Whiplash and Long-Term Outcome
This study examined the injury mechanisms and somatic, radiologic, and psychosocial variables in 117 whiplash patients for a follow-up period of two years.
The percentage of patients with residual pain was similar to that found in other studies: 44% had pain at 3 months, 30% at 6 months, 24% at 12 months, and 18% at 2 years. Only 4% of the patients were considered disabled at two years.
A large number of variables were taken into consideration, to determine which played a role in the long-term outcome of whiplash. The only factors found to play a significant role were:
Inclined or rotated head position at the time of collision. These patients were more likely to have pain at 2 year follow-up. A history of pre-traumatic headache predicted worse outcome. Patients with long-term symptoms were more likely to have radicular symptoms, anxiety, sleep disturbance, blurred vision, “symptoms of cranial nerve or brainstem dysfunction,” and signs of osteoarthrosis of the spine. These patients were also more likely to report more pain immediately after the accident.
Other important points made in this study:
“Our results suggest that the significance of psychosocial factors in determining recovery from whiplash has been overestimated due to excessive focusing on these factors retrospectively in highly selected samples of patients.”
“…the present findings support the view that poor outcome in the long term after whiplash injury (that is, late whiplash syndrome) is primarily related to the initial severity of the injury.”
This study is an important addition to the whiplash literature because, first, the patients in this study were unselected – that is, 117 patients were studied immediately after their accidents and followed for two years – and, secondly, the study was conducted in Switzerland, where the legal system allows reimbursement for medical expenses, but not for pain and suffering, eliminating the bias of compensation seeking behavior.
Radanov BP, Sturzenegger M, Di Stefano G. Long-term outcome after whiplash injury. A two-year follow-up considering the features of injury mechanisms and somatic, radiologic, and psychosocial findings. Medicine September 1995 74(5):281-296.
Chiropractic Treatment of Whiplash
Objective: Chiropractic manipulation has been shown to be effective in the treatment of many patients with chronic whiplash symptoms. Our aim was to identify, prior to commencing treatment, which patients would benefit from such manipulation.
Results: Three groups of patients were recognized on the basis of their symptoms at presentation. Group 1 contained 50 patients (54%) and consisted of those with neck pain radiating in a “coat-hanger” distribution, associated with a restricted range of neck movement but wit h no neurological deficit.
Group 2 contained 37 patients (34%) who had neurological symptoms or signs in association with neck pain and a restricted range of neck movement. These symptoms consisted of tingling, numbness, pins and needles in a dermatomal distribution in the arm or hand as well as both hypo and hyperaesthesia.
Group 3 contained 11 patients (12%) who described severe neck pain but all of whom had a full range of neck movement and no hard focal neurological symptoms. In addition it was noted that these patients commonly described an unusual complex of symptoms. These included blackouts, visual disturbance, nausea, and vomiting and chest pain, along with a non-dermatomal distribution of pain.
There was a statistically significant difference in outcome between the three groups (p<0.001) with only groups 1 and 2 improving following chiropractic manipulation.
Conclusion: 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.
The finding that patients in Group 3 had severe pain in the absence of physical signs, frequently complained of bizarre symptoms and were predominantly young females, raises the possibility that there is a significant non-organic component to their symptoms and the logical approach to this is to treat the psychological component of their whiplash injury before the physical.
Outcome: We anticipate improved targeting of chiropractic treatment in the management of chronic whiplash symptoms resulting in improved efficacy of such treatment.
Khan S, Cook J, Gargan M, Bannister G. A symptomatic classification of whiplash injury and the implications for treatment. [Abstract] World Congress on Whiplash-Associated Disorders 1999;p. 238.