Acute Whiplash Research Articles

Early McKenzie-Style Treatment Better Than Standard Care for Acute Whiplash Injuries?

Early McKenzie-Style Treatment Better Than Standard Care for Acute Whiplash Injuries?

Symbol.Is Active McKenzie Therapy Better Than Passive Care for Acute Whiplash?

Symbol.Is Active McKenzie Therapy Better Than Passive Care for Acute Whiplash?

Temporomandibular and Whiplash Injury in Lithuania

Objective: To ascertain the prevalence of symptoms of temporomandibular disorders [TMD] in whiplash victims in Lithuania versus healthy controls.Methods: In a controlled, retrospective cohort study in Lithuania, 210 rear-end collision victims [at 14–27 months following the collision] were surveyed for TMD symptoms. Results were compared to an age-and sex-matched control group, sampled randomly from the local population register.Results: In the accident group, 2.4% [4/165] reported jaw pain for one day or more per month compared to 3.3% [6/180] of controls. One [0.6%] accident victim and two [1.1%] controls had daily jaw pain. In both groups there was a low prevalence of jaw sounds, pain in or near the ear[s], jaw locking, tinnitus, and facial pain.Conclusion: Lithuanian accident victims do not appear to report chronic symptoms of TMD in association with an acute whiplash injury.

Prospective, Randomized, Controlled Study of Activity versus Collar, and the Natural History for Whiplash Injury, in Germany

Objectives: To examine the rate of recovery in groups of acute whiplash injury patients subjected to two different treatments, an activity program, or collar use.Methods: A prospective randomized study of 97 consecutive accident victims of rear-end collisions was carried out utilizing a control group of 50 healthy, age and sex-matched subjects. Symptoms recorded included presence and intensity of neck pain, neck stiffness, headache, shoulder pain, arm pain, and neck range of motion at 1, 2, 3, 6, and 12 weeks. There were 47 patients in the active therapy group [group 1], receiving active and passive mobilization in combination with postural exercises and advice over three weeks. The other 50 accident victims [CT] had a collar only for three weeks.Results: At three weeks, group 1 [active therapy] had significantly less pain and improved neck range of motion than CT [collar]. Symptom prevalence was no different at six weeks between group 1 and healthy controls. At 12 weeks, CT did not differ from healthy co...

Prevalence of temporomandibular disorders associated with whiplash injury in Lithuania

Objective. The purpose of this study was to ascertain the prevalence of symptoms of temporomandibular disorders in whiplash victims in Lithuania and compare it with the prevalence in otherwise healthy control subjects. Study Design. In a controlled historical cohort study in Lithuania, we asked each of 210 victims of vehicular rear-end collisions (at 14-27 months after the accident) to report the presence and frequency of a number of temporomandibular disorder symptoms. The results were compared with those for an age-matched and gender-matched control group, sampled randomly from the local population. Results. In the accident group, 2.4% of subjects (4/165) reported jaw pain for 1 day or more per month; this compared with 3.3% of the controls (6/180). One (0.6%) of the accident victims and 2 (1.1%) of the controls had daily jaw pain. In both groups there was a low prevalence of jaw sounds, pain in or near the ear(s), jaw locking, tinnitus, and facial pain. Conclusions. Unlike whiplash claimants in many Western societies, Lithuanian accident victims do not appear to report the chronic symptoms of temporomandibular disorders despite their acute whiplash injuries. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:653-7)

Pain after whiplash: a prospective controlled inception cohort study

OBJECTIVESIn Lithuania, there is little awareness of the notion that chronic symptoms may result from rear end collisions via the so-called whiplash injury. After most such collisions no contact with...

Cervical curvature in acute whiplash injuries: prospective comparative study with asymptomatic subjects

The cervical curvature of 488 patients with acute whiplash injury was prospectively studied by comparison with 495 asymptomatic healthy volunteers. Plain radiography of the cervical spine in the neutral position was evaluated qualitatively. No significant difference was noted in frequencies of non-lordotic cervical curvature and local angular kyphosis between acute whiplash injury patients and asymptomatic subjects. No significant association was apparent between clinical symptoms and cervical curvature. These results suggest that non-lordotic cervical curvature and angular kyphosis in acute whiplash injury patients constitute normal variants rather than pathological findings.

Acute whiplash injury: is there a role for MR imaging?--a prospective study of 100 patients.

To evaluate the findings from magnetic resonance (MR) imaging of the cervical spine and brain after acute whiplash injury. Within 3 weeks of trauma, 100 patients underwent MR imaging for evaluation of the cervical spine and the brain. In addition, plain radiographs were obtained, including functional images of the cervical spine. Only one patient had an abnormality on the MR image that was related to trauma (ie, prevertebral edema). In 17 patients, functional images showed a kyphotic angle, but no evidence of soft-tissue injury was seen on MR images. There is no role for MR imaging in the routine work-up of patients with acute whiplash injury who have normal plain radiographic findings and no evidence of a neurologic deficit. A kyphotic angle seen on functional images of the cervical spine should not be assumed to indicate soft-tissue injury and is most likely attributable to a compensating mechanism of hypermobility at a level of the spine above that at which hypomobility occurs, which is probably the result of a muscle spasm.

Cervicogenic Headache: A Personal View

Cervicogenic headache describes pain referred along the upper three cervical roots and is a common source of headache in the over fifties. A review of clinical features, anatomy, and investigations using neural blockade shows several clinical pictures. Diseases of the cranio-vertebral junction, e.g. syringomyelia, and tonsilar descent, can produce mechanical or hydrodynamic head and neck pain. Pre-existent migraine and tension headache may be precipitated or aggravated by cervical spondylosis, but the anatomical mechanism is unclear. Headaches which arise from and are primarily caused by disorders in the cervical spine are exemplified by spondylosis and acute whiplash injury, but are usually transient. Evidence for a cervicogenic mechanism of chronic whiplash headache is, however, lacking.

