Whiplash, has only recently become an epidemic. This is due to new safety standards resulting in stiffer vehicles. This stiffness decreases chance of death in a motor vehicle accident , but increases chance of soft tissue injury. Due to its relative newness, whiplash injury mechanisms and bio-mechanics are NOT taught in Physiotherapy, Acupuncture, Medical, Chiropractic, or Osteopathic Schools. Thus, it is very important to go to a Doctor with whiplash credentialing. The only doctors specifically trained in Whiplash injury mechanism and biomechanics and how to treat this disorder have post graduate certifications.
Statement from the Spine Research Institute of San Diego - Dr. Arthur Croft
"Management of CAD (Cervical Acceleration Deceleration injuries is a highly complex discipline that is, for all intents and purposes, not adequately addressed in a physician's training; whether they be medical, osteopathic or chiropractic physicians. Thousands of articles have been published on this topic in the past, and many new articles are published each year. An understanding of the subject matter requires familiarity with this comprehensive literature."
Treatment options, diagnostic criteria, and even the model for the etiology of CAD injuries change constantly and proper diagnosis and treatment of CAD injuries will result in a far better outcome for the patient. For this reason, all doctors who agree to treat CAD patients should become thoroughly familiar with the subject, and subsequently stay current as new findings are brought to light.
Currently, there are two primary organizations certifying doctors to diagnosis, evaluate, and treat whiplash patients. They are the Spine Research Institute of San Diego and the North American Spine Institute.
Whiplash Definition
Whiplash is the common name for neck sprains, such as those caused by hyperextension/flexion injury to the cervical, thoracic or lumbar spines. The injury is referred to as "whiplash" due to the neck or back being thrown forwards and/or backwards at a rapid speed. This may cause the fibers of the neck muscles to tear, resulting in pain and often a decreased range of movement. Whiplash and whiplash-associated disorders (WAD) represent a range of injuries to the neck caused by or related to a sudden distortion of the neck.
Whiplash is commonly associated with motor vehicle accidents, usually when the vehicle has been hit in the rear, however the injury can be sustained in many other ways, including falls from bicycles or horses.
Whiplash Causes
The most frequent cause of whiplash is a car accident. The speed of the cars involved in the accident or the amount of physical damage to the car may not relate to the intensity of neck injury; speeds as low as 2.5 miles per hour can produce enough energy to cause whiplash in occupants, there are several risk factors that can lead to an increased chance of pain and disability, which include but are not limited to previous DJD, prior injury, females, head rotation, impact direction, seatbelt usage, car bumpers, the two cars involved in the accident, and several other factors. For a complete list please consult your local chiropractor.
Other common causes of whiplash include contact sport injuries and blows to the head from a falling object or being assaulted.
Whiplash Symptoms
These signs and symptoms may occur immediately or minutes to hours after the initial injury; the sooner after the injury that symptoms develop, the greater the chance of chronic pain (most symptoms occur 48-72 hours after the accident according to the up to date research).
· Neck pain
· Neck swelling
· Tenderness along the back of your neck
· Muscle spasms (in the side, front, or back of your neck)
· Difficulty moving your neck around
· Headache
· Pain shooting from your neck into either shoulder or arm
· TMJ
· Sleeplessness
· Depression
· Difficulty concentrating
· Mid-back pain
· Low back pain
· Carpal Tunnel
· Thoracic Outlet Syndrome
Whiplash Grading Systems
Québec Task Force
The Québec Task Force (QTF) was a task force sponsored by the , Societe de l’assurance automobile du Quebec, the public auto insurer in Quebec, Canada. The QTF submitted a report on whiplash-associated disorders in 1995, which made specific recommendations on prevention, diagnosis and treatment of WAD. These recommendations have become the base for Guideline on the Management of Claims Involving Whiplash-Associated, a guide to classifying WAD and guidelines on managing the disorder. The full report titled Redefining "Whiplash" was published in the April 15, 1995 issue of Spine. An update was published in January of 2001.
Spine Research Institute of San Diego—Croft Guidelines
The QTF grading system is remarkably similar to the one developed by Dr. AC Croft in 1992 and subsequently published in 1993. However, the QTF Guidelines, published some 2 years later, fail to cite Dr. Croft's work. Croft AC: Treatment paradigm for cervical acceleration/deceleration injuries (whiplash). ACA J Chiro 30(1):41-45, 1993.
Quebec Task Force: Grades of Disorders
Four Grades of Whiplash Associated Disorders were defined by the Quebec Task Force on Whiplash Associated Disorders (WADs)
Grade 1: Complaints of neck pain, stiffness or tenderness only but no physical signs are noted by the examining physician.
Grade 2: Neck complaints and the examining physician finds decreased range of motion and point tenderness in the neck.
Grade 3: Decreased range of motion plus neurological signs such as decreased deep tendon reflexes, weakness, insomnia and sensory deficits
Grade 4: Neck Complaints and Fracture of Dislocation, or Injury to the Spinal Cord
Croft Grades of Disorders
Grade 1: Minimal; No limitations of motion; No Ligamentous Injury; No neurological findings
Grade 2: Slight; Limitation of Motion; No Ligamentous Injury; No Neurological Findings
Grade 3: Moderate; Limitations of Motion; Some Ligamentous Injury; Neurological findings may be present.
Grade 4: Moderate to Sever; Limitation of Motion; Ligamentous Injury; Neurological Findings Present; Fracture or Disc Derangement
Grade 5: Severe; Requires surgical management and/or stabilization
Stages of Injury - Croft
Stage 1: Acute, Inflammatory Phase; Up to 72 Hours
Stage 2: Subacute, Repair Phase; 72 hours to 12 months+
Stage 3: Remodeling Phase; 14 weeks to 12 months +
Stage 4: Chronic, Permanent
