Whiplash and Chiropractic
aka Cervical Acceleration – Deceleration  (CAD)
or Whiplash – Associated Disorders  (WAD)

The Bone and Joint Decade 2000–2010 Task Force on Neck Pain
And Its Associated Disorders: Executive Summary
J Manipulative Physiol Ther. 2009 (Feb); 32 (2 Suppl): S7–S9 ~ FULL TEXT
The prognosis for neck pain also appears to be multifactorial. Younger age was associated with a better prognosis, whereas poor health and prior neck pain episodes were associated with a poorer prognosis. Poorer prognosis was also associated with poor psychological health, worrying, and becoming angry or frustrated in response to neck pain. Greater optimism, a coping style that involved self-assurance, and having less need to socialize, were all associated with better prognosis. A number of nonsurgical treatments appeared to be more beneficial than usual care, sham, or alternative interventions but none of the active treatments were clearly superior to any other in the short or long term. Educational videos, mobilization, manual therapy, exercises, low-level laser therapy, and perhaps acupuncture appeared to have some benefit. For both WAD and other neck pain without radicular symptoms, interventions that focused on regaining function and returning to work as soon as possible were relatively more effective than interventions that did not have such a focus.

The Empowerment of People With Neck Pain: Introduction
The Bone and Joint Decade 2000–2010 Task Force
on Neck Pain and Its Associated Disorders
J Manipulative Physiol Ther. 2009 (Feb); 32 (2 Suppl): S10-S16 ~ FULL TEXT
It is difficult to predict the impact of the work done by the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders. Some of the sponsoring professional associations may endorse the findings and recommendations or incorporate specific recommendations into their own guidelines for clinical practice. Other professional groups or advocacy groups may feel that the findings of the Neck Pain Task Force are not compatible with their own perceptions regarding neck pain. One might look back at what happened in 1995 immediately after the publication of similar task force findings — specifically those from the Quebec Task Force on Whiplash Associated Disorders and from the Agency for Health Care Policy and Research on Acute Low Back Pain. These publications prompted considerable discussion and also some controversy over recommendations and conclusions. It is expected that government and insurance companies will take into account the recommendations of the Neck Pain Task Force when considering public policy decisions. However, these recommendations should not be considered prescriptive. Nor should they be interpreted in isolation by those determining such issues as reimbursement or public health policy.

A New Conceptual Model Of Neck Pain: Linking Onset, Course, And Care:
The Bone and Joint Decade 2000-2010 Task Force
on Neck Pain and Its Associated Disorders
J Manipulative Physiol Ther. 2009 (Feb); 32 (2 Suppl): S17–28 ~ FULL TEXT
This article describes the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) conceptual model for the onset, course, and care of neck pain. We start with the scope and rationale for proposing a new conceptual model, followed by its purposes and premises. After describing the model's components and associated case definitions, we conclude with a discussion on implications of the model.

Methods for the Best Evidence Synthesis on Neck Pain
and its Associated Disorders: The Bone and Joint
Decade 2000-2010 Task Force on Neck Pain
and Its Associated Disorders
J Manipulative Physiol Ther. 2009 (Feb); 32 (2): S39–S45 ~ FULL TEXT
In 1995, the Québec Task Force on Whiplash-Associated Disorders released the first systematic review of the literature on whiplash injuries. That endeavor produced a baseline of the information on the subject. [1] However, that group's mandate was focused specifically on whiplash injuries and did not permit consideration of neck pain resulting from occupational injuries/strains, or consideration of neck pain in the general population. It is also important to note that much new data on whiplash has been published in the intervening 12 years.   The authors of the 1995 Québec Task Force suggested that the next review of the literature should take place within 5 years. In 2000, we assembled an international task force of scientist/clinicians and methodologists, under the auspices of the Bone and Joint Decade 2000–2010. The mandate of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) was to make recommendations that would culminate in reducing the medical, social, and economic consequences of neck pain and its associated disorders.

