WHIPLASH @ CHIRO.ORG
 
   
Welcome to the whiplash Section @ Chiro.Org This section contains
a vast collection of articles detailing how chiropractic can help.


 
   

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

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:
Frankp@chiro.org

If there are terms in these articles you don't understand, you can get a definition from the Merriam Webster Medical Dictionary.   If you want information about a specific disease, you can access the Merck Manual.   You can also search Pub Med for more abstracts on this, or any other health topic.

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Whiplash Articles
 
   

Chiropractic And Chronic Neck Pain
A Chiro.Org article collection

This page discusses the benefits of chiropractic for chronic neck pain.

Radiculopathy and Chiropractic Page
A Chiro.Org article collection

This page discusses the benefits of chiropractic for radiculopathy.

Mechanism of Whiplash Injury
Clinical Biomechanics 1998 (Jun); 13 (4-5): 239-249 ~ FULL TEXT

The hyper-extension hypothesis of injury mechanism was not supported by these studies. We found a distinct bi-phasic kinematic response of the cervical spine to whiplash trauma. In the first phase, the spine formed an S-shaped curve with flexion at the upper levels and hyper-extension at the lower levels. In the second phase, all levels of the cervical spine were extended, and the head reached its maximum extension. The occurrence of anterior injuries in the lower levels in the first phase was confirmed by functional radiography, flexibility tests and imaging modalities. The largest dynamic elongation of the capsular ligaments was observed at C6–C7 level during the initial S-shaped phase of whiplash. Similarly, the maximum elongation of the vertebral artery occurred during the S-shape phase of whiplash. We propose, based upon our experimental findings, that the lower cervical spine is injured in hyperextension when the spine forms an S-shaped curve. Further, this occurs in the first whiplash phase before the neck is fully extended. At higher trauma accelerations, there is a tendency for the injuries to occur at the upper levels of the cervical spine. Our findings provide truer understanding of whiplash trauma and may help in improving the diagnosis, treatment, and prevention of these injuries.

Multivariable Prediction Models for the Recovery of
and Claim Closure Related to Post-collision Neck
Pain and Associated Disorders

Chiropractic & Manual Therapies 2023 (Aug 25); 31: 32 ~ FULL TEXT

We developed clinical prediction models that predict recovery and claim closure in individuals with NAD following traffic collisions. Prognostic factors included expectation of recovery, age, having a prior neck injury claim, percentage of body in pain, baseline neck pain and headache intensity, and disability. In addition, depressive symptoms remained predictive in the model predicting claim closure. Our models have limited predictive ability and require an impact analysis before being used in clinical settings.

The Nosological Classification of Whiplash-
associated Disorder: A Narrative Review

J Can Chiropr Assoc 2021 (Apr); 65 (1): 76–93 ~ FULL TEXT

A definitive etiopathological pathway displaying a causal relationship between MVC exposure and WAD development remains to be elucidated. While the face validity of WAD is good; as both clinicians and patients recognise the condition, the evidence supporting the various purported constructs suggesting a causal link between a trauma mechanism and the development of symptoms is inadequate. In the absence of a defined injury mechanism, a sophisticated understanding of the interconnected nature of biological, psychological, and social states and processes involved in the perception of pain is recommended. Therefore, future research is required to develop a better understanding of how to enhance individuals’ expectations and abilities to adapt and self-manage in the face of physical, emotional, and social challenges, as this appears to significantly impact recovery.

Is Acceleration a Valid Proxy for Injury Risk in
Minimal Damage Traffic Crashes? A Comparative
Review of Volunteer, ADL and Real-World Studies

Int. J. Environ. Res. Public Health 2021 (Mar 12); 18 (6): 2901 ~ FULL TEXT

We compared the occupant accelerations of minimal or no damage (i.e., 3 to 11 kph speed change or “delta V”) rear impact crash tests to the accelerations described in 6 of the most commonly reported ADLs in the reviewed studies. As a final step, the injury risk observed in real world crashes was compared to the results of the pooled crash test and ADL analyses, controlling for delta V. The results of the analyses indicated that average peak linear and angular acceleration forces observed at the head during rear impact crash tests were typically at least several times greater than average forces observed during ADLs. In contrast, the injury risk of real-world minimal damage rear impact crashes was estimated to be at least 2000 times greater than for any ADL. The results of our analysis indicate that the principle underlying the biomechanical injury causation approach, that occupant acceleration is a proxy for injury risk, is scientifically invalid. The biomechanical approach to injury causation in minimal damage crashes invariably results in the vast underestimation of the actual risk of such crashes, and should be discontinued as it is a scientifically invalid practice.

Revisiting Risk-stratified Whiplash-exposed
Patients 12 to 14 Years After Injury

Clinical Journal of Pain 2020 (Dec); 36 (12): 923–931 ~ FULL TEXT

Internal and long-term validation of DWGRAS was performed, but a low response rate indicates that results should be interpreted with caution. Furthermore, external validation needs to be done in long-term studies. An receiver operating characteristics curve of 0.73 (95% confidence interval 0.67; 0.79) predicting daily or weekly whiplash-related disability after 12 to 14 years was found using the DWGRAS risk score.

