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Whiplash is not an ailment or physical injury. It is a mechanical action that occurs to theneck under certain specific conditions and may or may not cause injury. The whiplashaction is one in which the head is thrown backward and forward in a lashing motion. Themore violently the head is thrown backward, the greater the strain on the muscles,ligaments, and joints in the neck. A severe injury could cause tearing of the neckligaments, spraining of joints in the upper spine or fracturing of one or more vertebrae. Onthe other hand, a less violent whiplashing action may lead to only minor injuries or noneat al . Consequently, treatment varies, depending on the type and severity of the injury.
Patients who have sustained an injury through the whiplashing action often go to theirdoctor with misconceptions that cause needless apprehension and fear regarding theirinjury. Fear presents a serious barrier to recovery. In treating these patients, therefore,one of the most important services a clinician can perform is to take the time to allay anyconcerns and to dispel the mystery surrounding the term "whiplash". This includesrejecting whiplash as a diagnosis. Misuse of terminology by clinicians can fuel the fearand lead to a resolute belief on the part of patients that their condition is critical andthat their neck will never be normal again.
According to Simon Carette of Laval University, chronic whiplash syndrome has becomeone of the most controversial conditions in medicine. In the United States, approximately20-40% of whiplash victims develop persistent symptoms. As with most chronicconditions, views vary as to whether these symptoms can be attributed to physicalcauses or whether psychological and psychosocial factors play a larger role. There is noconclusive evidence for either opinion.
At the Canadian Back Institute, we believe that, like all other back and neck patients,whiplash patients benefit more when the clinician is able to quickly identify a pattern ofpain and initiate appropriate therapy based on this pattern than when a precisepathologic diagnosis is sought.
ABSTRACTS
2. Psychological Disturbances and an Exaggerated Response to Pain Patients withWhiplash Injury.
3. Cognitive Functioning after Common Whiplash. A Controlled Follow-up Study.
4. Whiplash Injury: Misconceptions and Remedies. (review) 5. Cerebral Symptoms after Whiplash Injury of the Neck: A Prospective Clinical andNeuropsychological Study of Whiplash Injury.
6. Lack of Effect of Intraarticular Corticosteroids for Chronic Pain in the CervicalZygophyseal Joints.
7. Patterns of Injury and Recovery in Whiplash.
1. Whiplash: Folly and Fakery.
AUTHORS: Malleson, AndrewJOURNAL: Humane Medicine, Vol 6, No 3, Pgs 193-6, Summer 1990 The common result of whiplash injury is a sprain of the neck. Unlike other sprains, thesymptoms of whiplash can persist for years, and the unremitting symptoms can serve asa peg on which the victim can hang life's problems. Our medicolegal system oftenencourages litigants to do exactly this. The victim is discouraged from dealing with his orher problems; hence, we perpetuate unnecessary disability.
2. Psychological Disturbances and an Exaggerated Response to Pain Patients with
Whiplash Injury.
AUTHORS Lee J, Giles K, Drummond PDJOURNAL: Journal of Psychosomatic Research, Vol 37 , No 2 , Pgs 105-10, 1993 Psychological state, response to pain and style of interpreting everyday experiences weremeasured in 32 patients who had suffered a whiplash injury 1-84 months before thestudy. For comparison, measures were also obtained in 15 general practice attenders.
Ratings of depression and anxiety were greater in patents than in controls, and patientsreported more cold-induced pain during a cold pressor test. Within the patient sample,anxious subjects gave the highest ratings of cold-induced pain. Those with the longesthistory of pain gave the highest ratings of whiplash injury pain, and were most depressed.
Most of these patients were involved in litigation. The findings demonstrate that, likemost patients with chronic pain, whiplash injury sufferers are anxious and depressed.
Their psychological distress could be aggravated by litigation. Behavioural assessmentand treatment of chronic pain syndromes such as whiplash injury could benefit from earlyevaluation of the patient's psychological state, and response to standard painful stimuli.
3. Cognitive Functioning after Common Whiplash. A Controlled Follow-up Study.
AUTHORS: Radanov BP, Di Stefano G, Schnidrig A, Sturzenegger M, Augustiny KFJOURNAL: Archives of Neurology, Vol 50, No 1, Pgs 87-91, 1993 Jan A random sample of 98 patients with common whiplash was examined early after trauma(mean +/- SD, 7.3 +/- 3.9 days) and again 6 months later. Cognitive functioning wasassessed in conjunction with complaints, pain intensity, well-being, subjective cognitiveimpairment, neuroticism, and medication. At 6 months, 67 patients had fully recovered(asymptomatic group), while 31 were still symptomatic (symptomatic group).