The Burden and Determinants of Neck Pain in the
General Population: Results of the Bone and Joint
Decade 2000–2010 Task Force on Neck Pain
and Its Associated Disorders
J Manipulative Physiol Ther. 2009 (Feb); 32 (2 Suppl): S46–S60 ~ FULL TEXT
The annual cumulative incidence of WAD differed substantially between countries. They found that occupant seat position and collision impact direction were associated with WAD in one study. Eliminating insurance payments for pain and suffering were associated with a lower incidence of WAD injury claims in one study. Younger ages and being a female were both associated with filing claims or seeking care for WAD, although the evidence is not consistent. Preliminary evidence suggested that headrests/car seats, aimed to limiting head extension during

Course and Prognostic Factors for Neck Pain in the
General Population: Results of the Bone and Joint
Decade 2000–2010 Task Force on Neck Pain
and Its Associated Disorders
J Manipulative Physiol Ther. 2009 (Feb); 32 (2 Suppl): S87–S96 ~ FULL TEXT
The evidence suggests that approximately 50% of those with WAD will report neck pain symptoms 1 year after their injuries. Greater initial pain, more symptoms, and greater initial disability predicted slower recovery. Few factors related to the collision itself (for example, direction of the collision, headrest type) were prognostic; however, postinjury psychological factors such as passive coping style, depressed mood, and fear of movement were prognostic for slower or less complete recovery. There is also preliminary evidence that the prevailing compensation system is prognostic for recovery in WAD.

The Burden and Determinants of Neck Pain in Workers:
Results of the Bone and Joint Decade 2000–2010
Task Force on Neck Pain and Its
Associated Disorders
J Manipulative Physiol Ther. 2009 (Feb); 32 (2 Suppl): S70-86 ~ FULL TEXT
One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible. The annual prevalence of neck pain varied from 27.1% in Norway to 47.8% in Québec, Canada. Each year, between 11% and 14.1% of workers were limited in their activities because of neck pain. Risk factors associated with neck pain in workers include age, previous musculoskeletal pain, high quantitative job demands, low social support at work, job insecurity, low physical capacity, poor computer workstation design and work posture, sedentary work position, repetitive work and precision work. We found preliminary evidence that gender, occupation, headaches, emotional problems, smoking, poor job satisfaction, awkward work postures, poor physical work environment, and workers' ethnicity may be associated with neck pain. There is evidence that interventions aimed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers.

Course and Prognostic Factors for Neck Pain in Workers:
Results of the Bone and Joint Decade 2000–2010
Task Force on Neck Pain and Its
Associated Disorders
J Manipulative Physiol Ther. 2009 (Feb); 32 (2 Sup):S108–116 ~ FULL TEXT
We found 226 articles related to course and prognostic factors in neck pain and its associated disorders. After a critical review, 70 (31%) were accepted on scientific merit; 14 of these studies related to course and prognostic factors in working populations. Between 60% and 80% of workers with neck pain reported neck pain 1 year later. Few workplace or physical job demands were identified as being linked to recovery from neck pain. However, workers with little influence on their own work situation had a slightly poorer prognosis, and white-collar workers had a better prognosis than blue-collar workers. General exercise was associated with better prognosis; prior neck pain and prior sick leave were associated with poorer prognosis.

The Burden and Determinants of Neck Pain in Whiplash-associated
Disorders After Traffic Collisions: Results of the
Bone and Joint Decade 2000–2010 Task Force
on Neck Pain and Its Associated Disorders
J Manipulative Physiol Ther. 2009 (Feb); 32 (2 Suppl): S61-69 ~ FULL TEXT
The authors found 32 scientifically admissible studies related to the burden and determinants of WAD. In the Western world, visits to emergency rooms due to WAD have increased over the past 30 years. The annual cumulative incidence of WAD differed substantially between countries. They found that occupant seat position and collision impact direction were associated with WAD in one study. Eliminating insurance payments for pain and suffering were associated with a lower incidence of WAD injury claims in one study. Younger ages and being a female were both associated with filing claims or seeking care for WAD, although the evidence is not consistent. Preliminary evidence suggested that headrests/car seats, aimed to limiting head extension during rear-end collisions had a preventive effect on reporting WAD, especially in females.