The Course and Factors Associated with Recovery
of Whiplash-associated Disorders: An Updated
Systematic Review by the Ontario Protocol for
Traffic Injury Management (OPTIMa) Collaboration

European J Physiotherapy 2020 (Mar 25); 23 (5): 1–16 ~ FULL TEXT

The current best evidence synthesis updates findings published by the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders with respect to prognostic factors in WAD. This update provides a substantial body of evidence supporting the important prognostic role of post-collision psychological factors in WAD recovery.

Diagnostic Accuracy of Videofluoroscopy for Symptomatic
Cervical Spine Injury Following Whiplash Trauma

Int J Environ Res Public Health. 2020 (Mar 5); 17 (5): pii: E1693 ~ FULL TEXT

The videofluoroscopic examination of the cervical spine is a highly accurate test for identifying patients with symptomatic ligamentous instability after whiplash trauma. The imaging modality should be utilized more widely in the clinical investigation of chronic post-whiplash pain

Exposure to a Motor Vehicle Collision and the Risk
of Future Neck Pain: A Systematic Review
and Meta-analysis

PM R. 2019 (Nov); 11 (11): 1228–1239 ~ FULL TEXT

Eight articles were identified of which seven were of lower risk of bias. Six studies reported a positive association between a neck injury in an MVC and future NP compared to those without a neck injury in a MVC. Pooled analysis of the six studies indicated an unadjusted relative risk of future NP in the MVC exposed population with neck injury of 2.3 (95% CI [1.8, 3.1]), which equates to a 57% attributable risk under the exposed. In two studies where exposed subjects were either not injured or injury status was unknown, there was no increased risk of future NP.   There was a consistent positive association among studies that have examined the association between MVC-related neck injury and future NP. These findings are of potential interest to clinicians, insurers, patients, governmental agencies, and the courts.

Is a Government-regulated Rehabilitation Guideline
More Effective than General Practitioner Education
or Preferred-provider Rehabilitation in Promoting
Recovery from Acute Whiplash-associated Disorders?
A Pragmatic Randomised Controlled Trial
  NCT00546806
BMJ Open. 2019 (Jan 24); 9 (1): e021283 ~ FULL TEXT

The results of our trial suggest that a government-regulated guideline is not more effective than a physician-based education and activation or preferred-provider rehabilitation intervention in promoting global recovery of patients with acute WAD. Similarly, we found no differences in neck-specific outcomes, depression or quality of life between groups. However, the government-regulated guideline may be associated with temporary faster self-rated recovery in the first 80 days postinjury, but this finding needs to be validated in future research.

The Association Between a Lifetime History of Low Back
Injury in a Motor Vehicle Collision and Future
Low Back Pain: A Population-based Cohort Study

European Spine Journal 2018 (Jan); 27 (1): 136–144 ~ FULL TEXT

Our analysis suggests that a history of low back injury in a MVC is a risk factor for developing future troublesome LBP. The consequences of a low back injury in a MVC can predispose individuals to experience recurrent episodes of low back pain.

Is Exercise Effective for the Management of Neck Pain and
Associated Disorders or Whiplash-associated Disorders?
A Systematic Review by the Ontario Protocol for
Traffic Injury Management (OPTIMa) Collaboration

Spine J 2016 (Dec); 16 (12): 1503–1523 ~ FULL TEXT

We found evidence that supervised qigong, Iyengar yoga, and combined programs including strengthening, range of motion, and flexibility are effective for the management of persistent neck pain. We did not find evidence that one supervised exercise program is superior to another. Overall, most studies reported small effect sizes suggesting that a small clinical effect can be expected with the use of exercise alone.

Are Manual Therapies, Passive Physical Modalities,
or Acupuncture Effective for the Management of
Patients with Whiplash-associated Disorders
or Neck Pain and Associated Disorders?
An Update of the Bone and Joint Decade
Task Force on Neck Pain and
Its Associated Disorders
by the OPTIMa Collaboration

Spine J. 2016 (Dec); 16 (12): 1598-1630 ~ FULL TEXT

Our review adds new evidence to the Neck Pain Task Force and suggests that mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain. It also suggests that electroacupuncture, strain-counterstrain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, and ultrasound) are not effective and should not be used to manage neck pain.

Does Structured Patient Education Improve the Recovery
and Clinical Outcomes of Patients with Neck Pain?
A Systematic Review from the Ontario Protocol for
Traffic Injury Management (OPTIMa) Collaboration

Spine J. 2016 (Dec); 16 (12): 1524–1540

Results suggest that structured patient education alone cannot be expected to yield large benefits in clinical effectiveness compared with other conservative interventions (including spinal manipulation, massage, supervised exercise, and physiotherapy) for patients with WAD or NAD.   Moreover, structured patient education may be of benefit during the recovery of patients with WAD when used as an adjunct therapy to physiotherapy or emergency room care. These benefits are small and short lived.

Classifying Whiplash Recovery Status Using the Neck
Disability Index: Optimized Cutoff Points Derived
From Receiver Operating Characteristic

J Chiropractic Medicine 2016 (Jun); 15 (2): 95–101 ~ FULL TEXT

Although the optimal or perfect NDI score is 0, population studies have indicated that scores of generally healthy asymptomatic persons range from 4 to 5 in children to 7 in adults. Our goal was to investigate the optimal cutoff point for NDI score for a group of American adults who had suffered whiplash injury using their self-assessment of recovery as the state variable or criterion standard. The results of our investigation indicate that the optimal NDI score cutoff point for differentiating the recovery state after whiplash is 15. Misclassification errors are likely when using lower values.

