcome After Whiplash Injury: A 2-year Follow-up Considering Features of Injury Mechanism and Somatic, Radiologic, and Psychosocial Findings
Medicine (Baltimore) 1995 (Sep); 74 (5): 281–297
Previous studies, however, focused on somatic symptoms on the one hand or considered only psychological or neuropsychological variables on the other hand, often in loosely defined or selected groups of patients. No study so far has analyzed the long-term outcome in a nonselected group of patients using a clear injury definition considering patient history; somatic, radiologic, and neuropsychological findings; and features of the injury mechanisms assessed soon after trauma and during follow-up. With regard to baseline findings the following significant differences were found (on this cohort): Symptomatic patients were older, had higher incidence of rotated or inclined head position at the time of impact, had higher prevalence of pretraumatic headache, showed higher intensity of initial neck pain and headache, complained of a greater number of symptoms, had a higher incidence of symptoms of radicular deficit and higher average scores on a multiple symptom analysis, and displayed more degenerative signs (osteoarthrosis) on X ray.
Prognosis Following a Second Whiplash Injury
Injury 2000 (May); 31 (4): 249–251
Five percent of the population have suffered a whiplash injury. Of these, 43% suffer long–term symptoms. We undertook a retrospective study of 79 patients who had suffered two whiplash injuries.
Effect of Eliminating Compensation for Pain and Suffering on the
Outcome of Insurance Claims for Whiplash Injury
NEJM 2000 (Apr 20); 342 (16): 1179–1186
The incidence and prognosis of whiplash injury from motor vehicle collisions may be related to eligibility for compensation for pain and suffering. On January 1, 1995, the tort–compensation system for traffic injuries, which included payments for pain and suffering, in Saskatchewan, Canada, was changed to a no–fault system, which did not include such payments. To determine whether this change was associated with a decrease in claims and improved recovery after whiplash injury, we studied a population–based cohort of persons who filed insurance claims for traffic injuries between July 1, 1994, and December 31, 1995.
Cervical Nonorganic Signs: A New Clinical Tool to Assess Abnormal Illness Behavior in Neck Pain Patients: A Pilot Study
Arch Phys Med Rehabil 2000 (Feb); 81 (2): 170–175
For many years, the lumbar nonorganic signs (developed by Waddell and colleagues) have been a useful screening tool in the assessment of abnormal illness behavior in the low back pain population. For the first time, a group of cervical nonorganic signs have been developed, standardized, and proven reliable.
Concussion May Be More Serious Than Thought
A mild blow to the head may cause more brain damage than previously thought. California
researchers have found that head injuries that cause concussion can lead to changes that resemble brain damage in the comatose, and these changes can last for weeks.
How Have Chiropractors Fared in Recent Years with Whiplash Cases?
Lawrence Nordhoff, DC, QME
Chiropractors have been actively treating whiplash soft-tissue injuries for decades. This article explores how the chiropractic profession has fared in recent years compared to medical doctors and physical therapists. These comparisons will illustrate the percentage of claimants seeing the various providers in five-year increments. This paper shows that the chiropractic profession continues to have a healthy upward growth trend, whereas the number of claimants seeing MDs and PTs has declined or has had little growth in recent years.
Is It Safe to Adjust the Cervical Spine in the Presence of a Herniated Disc?
Donald Murphy, DC, DACAN
I am often asked by chiropractors, medical doctors and patients if manipulation of the cervical spine is safe in the presence of a cervical herniated nucleus pulposis (CHNP). I usually answer that in most circumstances it not only is safe, but it is often an essential aspect of treatment. I will clarify what this means and provide some of the evidence that supports this notion. I will also illustrate that in most of cases that require treatment, manipulation alone is not a sufficient approach, but that some form of rehabilitation is necessary.