Course and Prognostic Factors for Neck Pain in Whiplash-
associated Disorders (WAD): Results of the Bone and
Joint Decade 2000–2010 Task Force on Neck Pain
and Its Associated Disorders
J Manipulative Physiol Ther. 2009 (Feb); 32 (2 Sup): S97–107 ~ FULL TEXT
We found 226 articles related to course and prognostic factors in neck pain and its associated disorders. After a critical review, 70 (31%) were accepted on scientific merit; 47 of these studies related to course and prognostic factors in WAD. The evidence suggests that approximately 50% of those with WAD will report neck pain symptoms 1 year after their injuries. Greater initial pain, more symptoms, and greater initial disability predicted slower recovery. Few factors related to the collision itself (for example, direction of the collision, headrest type) were prognostic; however, postinjury psychological factors such as passive coping style, depressed mood, and fear of movement were prognostic for slower or less complete recovery. There is also preliminary evidence that the prevailing compensation system is prognostic for recovery in WAD.

Assessment of Neck Pain and Its Associated Disorders: Results of the
Bone and Joint Decade 2000–2010 Task Force on Neck Pain
and Its Associated Disorders
J Manipulative Physiol Ther. 2009 (Feb); 32 (2 Suppl): S117–S140 ~ FULL TEXT
We found 359 articles on assessment of neck pain. After critical review, 95 (35%) were judged scientifically admissible. Screening protocols have high predictive values to detect cervical spine fracture in alert, low-risk patients seeking emergency care after blunt neck trauma. Computerized tomography (CT) scans had better validity (in adults and elderly) than radiographs in assessing high-risk and/or multi-injured blunt trauma neck patients. In the absence of serious pathology, clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression. One exception is the manual provocation test for cervical radiculopathy, which has high positive predictive value. There was no evidence that specific MRI findings are associated with neck pain, cervicogenic headache, or whiplash exposure. No evidence supports using cervical provocative discography, anesthetic facet, or medial branch blocks in evaluating neck pain. Reliable and valid self-report questionnaires are useful in assessing pain, function, disability, and psychosocial status in individuals with neck pain.

Treatment of Neck Pain: Noninvasive Interventions:
Results of the Bone and Joint Decade 2000–2010
Task Force on Neck Pain and
Its Associated Disorders
J Manipulative Physiol Ther. 2009 (Feb); 32 (2 Suppl): S141–S175 ~ FULL TEXT
For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus.

Treatment of Neck Pain: Injections and Surgical Interventions:
Results of the Bone and Joint Decade 2000–2010 Task Force
on Neck Pain and Its Associated Disorders
J Manipulative Physiol Ther. 2009 (Feb); 32 (2 Suppl): S176–193 ~ FULL TEXT
Of the 31,878 articles screened, 1203 studies were relevant to the Neck Pain Task Force mandate and of these, 31 regarding treatment by surgery or injections were accepted as scientifically admissible. Radiofrequency neurotomy, cervical facet injections, cervical fusion and cervical arthroplasty for neck pain without radiculopathy are not supported by current evidence. We found there is support for short-term symptomatic improvement of radicular symptoms with epidural corticosteroids. It is not clear from the evidence that long-term outcomes are improved with the surgical treatment of cervical radiculopathy compared to nonoperative measures. However, relatively rapid and substantial symptomatic relief after surgical treatment seems to be reliably achieved. It is not evident that one open surgical technique is clearly superior to others for radiculopathy. Cervical foramenal or epidural injections are associated with relatively frequent minor adverse events (5%-20%); however, serious adverse events are very uncommon (<1%). After open surgical procedures on the cervical spine, potentially serious acute complications are seen in approximately 4% of patients.

Clinical Practice Implications of the Bone and Joint Decade
2000-2010 Task Force on Neck Pain and Its Associated
Disorders: From Concepts and Findings
to Recommendations
J Manipulative Physiol Ther. 2009 (Feb); 32 (2): S227–S243 ~ FULL TEXT
The Neck Pain Task Force recommends that people seeking care for neck pain should be triaged into 4 groups: Grade I neck pain with no signs of major pathology and no or little interference with daily activities; Grade II neck pain with no signs of major pathology, but interference with daily activities; Grade III neck pain with neurologic signs of nerve compression; Grade IV neck pain with signs of major pathology. In the emergency room after blunt trauma to the neck, triage should be based on the NEXUS criteria or the Canadian C-Spine Rule. Those with a high risk of fracture should be further investigated with plain radiographs and/or CT-scan. In ambulatory primary care, triage should be based on history and physical examination alone, including screening for red flags and neurologic examination for signs of radiculopathy. Exercises and mobilization have been shown to provide some degree of short-term relief of Grade I or Grade II neck pain after a motor vehicle collision. Exercises, mobilization, manipulation, analgesics, acupuncture, and low-level laser have been shown to provide some degree of short-term relief of Grade I or Grade II neck pain without trauma. Those with confirmed Grade III and severe persistent radicular symptoms might benefit from corticosteroid injections or surgery. Those with confirmed Grade IV neck pain require management specific to the diagnosed pathology.