The Treatment of Neck Pain-Associated Disorders
and Whiplash-Associated Disorders:
A Clinical Practice Guideline

J Manipulative Physiol Ther. 2016 (Oct); 39 (8): 523–564 ~ FULL TEXT

The objective was to develop a clinical practice guideline on the management of neck pain-associated disorders (NADs) and whiplash-associated disorders (WADs).
This guideline replaces 2 prior chiropractic guidelines on NADs and WADs.

Are People With Whiplash Associated Neck Pain
Different to People With Non-Specific Neck Pain?

J Orthop Sports Phys Ther. 2016 (Oct); 46 (10): 894–901

2,578 participants were included in the study. Of these 488 (19%) were classified as having WAD. At presentation patients with WAD were statistically different to patients without WAD for almost all characteristics investigated. While most differences were small (1.1 points on an 11-point pain rating scale and 11 percentage points on the Neck Disability Index) others including the presence of dizziness and memory difficulties were substantial. The between group differences in pain and disability increased significantly (P<.001) over 12 months. At 12–month follow-up the patients with WAD on average had approximately 2 points more pain and 16 percentage points more disability than those with non-specific neck pain.

Comparing 2 Whiplash Grading Systems To
Predict Clinical Outcomes

J Chiropractic Medicine 2016 (Jun); 15 (2): 81–86 ~ FULL TEXT

Applying the criteria of the original 1993 Croft grading system, the subset comprised 1 grade 1 injury, 32 grade 2 injuries, 53 grade 3 injuries, and 32 grade 4 injuries. Applying the criteria of the modified (QTF-WAD) grading system, there were 1 grade 1 injury, 89 grade 2 injuries, and 28 grade 3 injuries. Both whiplash grading systems correlated negatively with recovery; that is, higher severity grades predicted a lower probability of recovery, and statistically significant correlations were observed in both, but the Croft grading system substantially outperformed the QTF-WAD system on this measure.

Variations in Patterns of Utilization and Charges for
the Care of Neck Pain in North Carolina, 2000
to 2009: A Statewide Claims' Data Analysis

J Manipulative Physiol Ther. 2016 (May); 39 (4): 240–251 ~ FULL TEXT

Increases in utilization and charges were the highest among patterns involving MDs, PTs and referral providers.   These findings are consistent with previous studies showing that medical specialty, diagnostic imaging, and invasive procedures (eg, spine injections, surgery) [17, 19, 20, 21] are significant drivers of increasing spine care costs.
This is one of 3 of the Cost-Effectiveness Triumvirate articles.

Patients' Experiences With Vehicle Collision to Inform
the Development of Clinical Practice Guidelines:
A Narrative Inquiry

J Manipulative Physiol Ther 2016 (Mar); 39 (3): 218–228 ~ FULL TEXT

Four recommended directions were identified from the narrative inquiry process and applied. First, terminology that caused stigma was a concern. This resulted in modified language ("injured persons") being adopted by the Expert Panel, and a new nomenclature categorizing layers of injury was identified. Second, participants valued being engaged as partners with health care practitioners. This resulted in inclusion of shared decision-making as a foundational recommendation connecting CPGs and care planning. Third, emotional distress was recognized as a factor in recovery.

One- and Two-year Follow-up of a Randomized Trial of
Neck-specific Exercise with or without a Behavioural
Approach Compared with Prescription of Physical
Activity in Chronic Whiplash Disorder

J Rehabil Med 2016 (Jan); 48 (1): 56–64 ~ FULL TEXT

After 1-2 years, participants with chronic whiplash who were randomized to neck-specific exercise, with or without a behavioural approach, remained more improved than participants who were prescribed general physical activity.

A Population-based, Incidence Cohort Study of Mid-back
Pain After Traffic Collisions: Factors Associated
with Global Recovery

European Journal of Pain 2015 (Nov); 19 (10): 1486–1495 ~ FULL TEXT

Mid-back pain after traffic collisions is common, especially in women and in young individuals. A substantial proportion of participants in this cohort experienced a delayed recovery. Prognostic factors with the strongest influence on recovery were poor expectations for recovery and having a previous experience of a traffic injury.

Function in Patients With Cervical Radiculopathy or
Chronic Whiplash-Associated Disorders Compared
With Healthy Volunteers

J Manipulative Physiol Ther 2014 (May); 37 (4): 211–218 ~ FULL TEXT

Patient groups exhibited significantly lower performance than the healthy group in all physical measures (P < .0005) except for neck muscle endurance in flexion for women (P > .09). There was a general trend toward worse results in the CR group than the WAD group, with significant differences in neck active range of motion, left hand strength for women, pain intensity, Neck Disability Index, EuroQol 5-dimensional self-classifier, and Self-Efficacy Scale (P < .0001). Patients had worse values than healthy individuals in almost all physical measures. There was a trend toward worse results for CR than WAD patients.

The Rapid and Progressive Degeneration of the Cervical
Multifidus in Whiplash: An MRI Study
of Fatty Infiltration

Spine (Phila Pa 1976). 2015 (Jun 15); 40 (12): E694–700 ~ FULL TEXT

Thirty-six subjects with whiplash injury were enrolled at less than 1 week postinjury and classified at 3 months using percentage scores on the Neck Disability Index as recovered/mild (0%–28%) or severe (≥30%). A fat/water magnetic resonance imaging measure, patient self-report of pain-related disability, and post-traumatic stress disorder were collected at less than 1 week, 2 weeks, and 3 months postinjury. The effects of time and group (per Neck Disability Index) and the interaction of time by group on MFI were determined. Receiver operating characteristic curve analysis was used to determine a cut-point for MFI at 2 weeks to predict outcome at 3 months.

