SUMMARY: The anatomical pathological basis of whiplash is at last becoming clearer. More effective immediate management of the injury is being developed.  Restricted neck movement and recurrent whiplash predict poor outcome.  Injuries to cervical facet joints and clefts in intervertebral discs are common and under-diagnosed.  Psychological profile of the late whiplash patient  has not been confirmed.

ACUTE TREATMENT

More effective immediate management of the injury is being developed. 

Personal injury counsel should be aware that immediate treatment of cervical whiplash is changing. 

Evidence-Based Medicine has shown that wearing the time-honoured soft collar delays recovery in comparison with active exercise¹. 

By contrast, high dosage corticosteroid medication given within 8 hours of whiplash significantly reduced disabling symptoms and prolonged sick leave². 

LATE WHIPLASH

Arguments continue about the mechanism for symptoms that continue after 6 months.

To discredit a physical basis for late whiplash, Defence counsel often quote studies  from Lithuania, where there is no compensation for motor vehicle injuries. 

This earlier research  found that, 1-3 years after rear-end collision, there was no increase in prevalence of neck symptoms compared with the uninjured population. 

However, a more recent study³ in Sweden followed instead those MVA victims who reported neck pain at the time. 

Those with immediate symptoms were three times as likely to be complaining of neck pain seven years later. 

Which patients?

How can it be predicted whether the client is one of the 20-40% of whiplash victims whose symptoms will persist after 6 months as late whiplash? 

Restricted neck movement and recurrent whiplash predict poor outcome. 

Previously, 14 clinical features were needed to forecast⁴ reliably those who would have a poor long-term outcome.

According to a new study^{5 [Full text]}, measured restriction of  neck movement alone may be as accurate a predictor.

Almost all those who had apparently recovered completely after the first injury, developed persistent symptoms after the second accident. 

Pathology

Injuries to cervical facet joints and clefts in intervertebral discs are common and underdiagnosed. 

Determining the anatomical pathological basis of soft tissue injuries that do not result in death generally depends on animal research. 

Studies on primates that had been subjected to whiplash then sacrificed has now been supplemented by human studies of patients who probably suffered whiplash but died of an unrelated cause.

Two separate teams^7,8 of researchers undertook autopsy studies of a total of 38 cervical spines from traffic accident victims who had died of Traumatic Brain Injury.

They also failed to detect the vast majority of the many injuries to the facet joints and intervertebral discs that were revealed by autopsy. 

Psychological profile of the late whiplash patient has not been confirmed.

The proposition ⁹ of “accident neurosis” or “compensation neurosis” in whiplash injury has previously been challenged by well-designed research¹⁰. 

A recent study¹¹ further refutes the claim that litigation prolongs disability. 

Where facet joints in the cervical spine are identified as a source of ongoing pain, interrupting the transmission of pain signals by radiofrequency neurotomy can dramatically improve pain within a couple of weeks.

The success rates of the procedure were not significantly different for litigants and non-litigants. 

Furthermore, half of those litigants whose claims were settled within the study period had recurrence of pain after the settlement. 

A recent Canadian study¹² found no support for the claim that whiplash victims have a characteristic psychological profile. 

On the contrary, patterns of symptoms such as anxiety and depression were similar to those of sufferers from chronic benign pain caused by other conditions. 

Copyright © 2008 Electronic Handbook of Legal Medicine