- Significant injuries occur at low-speeds.
- Women suffer greater injuries than men because they have less strength in their neck muscles.
- Early mobilization is critical. Use of a cervical collar actually gives worse results than no treatment at all. Immobilization following injury causes muscle wasting and loss of strength that significantly delays recovery. Corticosteroids damage articular cartilage & decrease collagen strength & repair. Early mobilization improves healing & repair of bone, cartilage, ligaments, & tendons. It also improves joint proprioception, which helps to prevent early joint degeneration.
- Most whiplash injuries are occult and cannot be identified on conventional imaging such as x-ray, MRI, or CT scans.
- The peak inflammation associated with whiplash is located around the C2 vertebra and is the most common origination of headache symptoms. The C2/C3 facet joint in particular is the cause of cervicogenic headache 53% of the time.
- The severity of vehicle damage is not predictive of injury or outcome. Stiffer vehicles actually increase the probability of long-term consequences because the forces get focused on the head & neck. A more accurate predictor of outcome is if the injured person experiences acute neck pain within the same day of injury. These people are 3x more likely to report chronic neck pain 7 years later. Also of note, younger people generally have a better prognosis & require less treatment.
- Upper Cervical spine is most injured when head & neck are in flexed & rotated position at time of impact (e.g. looking at cell phone or child in back seat).
- Whiplash patients are 5x more likely to suffer from chronic neck pain compared to control population.
- Whiplash patients are at a significantly increased risk for premature disc degeneration. Most common site of disc injury is C5/C6.
- Cervical range of motion is the most important indicator of physical impairment. It has proven to be 90% accurate in diagnosing people with whiplash symptoms. Flexion and extension are usually the most impaired movements.
- Over 90% of whiplash patients under chiropractic care showed notable improvement over a 6 month period of care. Chiropractic treatment has been shown to be 5x more effective than Celebrex or Vioxx within 9 weeks of treatment. Chiropractic care has also been shown to have a 2x greater success rate than standard medical care, and a significantly higher success rate than Physical Therapy. Some measured markers include less work absences and less reliance on pain medications. Passive joint motion is superior to active exercise therapy.
- In order to get the best therapeutic outcome, treatment must be initiated within the first 3 months following whiplash injury. Recommended guidelines for acute or subacute recovery with treatment ranges from 2 months to 2 years, with a mean of 7 months. An appropriate initial treatment frequency is 2-3x per week for the initial 10 weeks of care.
~Noah Kaplan, D.C.
1. Linnman, Lieuwe, Fredrikson, et al. Elevated [11C]-D-Deprenyl Update in Chronic Whiplash Associated Disorder Suggests Persistent Musculoskeletal Inflammation. Public Library of Medicine One. April 6, 2011, Vol. 6 No. 4, pp.e19182.
2. Seletz, Emil MD. Whiplash Injuries: Neurophysiological Basis for Pain and Methods Used for Rehabilitation. Journal of the American Medical Association. November 29, 1958, pp. 1750-1755.
3. Gun, Osti, O’Riordan, et al. Risk Factors for Prolonged Disability after Whiplash Injury: A Prospective Study. Spine: Volume 30(4), Feb 15, 2005, pp. 386-391.
4. Brault, J. R., J. B. Wheeler, et al. (1998). Clinical Response of Human Subjects to rear-end automobile collisions. Arch Phys Med Rehabil 79(1): 72-80.
5. Kristjansson, Leivseth, Brinckmann, et al. Incrased sagittal plane segmental motion in the lower cervical spine in women with chronic whiplash-associated disorders, grades I-II: a case-control study using a new measurement protocol. Spine, October 1, 2003; 28(19):2215-2221.
6. Schofferman J, Bogduk N, Slosar P. Chronic whiplash and shiplash-associated disorders: an evidence-based approach. Journal of the American academy of orthopedic surgeons. October 2007; 15(10):596-606.
7. Hijioka, Narusawa, Nakamura. Risk factors for long-term treatment of whiplash injury in japan: analysis of 400 cases. Arch Orthop Trauma Surg, Vol. 121, 2001, pgs. 490-493.
8. G. Bannister, R. Amirfeyz, S. Kelley, M. Gargan. Whiplash Injury. Journal of bone and joint surgery (british). July 2009, vol. 91B, no. 7, pp. 845-850.
9. Chiropractic treatment of chronic whiplash injuries. Injury. Volume 27, issue 9, November 1996, pages 643-645.
10. A symptomatic classification of whiplash injury and the implications for treatment. The journal of ortho medicine. Volume 21(I), 1999, pages 22-25.
11. Panjabi, Ito, Pearson, et al. Injury mechanisms of the cervical intervertebral disc during simulated whiplash. Spine: Volume 29(11) June 1, 2004 pp 1217-1225.
12. Kellett, John. Acute soft tissue injuries – a review of the literature. Medicine and science in sports and exercise. Oct. 1986;18(5):489-500.
13. Uhrenholt, Grunnet-Nilsson, Hartvigsen. Cervical spine lesions after road traffic accidents: A systematic review. Spine: Sept 1, 2002;27:1934-1941.
14. Dall’Alba, Sterling, Treleaven, et al. Cervical range of motion discriminates between asymptomatic persons and those with whiplash. Spine 2001;26:2090-2094 (Oct 1, 2001).
15. Giuliano V., Giuliano C., Pinto, et al. Soft tissue injury protocol using motion MRI for cervical spine trauma assessment. Emergency radiology, 10:March 2004, pp. 241-245.
16. Muller, Lynton, Giles. Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. Journal of manipulative and physiological therapeutics. Jan 2005, Volume 28, Number 1.
17. Hoving, Koes, Henrica et al. Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain: a randomized, controlled trial. Annals of internal medicine, vol. 136 No. 10, Pages 713-722, May 21, 2002.
18. Schofferman J, Wasserman S. Successful treatment of low back pain and neck pain after a motor vehicle accident despite litigation; spine May 1, 1994;19(9):1007-10.
19. Mercy Document, Appleton, 1992.
20. Foreman SM, Croft AC. Whiplash Injuries: the cervical acceleration/Deceleration syndrome; 3rd edition, Philadelphia, Lippincott Williams & Wilkins, 2002, pp. 525-526.
21. Tomlinson, Gargan, and Bannister. The fluctuation in recovery following whiplash injury: 7.5 year prospective review. Injury. Volume 36, Issue 6, June 2005, Pages 758-761.