Mild Traumatic Brain Injury After Motor Vehicle
Collisions: What Are the Symptoms and Who
Treats Them? A Population-Based 1-Year
Inception Cohort Study

Arch Phys Med Rehabil. 2014 (Mar); 95 (3 Suppl): S286–294 ~ FULL TEXT

In this first population-based inception cohort study of individuals who have experienced a mild traumatic brain injury (MTBI) during a car collision, we found a high prevalence of multiple symptoms and pain at several body sites. In addition, care-seeking from multiple providers continued throughout the first year postinjury. Studies investigating how clusters of symptoms interact and affect prognosis are needed. Most urgently however, high-quality clinical trials investigating the effectiveness and cost-effectiveness of the many kinds of treatments given to these patients are needed.

Exploring the Clinical Course of Neck Pain in
Physical Therapy: A Longitudinal Study

Arch Phys Med Rehabil. 2014 (Feb); 95 (2): 303–308 ~ FULL TEXT

The purpose of this exploratory study was to longitudinally describe the clinical course of mechanical neck pain during 1 month of usual-care outpatient physical therapy treatment. This was intended as a hypothesis-generating rather than confirmatory exercise and to provide guidance for future clinical trials of nonmedical neck pain management. We have shown that the trajectory, on average, in our sample of 50 subjects with mechanical neck pain of varying cause and duration, suggests an improvement of roughly 1.5 NDI points and 0.5 NRS points per week that adequately approximates a linear curve. In showing a mean linear trend over the course of 1 month, clinical trialists can be confident that a 1-month follow-up period is neither too short to identify measurable change, nor too long to risk missing early, rapid change.

The Course of Serum Inflammatory Biomarkers Following
Whiplash Injury and their Relationship to Sensory
and Muscle Measures: A Longitudinal Cohort Study

PLoS One. 2013 (Oct 17); 8 (10): e77903 ~ FULL TEXT

In summary, the results demonstrate initially higher levels of serum C-reactive protein (CRP) following whiplash injury that persist in those with persistent moderate/severe pain and disability and show moderate associations with mechanical and cold hyperalgesia. In contrast serum levels of TNF-? are elevated in those with good or fair recovery and are negatively associated with amounts of fatty infiltrate in the cervical extensor muscles. Inflammatory biomarkers appear to be associated with the presentation of acute and chronic WAD.

A New Stratified Risk Assessment Tool for Whiplash Injuries
Developed from a Prospective Observational Study

BMJ Open 2013 (Jan 30); 3 (1): e002050 ~ FULL TEXT

The risk assessment score is applicable and inexpensive. The early identification of whiplash-exposed persons at risk for chronic pain and work disability is important for planning future treatment in scientific studies.

More research is needed at present, but risk stratification might have a place in the clinic for individual guidance and management of the acute and the subacute whiplash patient. Application of the risk assessment score may be a valuable alternative to the present WAD grading system in predicting work disability and pain and certain psychosocial parameters after neck injury. Furthermore, a similar biopsychosocial risk assessment could be considered in other acute conditions bearing a risk of long-term development of other chronic dysfunctional pain conditions.

Comparison of Outcomes in Neck Pain Patients With
and Without Dizziness Undergoing Chiropractic
Treatment: A Prospective Cohort Study With
6 month Follow-up

Chiropractic & Manual Therapies 2013 (Jan 7); 21: 3 ~ FULL TEXT

Neck pain patients with dizziness reported significantly higher pain and disability scores at baseline compared to patients without dizziness. A high proportion of patients in both groups reported clinically relevant improvement on the PGIC scale. At 6 months after start of chiropractic treatment there were no differences in any outcome measures between the two groups.

Sleep Characteristics in Patients with
Whiplash-Associated Disorders:
A Descriptive Study

Topics in Integrative Health Care 2012 (Dec 31); 3 (4) ~ FULL TEXT

Neck pain related to whiplash-associated disorders (WAD) constitutes a significant health issue that leads patients to seek medical care in chiropractic and other physical therapy, rehabilitative clinics. Studies have indicated that individuals experience multiple clinical manifestations of WADs that lead to chronicity including postural changes, disability, headache, fatigue, and sleep disturbances. [1–4] Although studies have shown that sleep disturbances occur as a result of chronic pain, few studies have explored the relationship between patients with WAD and sleep quality. [4–6]

Responsiveness of the Cervical Northern American Spine
Society Questionnaire (NASS) and the Short Form
36 (SF–36) in Chronic Whiplash

Clinical Rehabilitation 2012 (Feb); 26 (2): 142–151

The NASS was consistently less responsive in function than the SF-36 and cannot be recommended as a specific instrument to measure pain and function more responsively than the SF-36 in chronic whiplash disorder.   The SF-36 seems to be a powerful, responsive instrument in chronic pain.

