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Whiplash Update

This past year a substantial number of peer reviewed publications addressing whiplash associated disorders (WAD) have appeared in the scientific literature.  These manuscripts examine a broad spectrum of topics including neurologic sequela, psychological issues, diagnosis, treatment, prevention, prognosis and compensation.  Patients respond favorably to chiropractic management of the initial whiplash symptoms, as well as the sequela of WAD, e.g. headache, postural changes and biomechanical problems.  Some of the more important findings of the recent research include the following:

  • Postural changes: Mild traumatic brain injury (MTBI) patients were compared with WAD subjects and a “similar pattern of balance impairment was present in patients with whiplash injury with and without MTBI. However, the impairment was greater for stance and complex gait tasks in WAD patients with MTBI.” Another systematic review of whiplash studies found that “the decreased postural stability in people with neck pain appears to be associated with the presence of pain and correlates with the extent of proprioceptive impairment, but appears unrelated to pain duration.” A third study evaluated postural sway in WAD patients and concluded that the “Increased magnitude of the slow sway component implies an aberration in sensory feedback or processing of sensory information in WAD.”
  • Biomechanical changes: In a comparison between WAD and asymptomatic subjects, the WAD group “revealed a significantly reduced clavicle retraction and scapular upward rotation as well as decreased cranial angle.”
  • Pathophysiological changes: Magnetic resonance imaging (MRI) revealed muscle fatty infiltrates in the cervical extensors.  These changes “occur soon following whiplash injury and suggest the possibility for the occurrence of a more severe injury with subsequent [post traumatic stress disorder] PTSD in patients with persistent symptoms.”
  • Symptoms/Sequela:  “Subjects with self reported whiplash injury had significantly more headache and musculoskeletal complaints than those without…”
  • Prognostic signs: One study compared those patients who recovered from WAD within three month with those that did not.  They concluded that “the recovered group had significantly better scores on all health outcome measures; SF36 Physical Component Score, SF36 Mental Component Score and the PCS (p<0.001). The significant independent predictors of poorer health and non-recovery were helplessness (p<0.001), older age (p<0.001) and pre-injury work status being affected (p<0.001) (r(2)=.624).”
  • Psychological: Anxiety and depression are characteristics often associated with WAD.  One longitudinal study concluded that “This is the first published study with a prewhiplash prospective evaluation of psychological status. Our findings are in conflict with previous research suggesting whiplash to be the cause of associated psychological symptoms rather than their consequence. Self-reported whiplash injury was clinically relevant as it independently increased subsequent disability pension award. The strength of this effect, even in the absence of neck pain, suggests the ascertainment of this diagnostic label, or factors associated with this, are important predictors of disability.”  Another study concluded that “It appears that important psychological factors (fear avoidance beliefs and pain amplification) do have some influence on self-ratings of disability in chronic WAD sufferers.”

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