Section 5


Through its work and scientific exchanges over the last few years, the Quebec Task Force on Whiplash-Associated Disorders has defined the skills and knowledge needed for optimal management of WAD patients. In our opinion, the primary interventionist must possess the qualities of a clinical anatomist. In addition to his/her basic knowledge of topographical anatomy, this clinician must have an in-depth knowledge of neuroanatomy and more particularly, of peripheral neuroanatomy. He/she must have basic knowledge of the autonomic nervous system and its influence on the locomotor system. He/she must be an excellent diagnostician. He/she must possess fundamental knowledge of rehabilitation of the musculoskeletal system, including psychosomatic medicine and the social aspects of chronic disorders of the musculoskeletal system. Also, he/she must possess the essential knowledge for the prescription of combined care, including principles, scope and value of activation and other interventions. Finally, he/she must acquire knowledge of the basic principles of clinical epidemiology. Unfortunately, there are significant gaps in the teaching of these skills and knowledge in the training programs of all clinicians. Some specialists in various disciplines (medicine, physiotherapy, occupational therapy, biomechanics and chiropractic) have acquired these fundamental skills through individual voluntary postgraduate training. Most formal specialty training, however, does not encompass all the necessary areas of knowledge and skills for management of musculoskeletal disorders. We must realize that most primary interventionists in the management of WAD have little chance of being effective, given the present university teaching curricula. Conscious of the significant morbidity and socioeconomic costs of musculoskeletal ailments, and in particular WAD, we recommend that an international effort be made to integrate training in the skills essential to the proper management of WAD into the curriculum of those health-care professionals involved in the diagnosis, treatment and rehabilitation of WAD. In addition, there should be a considerable effort made to educate clinicians already involved in the management of WAD through postgraduate education programs.