The Risk Assessment Score in Acute Whiplash Injury
Predicts Outcome and Reflects Biopsychosocial Factors

Spine (Phila Pa 1976). 2011 (Dec 1); 36 (25 Suppl): S263–267

A receiver operating characteristics curve for the Risk Assessment Score and 1–year work disability showed an area of 0.90. Risk strata and number of sick days showed a log-linear relationship. In stratum 1 full recovery was encountered, but for high-risk patients in stratum 6 only 50% and 7 only 20% had returned to work after 1 year (P < 5.4 × 10). Strength measures, psychophysical pain measurements, and psychological and social data (reported elsewhere) showed significant relation to risk strata. The Risk Assessment score is suggested as a valuable tool for grading WLP early after injury. It has reasonable screening power for encountering work disability and reflects the biopsychosocial nature of whiplash injuries.

Pain-related Emotions in Early Stages of Recovery in
Whiplash-associated Disorders: Their Presence,
Intensity, and Association With Pain Recovery

Psychosom Med. 2011 (Oct); 73 (8): 708–715

Psychological factors such as depression affect recovery after whiplash-associated disorders. This study examined the prevalence of pain-related emotions, such as frustration, anger, and anxiety, and their predictive value for postcrash pain recovery during a 1-year follow-up.

Application of a Diagnosis-Based Clinical
Decision Guide in Patients with Neck Pain

Chiropractic & Manual Therapies 2011 (Aug 27); 19 (1): 19 ~ FULL TEXT

Neck pain (NP) is a common cause of disability. Accurate and efficacious methods of diagnosis and treatment have been elusive. A diagnosis-based clinical decision guide (DBCDG; previously referred to as a diagnosis-based clinical decision rule) has been proposed which attempts to provide the clinician with a systematic, evidence-based guide in applying the biopsychosocial model of care. The approach is based on three questions of diagnosis. The purpose of this study is to present the prevalence of findings using the DBCDG in consecutive patients with NP.

Management of Neck Pain in Royal Australian Air Force
Fast Jet Aircrew

Military Medicine 2011 (Jan); 176 (1): 106–109 ~ FULL TEXT

Eighty-two RAAF FJ aircrew responded to the survey. Ninety-five percent of the respondents experienced flight-related neck pain. The most commonly sought treatment modalities were on-base medical and physiotherapy services. Many respondents reported that currently provided on-base treatment and ancillary services such as chiropractic therapy are the most effective in alleviating symptoms.

A Systematic Review of Chiropractic Management of Adults
with Whiplash-Associated Disorders: Recommendations
for Advancing Evidence-based Practice and Research

Work (A Journal of Prevention, Assessment and Rehabilitation) 2010; 35 (3): 369–394

There is a baseline of evidence that suggests chiropractic care improves cervical range of motion (cROM) and pain in the management of WAD. However, the level of this evidence relevant to clinical practice remains low or draws on clinical consensus at this time. The WAD-Plus Model has implications for use by chiropractors and interdisciplinary professionals in the assessment and management of acute, subacute and chronic pain due to WAD. Furthermore, the WAD-Plus Model can be used in the future study of interventions and outcomes to advance evidence-based care in the management of WAD.

The Cervical Flexion-Relaxation Ratio: Reproducibility and
Comparison Between Chronic Neck Pain Patients and Controls

Spine (Phila Pa 1976) 2010 (Nov 15); 35 (24): 2103–2108

The cervical extensor muscles exhibit a consistent flexion-relaxation (FFR) phenomenon in healthy control subjects and the measurement is highly reproducible when measured 4 weeks apart in both controls and chronic neck pain patients. The FRR in neck pain patients is significantly higher than in control subjects suggesting that this measure may be a useful marker of altered neuromuscular function.

Whiplash-associated Disorders:
Who Gets Depressed? Who Stays Depressed?

European Spine Journal 2010 (Jun); 19 (6): 945–956 ~ FULL TEXT

In a prior study we reported that post crash depression is common following crash related WAD. As a follow-up to that, we now report the characteristics that can assist clinicians to identify not only which patients are more likely to experience post-crash depression, but also identify which are at risk for a more severe course of depression. This is important because depressed mood in those with WAD is not only an additional health burden in itself, but is also associated with slower recovery. The most important characteristics in identifying those with WAD who are likely to experience depression were higher post crash pain, other post-crash symptoms, sustaining a fractured bone, the presence of post-crash anxiety, and the presence of prior mental health problems.

The Association Between a Lifetime History of a Neck Injury
in a Motor Vehicle Collision and Future Neck Pain:
A Population-based Cohort Study

European Spine Journal 2010 (Jun); 19 (6): 972–981 ~ FULL TEXT

The objective of this population-based cohort study was to investigate the association between a lifetime history of neck injury from a motor vehicle collision and the development of troublesome neck pain. The current evidence suggests that individuals with a history of neck injury in a traffic collision are more likely to experience future neck pain. We formed a cohort of 919 randomly sampled Saskatchewan adults with no or mild neck pain in September 1995. At baseline, participants were asked if they ever injured their neck in a motor vehicle collision. Six and twelve months later, we asked about the presence of troublesome neck pain (grade II–IV) on the chronic pain grade questionnaire.   We found a positive association between a history of neck injury in a motor vehicle collision and the onset of troublesome neck pain after controlling for bodily pain and body mass index (adjusted HRR = 2.14; 95% CI 1.12–4.10). Our analysis suggests that a history of neck injury in a motor vehicle collision is a risk factor for developing future troublesome neck pain.




   The Bone and Joint Decade 2000–2010 Task Force   



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.


