Whiplash

"Today, the largest single contributor to chronic neck pain and overall spine pain are motor vehicle crashes. Of the six million injuries per year, about three million are whiplash-type injuries. Of those, 500,000 to 900,000 will develop chronic pain." A. Croft, Journal of the American Chiropractic Association, Feb. 2000, 37:2.

Other estimates state 43% will go on to have chronic pain as a result of whiplash. (Woodward)

• How crash severity in rear impacts influences short and long-term consequences to the neck.
  Krafft M, Kullgren A, Tingvall C, Bostrom O, Fredriksson R. Folksam Research, Stockholm, Sweden.
  Accid Anal Prev 2000 Mar;32(2):187-95
  
  The main public-health problem concerning WAD (whiplash associated disorders) are injuries leading to long-term consequences. Yet epidemiological studies mostly concentrate on data based on the injury outcome occurring shortly after the crash. The purpose of this article is to study the influence of crash severity in rear impacts leading to short and long-term consequences to the neck (WAD 1-3), lasting less than or more than 1 year. The influence of change of velocity as well as the car acceleration were investigated by using data from crash pulse recorders (CPR) installed in vehicles, involved in rear impacts. The influence of the car acceleration were also investigated by studying the frequency of occurrence of a tow-bar (hinge) on the struck car. Apart from real-life data, full-scale car-to-car crashes were performed to evaluate the influence of a tow-bar on the struck car. 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. Out of the 28 crash recorder-equipped struck cars involving 38 occupants, 15 sustained no injury where the peak acceleration was 6g or less, 20 sustained short-term consequences where the peak acceleration was 10g or less. Three occupants from two different crashes sustained long-term consequences. 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.
  
  
• A symptomatic classification of whiplash injury and the implications for treatment. Khan S, Cook J, Gargan M, Bannister G.
  Journal of Orthopaedic Medicine 1999;21(1):22-25.
  
  Conventional treatment of patients with whiplash symptoms is disappointing. A retrospective study by Woodward et al., demonstrated that chiropractic treatment benefited 26 of 28 patients suffering from chronic whiplash syndrome. The question was not whether chiropractic was beneficial for acute whiplash patients, but to determine which patients with chronic whiplash will benefit from chiropractic treatment. The authors interviewed 100 consecutive chiropractic referrals for chronic whiplash symptoms, seven of which were lost to follow up. They were able to divide the remaining 93 patients into three symptom groups: Group 1: patients with "neck pain radiating in a 'coat hanger' distribution, associated with restricted range of neck movement but with no neurological deficit"; Group 2: patients with "neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement"; Group 3: patients who described severe neck pain but all of whom has a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes. These patients also described an unusual complex of symptoms, including blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain. The patients underwent an average of 19.3 adjustments over the course of 4.1 months (mean). The patients were then surveyed and their improvement reported as follows:
  
  Group 1
  24% - Asymptomatic
  24% - Improved by Two Symptom Grades
  24% - Improved by One Symptom Grade
  28% - No Improvement
  
  Group 2
  38% - Asymptomatic
  43% - Improved by Two Symptom Grades
  13% - Improved by One Symptom Grade
  6% - No Improvement
  
  Group 3
  0% - Asymptomatic
  9% - Improved by Two Symptom Grades
  18%- Improved by One Symptom Grade
  64%- No Improvement
  9% - Got Worse
  
  Woodward, et al., found improvement in chronic symptoms in 26 of 28 patients (93%) following chiropractic treatment. Our results confirm the efficacy of chiropractic, with 69 of our 93 patients (74%) improving following treatment. Our study suggests that such a group of nonresponders does exist, represented by group 3. The defining characteristics of patients in this group were the full range of neck movement in association with neck pain, bizarre symptoms, female sex and ongoing litigation. The mean age of the group at 29.5 (16-43) was lower than that of the other two groups (mean 36.8, range 18-65). The results from this study provide further evidence that chiropractic is an effective treatment for chronic whiplash symptoms. However, our identification of a group of patients who fail to respond to such treatment, highlights the need for a careful history and physical examination before commencing treatment.
  
  
• Chiropractic treatment of chronic 'whiplash' injuries.
  Woodward MN, Cook JC, Gargan MF, Bannister GC. University Department of Orthopaedic Surgery, Bristol, UK.
  Injury 1996 Nov;27(9):643-5
  
  Forty-three per cent of patients will suffer long-term symptoms following 'whiplash' injury, for which no conventional treatment has proven to be effective. A retrospective study was undertaken to determine the effects of chiropractic in a group of 28 patients who had been referred with chronic 'whiplash' syndrome. The severity of patients' symptoms was assessed before and after treatment using the Gargan and Bannister (1990) classification. 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.