Research Priorities and Methodological Implications:
The Bone and Joint Decade 2000-2010 Task Force
on Neck Pain and Its Associated Disorders
J Manipulative Physiol Ther. 2009 (Feb); 32 (2): S227–S243 ~ FULL TEXT
We outline a large number of gaps in the current literature. For example, we found important gaps in our knowledge about neck pain in children (risk factors, screening criteria to rule out serious injury, management, course and prognosis); and in the prevention of neck pain-related activity limitations. Few studies addressed the impact of culture or social policies (such as governmental health policies or insurance compensation policies) on neck pain. A number of important questions remain about the effectiveness of commonly used interventions for neck pain.

A Review of the Otological Aspects of Whiplash Injury
Journal of Forensic and Legal Medicine 2009 (Feb); 16 (2): 53–55
Approximately 10% of patients who have suffered with whiplash injury will develop otological symptoms such as tinnitus, deafness and vertigo. Some of these are purely subjective symptoms; nevertheless, for the majority there are specific tests that can be undertaken. These tests can quantify the extent and severity of the symptoms as well as provide guidance as to the correct rehabilitation pathway. This article reviews the body of literature relating to the otological aspects of whiplash injury and gives an overview for medical and legal professionals.

Predictors For Immediate and Global Responses to
Chiropractic Manipulation of the Cervical Spine
J Manipulative Physiol Ther 2008 (Mar); 31 (3): 172–183 ~ FULL TEXT
This study is the first attempt to identify variables that can predict immediate outcomes in terms of improvement and worsening of presenting symptoms, and global improvement, after cervical spine manipulation. From the findings, it was possible to identify some predictors of immediate improvement in presenting symptoms after cervical spine manipulation. Patients presenting with symptoms of “reduced neck, shoulder, arm movement, stiffness,” “neck pain,” “upper, mid back pain,” “headache,” “shoulder, arm pain,” and/or “none or one presenting symptom only” are likely to report immediate improvement in these symptoms after treatment. Patients presenting with any 4 of these symptoms were shown to have the highest probability of immediate improvement. This finding may enhance clinical decision making for selecting cervical manipulation in the treatment of patients with one or more of these complaints. Although it was possible to identify a number of predictor variables for immediate worsening in presenting symptoms and global improvement after cervical spine manipulation, these failed to provide a robust predictive model for clinical application.

Impact of Motor Vehicle Accidents on Neck Pain
and Disability in General Practice
British Journal of General Practice 2008 (Sep); 58 (554): 624–629 ~ FULL TEXT
This study showed that the percentage of patients who had been involved in an MVA and reported continuous neck pain was significantly higher than for those patients with other self-reported causes of neck pain. Reported prevalences of continuous neck pain in patients who had experienced MVAs vary widely in the literature and seem to consist of two different groups of figures – lower prevalence figures of chronic neck pain range between 8% and 24%, [21] while higher reported figures range from 43% up to 66%. [22, 23] Marshall reported that even 80% of patients experienced neck discomfort after an MVA. [12]

A Distinct Pattern of Myofascial Findings in Patients
After Whiplash Injury
Archives of Physical Medicine and Rehabilitation 2008 (Jul); 89 (7): 1290–1293
Forty (85.1%) of the patients with whiplash had positive trigger points in the semispinalis capitis muscle. The patients with whiplash had a significantly higher prevalence of positive trigger points in the semispinalis capitis muscle than any of the control groups (P<.05). For the other examined muscles, the prevalence of trigger points in the patients with whiplash did not differ significantly from the patients with fibromyalgia or nontraumatic chronic cervical syndrome. It did differ from the patients with endogenous depression and the healthy controls.

Physical and Psychological Aspects of Whiplash:
Important Considerations for Primary Care Assessment
Manual Therapy 2008 (May); 13 (2): 93–102
Whiplash is a heterogenous and in many, a complex condition involving both physical and psychological factors. Primary care practitioners are often the first healthcare contact for individuals with a whiplash injury and as such play an important role in gauging prognosis as well as providing appropriate management for whiplash injured patients. It is imperative that factors associated with poor outcome are recognized and managed in the primary care environment at the crucial early acute stage post injury.