 End of Bone and Joint Decade 2000–2010 Task Force  


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




Low Speed Rear End Impact Collisions (LOSRIC)

Is Acceleration a Valid Proxy for Injury Risk in
Minimal Damage Traffic Crashes? A Comparative
Review of Volunteer, ADL and Real-World Studies

Int. J. Environ. Res. Public Health 2021 (Mar 12); 18 (6): 2901 ~ FULL TEXT

We compared the occupant accelerations of minimal or no damage (i.e., 3 to 11 kph speed change or “delta V”) rear impact crash tests to the accelerations described in 6 of the most commonly reported ADLs in the reviewed studies. As a final step, the injury risk observed in real world crashes was compared to the results of the pooled crash test and ADL analyses, controlling for delta V. The results of the analyses indicated that average peak linear and angular acceleration forces observed at the head during rear impact crash tests were typically at least several times greater than average forces observed during ADLs. In contrast, the injury risk of real-world minimal damage rear impact crashes was estimated to be at least 2000 times greater than for any ADL. The results of our analysis indicate that the principle underlying the biomechanical injury causation approach, that occupant acceleration is a proxy for injury risk, is scientifically invalid. The biomechanical approach to injury causation in minimal damage crashes invariably results in the vast underestimation of the actual risk of such crashes, and should be discontinued as it is a scientifically invalid practice.

Jaw Symptoms and Signs and the Connection to
Cranial Cervical Symptoms and Post-traumatic
Stress During the First Year After a Whiplash Trauma

Disabil Rehabil. 2010; 32 (24): 1987–1998

Jaw symptoms were initially reported by three men (5%) and three women (4%), and subsequently developed in eight women (10%) during the following year. Jaw signs were noted initially in 53 subjects (37%) and in 28 subjects (24%) after 1 year, without difference between sexes, and more often after low-speed impacts.

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]

The Rate of Change of Acceleration:
Implications to Head Kinematics During Rear-end Impacts

Accid Anal Prev. 2008 (May); 40 (3): 1063–1068

Results demonstrated that the jerk magnitude significantly affected forehead acceleration in the vertical and horizontal directions. Increasing the magnitude of the platform acceleration also differentially affected the horizontal and vertical forehead accelerations. This indicates that the level of jerk influences the resulting head kinematics and should be considered when designing or interpreting experiments that are attempting to predict injury from whiplash-like perturbations.

Significant Spinal Injury Resulting From Low-level Accelerations:
A Case Series of Roller Coaster Injuries

Arch Phys Med Rehabil. 2005 (Nov); 86 (11): 2126–2130

The results of this study suggest that there is no established minimum threshold of significant spine injury. The greatest explanation for injury from traumatic loading of the spine is individual susceptibility to injury, an unpredictable variable.

Correlating Crash Severity With Injury Risk, Injury Severity,
and Long-term Symptoms In Low Velocity Motor Vehicle Collisions

Med Sci Monit. 2005 (Oct); 11 (10): RA316–321

A substantial number of injuries are reported in crashes of little or no property damage. Property damage is an unreliable predictor of injury risk or outcome in low velocity crashes. The MIST protocol for prediction of injury does not appear to be valid.

Awareness Affects the Response of Human Subjects Exposed
to a Single Whiplash-Like Perturbation

Spine (Phila Pa 1976) 2003 (Apr 1); 28 (7): 671–679

The larger retractions observed in surprised females likely produce larger tissue strains and may increase injury potential. Aware human subjects may not replicate the muscle response, kinematic response, or whiplash injury potential of unprepared occupants in real collisions.

Low Speed Frontal Crashes and Low Speed Rear Crashes:
Is There a Differential Risk for Injury?

Annu Proc Assoc Adv Automot Med. 2002; 46: 79–91

Analysis of data revealed that the rear impact vector crash resulted in 2.8 times greater head linear acceleration than frontal crashes. Rear impact crashes resulted in biphasic, complex kinematics compared to the monophasic, less complex frontal crashes. Rear impact crashes were rated markedly less tolerable. Sex-specific differences are also discussed.

How Crash Severity in Rear Impacts Influences
Short- and Long-term Consequences to the Neck

Accid Anal Prev 2000 (Mar); 32 (2): 187–195

The two crashes which resulted in long-term disabling neck injuries had the highest peak acceleration (15 and 13 x g), but not the highest change of velocity. The crash tests showed that a tow-bar may significantly affect the acceleration of the car as well as that of the occupant. According to real-life crashes, a tow-bar on the struck car increased the risk of long-term consequences by 22% but did not affect the risk of short-term consequences.

A Review and Methodologic Critique
of the Literature Refuting Whiplash Syndrome

Spine (Phila Pa 1976) 1999 (Jan 1); 24 (1): 86–96

The validity of whiplash syndrome has been a source of debate in the medical literature for many years. Some authors have published articles suggesting that whiplash injuries are impossible at certain collision speeds; others have stated that the problem is psychological, or is feigned as a means to obtain secondary financial gain. These articles contradict the majority of the literature, which shows that whiplash injuries and their sequelae are a highly prevalent problem that affects a significant proportion of the population.

Low Speed Rear End Impacts: Vehicle and Occupant Response
J Manipulative Physiol Ther 1998 (Nov); 21 (1): 629–639

In low impact collisions, there are usually no skid marks, minor or no visible damage to the vehicle. There is a lack of relationship between occupant injury vehicle speed and/or damage. There does not appear to be an absolute speed or damage to a vehicle for a person to experience injury. Crash tests indicate a change of vehicle velocity of 4km/h (2.5 mph) may produce occupant symptoms. Vehicle damage may not occur until 14–15km/h (8.7 mph).