Whiplash & Chiropractic: New Horizons
JACA: Article Abstracts: February 2000
Whiplash is an enigmatic injury. We spend billions of dollars each year to treat it. Yet many lawyers, legislators, and medical doctors deny its existence. It affects millions of people around the world, yet research is severely under-funded. It is a largely preventable injury, yet we do little to prevent it. Fortunately, times are changing as whiplash enters a new phase of research and understanding.
Collected article citations on CAD
There are many citations here to consider.
Traumatic Brain Injury Website
A variety of resources.
Whiplash Injury and Chronic Neck Pain
NEJM 1994 (Apr 14): 330 (15)
Whiplash injuries occur in more than 1 million people in the United States every year (1). Although the majority become asymptomatic in a matter of weeks to a few months, 20 to 40 percent have symptoms that are sometimes debilitating and persist for years. This so–called late whiplash syndrome has become one of the most controversial conditions in medicine. Some attribute the persistent symptoms to unresolved injury, whereas others attribute them to underlying psychological factors or the possibility of financial gain.
Cervical Zygapophyseal Joint Pain Patterns Part I:
A Study in Normal Volunteers
Spine 1990 (Jun); 15 (6): 453–457
The pain patterns evoked by stimulation of normal cervical zygapophyseal joints were determined in five volunteers. Under fluoroscopic control, joints at segments C2-3 to C6-7 were stimulated by distending the joint capsule with injections of contrast medium. Each joint produced a clinically distinguishable, characteristic pattern of pain, which enabled the construction of pain charts that putatively could be of value in determining the segmental location of symptomatic joints in patients presenting with cervical zygapophyseal pain.
Chiropractic Care for Spinal Whiplash Injuries
David BenEliyahu, DC, DAAPM, DACBSP
Studies on the efficacy of chiropractic care for patients suffering with pain secondary to whiplash injury are appearing in the literature. In 1996, Woodward et al. published a study in Injury on the efficacy of chiropractic treatment of whiplash injuries.1 The authors of this study were from the Department of Orthopedic Surgery in Bristol, England. In 1994, Gargan and Bannister published a paper on the recovery rate of patients with whiplash injuries and found that if patients were still symptomatic after three months, there was almost a 90% chance they would remain so.2 No conventional medical treatment has been shown to be effective in these established chronic whiplash injury patients.3,4 However, most DCs treating whiplash injury patients have empirically found high success rates in the recovery of these types of patients.
The Failure of Standard Orthopedic and Neurologic Tests, Part I
Chiropractors are regularly called upon to evaluate and treat those patients involved in motor vehicle accidents. The chiropractor often faces a significant dilemma when attempting to report findings from the standard orthopedic and neurologic tests. On one hand the doctor realizes that the patient has been injured, however the standard orthopedic and neurologic tests that we learned in school and in postgraduate programs are not sensitive for what the patient actually suffers with.
The Failure of Standard Orthopedic and Neurologic Tests, Part II
Tests which I believe are sensitive to the whiplash-injured patient can be divided into two categories: those which are listed by physical examination, and those which are listed by other diagnostic tests. Examination procedures which are more sensitive to the tissues innervated by the dorsal ramus include: 1) palpation, 2) provocative tests, 3) motion palpation. There are several diagnostic tests which are more sensitive in assessing whiplash trauma. They are: 1) Stress films, 2) Videofluoroscopy, 3) Diagnostic ultrasound
One–Third Of Children In Road Traffic Accidents Develop Stress Disorder
LONDON, ENGLAND –– Dec. 11, 1998 –– In a study of 119
children involved in road traffic accidents during 1997 Dr. Paul
Stallard and colleagues from the Royal United Hospital in Bath
reveal that one–third were found to be suffering from
post–traumatic stress disorder. Published in this week's issue of the British Medical Journal,
the study found that young people displayed symptoms including sleep disturbance and nightmares, separation anxiety, difficulties in concentration, intrusive thoughts, difficulties in talking to parents and friends, mood disturbance, deterioration in academic performance, specific fears and accident related play.
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