Symptomatic patients who were older at baseline, had a greater variety of symptoms,higher neck pain intensity, and greater subjective cognitive impairment. At baseline, bothgroups scored poorly on tests requiring complex attentional processing. Alneuropsychological functions improved to normal at 6 months in both groups. Thisimprovement cannot be explained by a practice effect, as shown by the results of normalvolunteers. The symptomatic group showed delayed recovery regarding complexattentional functioning, which may be related to adverse affects of medication.
4. Whiplash Injury: Misconceptions and Remedies. (review)
AUTHORS: Livingston MJOURNAL Australian Family Physician, Vol 21, No 11, Pgs 1642-3, 1646-7, 1992 Nov Misconceptions about whiplash injury and its common course are discussed. Differentpatient populations appear to suffer to varying degrees and social copying is evident incertain groups--features shared with the Australian 1983 to 1985 'epidemic' of 'repetitivestrain syndrome'. Psychosocial factors and overtreatment delay recovery. Familyphysicians have the opportunity to properly assess and manage most patients. Wastefultherapy must be discouraged, and self care and patient responsibility encouraged.
5. Cerebral Symptoms after Whiplash Injury of the Neck: A Prospective Clinical
and Neuropsychological Study of Whiplash Injury.
AUTHORS: Ettlin TM, Kischka U, Reichmann S, Radii EW, Heim S, Wengen D, Benson DF JOURNAL: Journal of Neurology, Neurosurgery & Psychiatry, Vol 55, No 10, Pgs 943-8,1992 Oct Twenty one unselected patients with an acute whiplash injury of the neck hadneurological and neuropsychological assessment, cervical x-rays, EEG, BAEP, MRI, and anotoneurological examination within two weeks of the injury. Subjectively, 13 patientsreported concentration deficits, 18 reported sleep disturbances, 9 had symptoms ofdepression and 7 female patients told of menstrual irregularities. Neuropsychologicalexamination revealed significantly lower performance in tests related to attention andconcentration compared to sex, age and educational matched control subjects.
Otoneurological examination showed abnormalities in 9 of 17 whiplash subjects. EEGshowed questionable changes in 8 of 18 recordings. MRI and BAEP were normal in alpatients. Repeat neuropsychological testing in 15 patients at three months showed thatattention deficits had improved but were still shown in 12 of 14 and the concentrationdeficits in 8 of 13 patients. At one year al patients had returned to work, 16 to ful and 5to part time employment. In 4, cognitive dysfunction remained the only significantproblem. These findings are discussed as being compatible with possible damage to basalfrontal and upper brain stem structures after whiplash injury of the neck.
6. Lack of Effect of Intraarticular Corticosteroids for Chronic Pain in the Cervical
Zygophyseal Joints.
AUTHORS: Barnsley L, Lord SM, Wallis BJ, Bogduk NJOURNAL: New England Journal of Medicine,, Vol 330, No 15, Pgs 1047-1050, 1994 Background. Chronic pain in the cervical zygapophyseal joints is a common problem aftera whiplash injury. Treatment with intraarticular injections of corticosteroid preparationshas been advocated, but the value of this approach has not been established. Wecompared the efficacy of depot injection of a corticosteroid preparation with the efficacyof an injection of a local anesthetic agent in patients with painful cervical zygapophysealjoints. Methods. Sixteen men and 25 women with pain in on or more cervicalzygapophyseal joints after automobile accidents (mean age, 43 years; median duration ofpain, 39 months) were randomly assigned to receive a 1-ml intraarticular injection ofeither bupivacaine (0.5 percent) or betamethasone (5.7 mg) under double-blindconditions. The patients were followed by means of regular telephone contact and clinicvisits until they reported a return to a level of pain equivalent to 50 percent of thepreinjection level. The time from treatment to a 50 percent return of pain was comparedin the two groups with the use of a survival analysis. Results. Less than half the patientsreported relief of pain for more than one week, and less than one in five patients reportedrelief for more than one month, irrespective of the treatment received. The median timeto a return of 50 percent of the preinjection level of pain was 3 days in the 21 patients inthe corticosteroid group and 3.5 days in the 20 patients in the local-anesthetic group(P=0.42). Conclusions. Intraarticular injection of betamethasone is not effective therapyfor pain in the cervical zygapophyseal joints after a whiplash injury.
7. Patterns of Injury and Recovery in Whiplash.
AUTHORS: Pennie B, Agambar LJOURNAL: Injury; British Journal of Accident Surgery, Vol 22, No 1, Pgs 57-9, 1991 Jan Whiplash injuries were studied prospectively in 151 patients. Patterns of injury andrecovery were found not to depend on the type of accident. Clinical and radiologicalfindings were correlated with the possible pathological bases for the symptom and signs;some of these were found to be unlikely to be contributors to the clinical picture. Thefactors which might contribute to a delay in recovery were reviewed, and compensationclaims were found not to affect outcome significantly. It is suggested that many patientshave sustained an important injury, the exact nature of which remains unclear.

Source: http://www.cbi.ca/documents/11421/1034206/Whiplash.pdf