Chronic Cervical Zygapophysial Joint Pain After Whiplash:
A Placebo–Controlled Prevalence Study

Spine (Phila Pa 1976) 1996 (Aug 1); 21 (15): 1737–1744

The prevalence of cervical zygapophysial joint pain after whiplash has been studied by means of comparative local anesthetic blocks. The concern is that such blocks may be compromised by placebo responses and that prevalence estimates based on such blocks may exaggerate the importance of this condition. In this study, sixty-eight consecutive patients referred for chronic neck pain after whiplash were studied. Those who did not experience pain relief together with the patients with dominant neck pain proceeded to undergo placebo-controlled local anesthetic blocks. Two different local anesthetics and a placebo injection of normal saline were administered in random order and under double-blindfolded conditions. A positive diagnosis was made if the patient's pain was completely and reproducibly relieved by each local anesthetic but not by the placebo injection. Overall, the prevalence of cervical zygapophysial joint pain (C2–C3 or below) was 60% (93% confidence interval, 46%, 73%).

The Prevalence of Chronic Cervical Zygapophysial
Joint Pain After Whiplash

Spine (Phila Pa 1976) 1995 (Jan 1); 20 (1): 20–26

In a significant proportion of patients with whiplash, chronic, refractory neck pain develops. Provisional data suggest many of these patients have zygapophysial joint pain, but the diagnosis has been established by single, uncontrolled diagnostic block. In this study, fifty consecutive, referred patients with chronic neck pain after whiplash injury were studied using double-blind, controlled, diagnostic blocks of the cervical zygapophysial joints. On separate occasions, the joint was blocked with either lignocaine or bupivacaine in random order. A positive diagnosis was made only if both blocks relieved the patient's pain and bupivacaine provided longer relief. In this population, cervical zygapophysial joint pain was the most common source of chronic neck pain after whiplash.

Making the Case Against Late Whiplash
Arthur C. Croft, DC, MS, FACO, FACFE
Dynamic Chiropractic – March 6, 2000

It seems that 1999 was a banner year for the whiplash naysayers. In addition to the barriers such literature imposes for advances in automotive safety, it provides an ongoing source of grist for the ever-polarized medicolegal mill. Readers may recall my criticisms of the first Lithuanian paper of 1996 (reference 10), which appeared in DC that year. The authors revisited this problem of late whiplash more recently. Subsequently, a spate of particularly bad literature has appeared (chiefly from a Dr. Ferrari) that uses, as its chief foundation, these two fundamentally flawed misadventures of science. In this article, I'll explore the major problems with the recent (1999) Lithuanian paper and juxtapose them with the 1996 paper.




Return to Work

Return to Work a Bumpy Road: A Qualitative
Study on Experiences of Work Ability and
Work Situation in Individuals with Chronic
Whiplash-associated Disorders

BMC Public Health 2021 (Apr 23); 21 (1): 785 ~ FULL TEXT

Individuals with chronic with whiplash-associated disorders (WAD) often struggle to return to work. Emotional and practical support from stakeholders is imperative to the success of return to work and needs to be strengthened. Participation in a neck-specific exercise programme, including acknowledgement and information about WAD, could positively affect the work ability of WAD sufferers. This study has suggested management strategies to support the ability to work for individuals with chronic WAD and highlights the need to incorporate a healthy and sustainable return to work in the rehabilitation of individuals with WAD, thereby making the return to work a success.

Return to Work Helps Maintain Treatment Gains
in the Rehabilitation of Whiplash Injury

Pain 2017 (May); 158 (5): 980–987 ~ FULL TEXT

This study examined the relation between return to work and the maintenance of treatment gains made over the course of a rehabilitation intervention. The study sample consisted of 110 individuals who had sustained whiplash injuries in rear collision motor vehicle accidents and were work-disabled at the time of enrolment in the study. Participants completed pre- and post-treatment measures of pain severity, disability, cervical range of motion, depression, posttraumatic stress symptoms, and catastrophizing. Pain severity was assessed again at 1-year follow-up. At 1-year follow-up, 73 participants had returned to work and 37 remained work-disabled. Analyses revealed that participants who returned to work were more likely to maintain treatment gains (77.5%) than participants who remained work-disabled (48%), x2 = 6.3, P < 0.01. The results of a regression analysis revealed that the relation between return to work and the maintenance of treatment gains remained significant (β = 0.30, P < 0.01), even when controlling for potential confounders such as pain severity, restricted range of motion, depression, and pain catastrophizing. The Discussion addresses the processes by which prolonged work-disability might contribute to the failure to maintain treatment gains. Important knowledge gaps still remain concerning the individual, workplace, and system variables that might play a role in whether or not the gains made in the rehabilitation of whiplash injury are maintained. Clinical implications of the findings are also addressed.

The Importance, Measurement and Practical
Implications of Worker's Expectations for
Return to Work

Disabil Rehabil 2015; 37 (20): 1808–1816 ~ FULL TEXT

To date there has been a lot of inconsistency in the way that workers' expectations for RTW have been measured. In addition, most previously used measures have wording difficulties that limit application and interpretability. However, it would seem that these can be overcome with relative ease, and with further development, we will have access to a tool that can provide an opportunity to start a conversation that could help identify problems that might not otherwise be identified. This, in turn, has the potential to facilitate triage, and ultimately, help those involved in RTW management to help their clients achieve their RTW goals.