Fatty Infiltration in the Cervical Extensor Muscles
in Persistent Whiplash-Associated Disorders:
A Magnetic Resonance Imaging Analysis
Spine (Phila Pa 1976) 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.

Chronic Neck Pain and Whiplash: A Case-control Study
of the Relationship Between Acute Whiplash
Injuries and Chronic Neck Pain
Pain Res Manag. 2006 (Summer); 11 (2): 79–83
Patients were defined as individuals with chronic neck pain, and controls as those with chronic back pain. The two groups were surveyed for cause of chronic pain as well as demographic information. The two groups were compared using an exposure-odds ratio. Forty-five per cent of the patients attributed their pain to a motor vehicle accident. An OR of 4.0 and 2.1 was calculated for men and women, respectively. Based on the results of the present study, it reasonable to infer that a significant proportion of individuals with chronic neck pain in the general population were originally injured in a motor vehicle accident.

Multiplanar Cervical Spine Injury
Due to Head-Turned Rear Impact
Spine (Phila Pa 1976) 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.

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 < or = 2 risk factors to 62% with > or = 5.

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.

Patients With Neck Pain Demonstrate Reduced
Electromyographic Activity of the Deep Cervical
Flexor Muscles During Performance of the
Craniocervical Flexion Test
Spine (Phila Pa 1976). 2004 (Oct 1); 29 (19): 2108–2114 ~ FULL TEXT
There was a strong linear relation between the electromyographic amplitude of the deep cervical flexor muscles and the incremental stages of the craniocervical flexion test for control and individuals with neck pain (P = 0.002). However, the amplitude of deep cervical flexor electromyographic activity was less for the group with neck pain than controls, and this difference was significant for the higher increments of the task (P < 0.05). Although not significant, there was a strong trend for greater sternocleidomastoid and anterior scalene electromyographic activity for the group with neck pain.

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.

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.

The Possibility to Use Simple Validated Questionnaires to
Predict Long–term Health Problems After Whiplash Injury
Spine (Phila Pa 1976) 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.

Characterization of Acute Whiplash–associated Disorders
Spine (Phila Pa 1976). 2004 (Jan 15); 29 (2): 182–188
Acute whiplash subjects with higher levels of pain and disability were distinguished by sensory hypersensitivity to a variety of stimuli, suggestive of central nervous system sensitization occurring soon after injury. These responses occurred independently of psychological distress. These findings may be important for the differential diagnosis of acute whiplash injury and could be one reason why those with higher initial pain and disability demonstrate a poorer outcome.

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.
There are more articles like this at our: Cervical Curve Page

Sensory Hypersensitivity Occurs Soon After Whiplash
Injury and Is Associated with Poor Recovery
Pain. 2003 (Aug); 104 (3): 509–517 ~ FULL TEXT
All whiplash groups demonstrated local mechanical hyperalgesia in the cervical spine at 1 month post–injury. This hyperalgesia persisted in those with moderate/severe symptoms at 6 months but resolved by 2 months in those who had recovered or reported persistent mild symptoms. Only those with persistent moderate/severe symptoms at 6 months demonstrated generalised hypersensitivity to all sensory tests. These changes occurred within 1 month of injury and remained unchanged throughout the study period.

Cervical Spine Geometry Correlated to Cervical
Degenerative Disease in a Symptomatic Group
J Manipulative Physiol Ther 2003 (Jul); 26 (6): 341–346 ~ FULL TEXT
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.

Development of Motor System Dysfunction Following
Whiplash Injury
Pain. 2003 (May); 103 (1–2): 65–73
Dysfunction in the motor system is a feature of persistent whiplash associated disorders. Little is known about motor dysfunction in the early stages following injury and of its progress in those persons who recover and those who develop persistent symptoms. This study measured prospectively, motor system function (cervical range of movement (ROM), joint position error (JPE) and activity of the superficial neck flexors (EMG) during a test of cranio–cervical flexion) as well as a measure of fear of re–injury (TAMPA) in 66 whiplash subjects within 1 month of injury and then 2 and 3 months post injury. Subjects were classified at 3 months post injury using scores on the neck disability index: recovered (<8), mild pain and disability (10–28) or moderate/severe pain and disability (>30).