Decreased width of the spinal canal in patients with chronic symptoms after whiplash injury.

The sagittal diameter of the cervical spinal canal was measured on standard lateral radiographs of 48 consecutive patients with acute whiplash injury. A follow-up was done 12 months after injury. The purpose of this study was to evaluate the relationship between spinal canal width and chronic symptoms after whiplash injury. A narrow sagittal diameter of the cervical spinal canal has been correlated with neurologic deficits in degenerative conditions and after fractures. The authors are not aware of previous studies on whiplash patients related to this area. Forty-eight consecutive patients were evaluated for whiplash trauma after car accidents. Twenty-four patients (12 men and 12 women; mean age, 37 years) had persistent symptoms after 12 months, while 24 patients (12 men and 12 women; mean age, 34 years) were asymptomatic. All measurements were done from standard lateral radiographs with a graphic digitizer connected to a microcomputer. Three anteroposterior and one oblique measurement of the canal were reconstructed for each vertebrae from C2-C6. Multivariate analysis of variance was used to evaluate any association between gender, remaining symptoms at follow-up, and the recorded values of the spinal canal width. The spinal canal was significantly smaller in the patients with persistent symptoms than in the asymptomatic group. A significant difference also was found between men and women. Narrow diameter of the cervical spinal canal is unfavorable in patients with whiplash.

Whiplash as a total-body injury

In our highly active society, individuals and groups push their physical limits. Consequently, the incidence of whiplash injury is increasing. Patients may not recover rapidly or fully from a whiplash injury, thus leading to chronic neck and spinal symptoms and litigation. Physicians must recognize whiplash injury as a manifestation of total-body trauma and treat accordingly, with particular emphasis on alleviating abnormal tension of the fascia. Precise description of the accident, followed by healing methods tailored to well-defined bodily injury, aids in effective management. Whiplash injury poses a challenge to the osteopathic physician to sharpen skills in defining the injury based on the details of the accident and to incorporate myofascial release treatment into traditional modes of whiplash treatment. Fortunately, many highly respected osteopathic physicians have written extensively on the subject and the tools are at hand to refine treatment for both acute and chronic whiplash.

MRI and neurology in acute whiplash trauma. No correlation in prospective examination of 39 cases.

39 consecutive cases of whiplash injury of the neck were examined clinically and with MRI at a mean of 11 days after trauma. 26 of these showed changes on MRI with disc lesions in 25, 10 of which were classified as disc herniations, and a muscle lesion in 1 case. All had neck pain or headache. 29 cases had neurological deficits, mostly sensibility disturbances. 22 of the 26 cases with pathologic MRI findings had neurological signs, as had 7 of the 10 cases with disc herniation. The relationship between the MRI findings and the clinical symptoms and signs was poor.

Cerebral symptoms after whiplash injury of the neck: a prospective clinical and neuropsychological study of whiplash injury.

Twenty one unselected patients with an acute whiplash injury of the neck had neurological and neuropsychological assessment, cervical x rays, EEG, BAEP, MRI, and an otoneurological examination within two weeks of the injury. Subjectively, 13 patients reported concentration deficits, 18 reported sleep disturbances, 9 had symptoms of depression, and 7 female patients told of menstrual irregularities. Neuropsychological examination revealed significantly lower performance in tests related to attention and concentration compared to sex, age and educational matched control subjects. Otoneurological examination showed abnormalities in 9 of 17 whiplash subjects. EEG showed questionable changes in 8 of 18 recordings. MRI and BAEP were normal in all patients. Repeat neuropsychological testing in 15 patients at three months showed that attention deficits had improved but were still shown in 12 of 14 and the concentration deficits in 8 of 13 patients. At one year all patients had returned to work, 16 to full and 5 to part time employment. In 4, cognitive dysfunction remained the only significant problem. These findings are discussed as being compatible with possible damage to basal frontal and upper brain stem structures after whiplash injury of the neck.

Low energy high frequency pulsed electromagnetic therapy for acute whiplash injuries. A double blind randomized controlled study

The standard treatment of acute whiplash injuries (soft collar and analgesia) is frequently unsuccessful. Pulsed electromagnetic therapy PEMT (as pulsed 27 MHz) has been shown to have pro-healing and anti-inflammatory effects. This study examines the effect of PEMT on the acute whiplash syndrome. One half of the 40 patients entering the study received active PEMT collars: the other half facsimile (placebo). All patients were given instructions to wear the collar for eight hours a day at home and advised to mobilise their necks. At 2 and 4 weeks the actively treated group had significantly improved (p less than 0.05) in terms of pain (visual analogue scale). By chance movement scores for the PEMT group were significantly worse at entry to the study than the control group (p less than 0.05). At 12 weeks they had become significantly better (p less than 0.05). PEMT as described is safe for domiciliary use and this study suggests that PEMT has a beneficial effect in the management of the acute whiplash injury.

Scintigraphic findings in acute whiplash injury of the cervical spine

A prospective scintigraphic and radiographic study was carried out in 35 patients with a whiplash injury of the cervical spine. The scintigraphic findings were within normal limits in 31 of the patients, while four had either a focal or multifocal increase in activity. Plain radiography revealed skeletal changes secondary to spondylosis in three patients and a localized bony spur with avulsion of a barely visible fragment in one. Our investigation shows that skeletal lesions after whiplash injury, although very few, are shown by plain skeletal radiography. Scintigraphy is not indicated for screening purposes.

Points: Early mobilisation of acute whiplash injuries

Points: Early mobilisation of acute whiplash injuries