Beliefs and Expectations for Recovery, Coping,
and Depression in Whiplash-Associated Disorders:
Lessening the Transition to Chronicity

Spine (Phila Pa 1976) 2011 (Dec 1); 36 (25 Suppl): S250–S256 ~ FULL TEXT

Beliefs, expectations, coping, and depression all predict WAD recovery. Efforts to address these factors should take a broad-based approach. These psychological constructs should be viewed as being developed and maintained within the broader social context of family, social networks, employment, and societal processes in general. There is need for a research and clinical paradigm, which acknowledges the interrelationships between internal processes and the social context in attempts to optimize recovery and functioning in those with WAD.

Expectations for Recovery Important in the
Prognosis of Whiplash Injuries

PLoS Med. 2008 (May 13); 5 (5): e105 ~ FULL TEXT

In conclusion, we suggest early assessment of expectations for recovery to be made, in order to identify people at risk for poor prognosis after WAD. Furthermore, controlled studies on interventions aimed at modifying expectations are warranted. Such studies could be conducted on the population level, similar to the successful media campaign on back pain beliefs, which decreased disability claims, both in terms of incidence and time on benefits. [31, 32] Alternatively interventions targeting persons in the acute phase of an injury should be evaluated. Finally, it is not inconceivable that our findings can be extended to persons with pain conditions other than WAD.




Primary Whiplash Resources

Chiropractic And Chronic Neck Pain
A Chiro.Org article collection

This page discusses the benefits of chiropractic for chronic neck pain.

Mild Traumatic Brain Injury (MTBI)
A Chiro.Org article collection

This page reviews guidelines for care and contains some interesting case studies on MTBI.

Radiculopathy and Chiropractic Page
A Chiro.Org article collection

This page discusses the benefits of chiropractic for radiculopathy.

Neck and Back Pain in Children
A Chiro.Org article collection

This page discusses the benefits of chiropractic for children.

Headaches in Children
A Chiro.Org article collection

This page also discusses the benefits of chiropractic for children.

Neck Disorder Guidelines
A Chiro.Org article collection

New additions include 7 tables from Dr. Arthur C. Croft's Whiplash Injuries: The Cervical Acceleration/ Deceleration Syndrome which contain information on complicating factors for recovery, guidelines for frequency and duration of care, treatment adjuncts and contraindications to manipulation. It also includes guidelines from the California Industrial Medical Council.
You may also want to review the complete Guidelines Section.

Cervical Spine Trauma
Chapter 22 from: “The Rehabilitation Monograph Series”

By Richard C. Schafer, D.C., FICC and the ACAPress
The cervical spine provides structural stability and support for the cranium, and a flexible and protective column for movement and balance adaptation, along with housing of the spinal cord and vertebral arteries. It also allows for directional orientation of the eyes and ears. Nowhere in the spine is the relationship between the osseous structures and the surrounding neurologic and vascular beds as intimate or subject to disturbance as it is in the cervical region. Whether induced by trauma or not, cervical subluxation syndromes may be reflected in total body habitus. IVF insults, and the effects of articular fixations can manifest throughout the motor, sensory, and autonomic nervous systems. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the cervical spine, as may numerous brainstem disorders.

Soft-Tissue Neck Trauma
Chapter 15 from: “The Rehabilitation Monograph Series”

By Richard C. Schafer, D.C., FICC and the ACAPress
The mechanical relationship between the head and neck has been crudely compared to a brick attached to a flexible rod. As the structural mass of the head is so much greater than that of the neck, it is no wonder that injuries of the neck are so prevalent. Even the person with a short neck and well-developed neck muscles and ligaments is not free of potential injury.

Joint Trauma
Chapter 8 from: “The Rehabilitation Monograph Series”

By Richard C. Schafer, D.C., FICC and the ACAPress
The general stability of synovial joints is established by action of surrounding muscles. Excessive joint stress results in strained muscles and tendons and sprained or ruptured ligaments and capsules. When stress is chronic, degenerative changes occur. The lining of synovial joints is slightly phagocytic, is regenerative if damaged, and secretes synovial fluid that is a nutritive lubricant having bacteriostatic and anticoagulant characteristics. This anticoagulant effect may result in poor callus formation in intra-articular fractures where the fracture line is exposed to synovial fluid. Synovial versus mechanical causes of joint pain are shown in Table 1.

Arthur C. Croft, D.C. "Dynamic Chiropractic" Articles
A Chiro.Org article collection

There are 107 articles here for your review. You may also enjoy reviewing Dr. Croft's website.

Whiplash: A Medical Doctor's Review of the Literature
A Chiro.Org article collection

Enjoy this facinating collection of citations on the effects of rear-end motor vehicle accidents.

What Causes Chronic Neck Pain?
North American Spine Society
It is usually not possible to know the exact cause of neck pain in the days or weeks after a car accident. We know the muscles and ligaments get strained and are probably inflamed, but they usually heal within six to ten weeks. Pain that lasts longer (than 6–10 weeks) is usually due to deeper problems such as injury to the disc or facet joint, or both. Read more here.

The Highway Safety's Whiplash Page
Insurance Institute for Highway Safety
This page accurately defines whiplash injury, and offers other interesting FAQs


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