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.

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.

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 ~ FULL TEXT
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.
There are more articles like this at our: Cervical Curve Page

Cervical Spine Lesions After Road Traffic Accidents:
A Systematic Review
Spine (Phila Pa 1976) 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. 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.

Psychiatry of Whiplash Neck Injury
Br J Psychiatry 2002 (May); 180: 441–448 ~ FULL TEXT
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.
NOTE: This paper helps to dispell the inaccurate conclusion that compensation drives outcomes in whiplash case as suggested in the New England Journal of Medicine 2000 (Apr 20) by eliminating insurer's bias.

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.

Central Hypersensitivity In Chronic Pain After
Whiplash Injury
Clin J Pain. 2001 (Dec); 17 (4): 306–315
The authors found a hypersensitivity to peripheral stimulation in whiplash patients. Hypersensitivity was observed after cutaneous and muscular stimulation, at both neck and lower limb. Because hypersensitivity was observed in healthy tissues, it resulted from alterations in the central processing of sensory stimuli (central hypersensitivity). Central hypersensitivity was not dependent on a nociceptive input arising from the painful and tender muscles.

Whiplash Injury and Occult Vertebral Fracture: A Case Series of
Bone SPECT Imaging of Patients With Persisting Spine Pain
Following a Motor Vehicle Crash
Cervical Spine Research Society 29th Annual Meeting, Monterey, CA Nov 29 - Dec 1, 2001
Our results, even though of a limited sample of patients, suggest a possible pathological mechanism at work in chronic whiplash that has not been previously described. While other authors have reported vertebral fractures resulting from whiplash trauma, none that we are aware of have suggested unhealed fractures as a potential source of chronic pain. Lack of specificity of bone scan and SPECT imaging for fracture may be a factor in our series, however, the high correlation of symptoms to findings suggests a traumatic rather than degenerative etiology. Greater subject numbers are needed in order to perform meaningful subgroup analyses relating to gender, age, and injury and crash details as risk factors for occult spinal fracture following whiplash. Our findings may point to more effective methods of dealing with chronic spine pain resulting from motor vehicle crashes.

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
New England Journal of Medicine 2000 (Apr 20); 342 (16): 1179–1186 ~ FULL TEXT
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.
NOTE: The following paper helps to dispell these inaccurate conclusion that compensation drives outcomes in whiplash cases [Br J Psychiatry 2002 (May)] by eliminating insurer's bias.

Is It Safe to Adjust the Cervical Spine in the Presence
of a Herniated Disc?
Dynamic Chiropractic – June 12, 2000
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.

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.

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
Dynamic Chiropractic – April 8, 2004
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.

Motion Analysis of Cervical Vertebrae
During Whiplash Loading
Spine (Phila Pa 1976) 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.

Whiplash Associated Disorders: Redefining Whiplash
and Its Management by the Quebec Task Force:
A Critical Evaluation
Spine (Phila Pa 1976) 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 also want to review the original Quebec Task Force Report on WAD.

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.

Conservative Management of Mechanical Neck Pain:
Systematic Overview and Meta-analysis
British Medical Journal 1996 (Nov 23); 313 (7068): 1291–1296 ~ FULL TEXT
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 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.

Whiplash Injury and Chronic Neck Pain
New England Journal of Medicine 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.

The Rate of Recovery Following Whiplash Injury
European Spine Journal 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.

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.

Cervical Zygapophyseal Joint Pain Patterns
Part I: A Study in Normal Volunteers
Spine (Phila Pa 1976) 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.

The Risk of Injury for Children
Exposed to Whiplash Trauma
Arthur C. Croft, DC, MS, FACO
Dynamic Chiropractic (December 14, 2000)
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]

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.

Concussion May Be More Serious Than Thought
J Neurotrauma 2000 (May); 17 (5): 389–401
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
Dynamic Chiropractic (May 15, 2000)
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.

Chiropractic Care for Spinal Whiplash Injuries
David BenEliyahu, DC, DAAPM, DACBSP
Dynamic Chiropractic – November 15, 1999
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
Ronald Eccles Jr., DC, DABCO, DACAN
Dynamic Chiropractic – September 1, 1995
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
Ronald Eccles Jr., DC, DABCO, DACAN
Dynamic Chiropractic Sept 25, 1995
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