Chronic Whiplash Research Articles

Prognostic Factors of Perceived Disability and Perceived Recovery After Whiplash: A Longitudinal, Prospective Study With One-year Follow-up.

The understanding of the role that cognitive and emotional factors play in how an individual recovers from a whiplash injury is important. Hence, we sought to evaluate whether pain-related cognitions (self-efficacy beliefs, expectation of recovery, pain catastrophizing, optimism, and pessimism) and emotions (kinesiophobia) are longitudinally associated with the transition to chronic whiplash-associated disorders in terms of perceived disability and perceived recovery at 6 and 12 months. One hundred sixty-one participants with acute or subacute whiplash-associated disorder were included. The predictors were: self-efficacy beliefs, expectation of recovery, pain catastrophizing, optimism, pessimism, pain intensity, and kinesiophobia. The 2 outcomes were the dichotomized scores of perceived disability and recovery expectations at 6 and 12 months. Stepwise regression with bootstrap resampling was performed to identify the predictors most strongly associated with the outcomes and the stability of such selection. Baseline perceived disability, pain catastrophizing, and expectation of recovery were the most likely to be statistically significant, with an overage frequency of 87.2%, 84.0%, and 84.0%, respectively. Individuals with higher expectations of recovery and lower levels of pain catastrophizing and perceived disability at baseline have higher perceived recovery and perceived disability at 6 and 12 months. These results have important clinical implications as both factors are modifiable through health education approaches.

Effects of physical activity and sitting on health outcomes in adults with whiplash associated disorders

Background In spite of known detrimental effects of physical inactivity and sitting, little is known about levels of physical activity (PA) and sitting in adults with chronic whiplash associated disorders (WAD) and their effects on health outcomes. Methods This cross-sectional study compared PA and sitting levels between 258 adults with WAD and 30 healthy controls. Adults with WAD were divided into four categories based on achieving ‘low’ or moderate-to-vigorous PA (‘MVPA’) levels and sitting greater (‘high sit’)/less (‘low sit’) than 8 hours daily on the International Physical Activity Questionnaire. Kruskal-Wallis tests compared health outcomes across these categories, followed by Mann–Whitney tests for pairwise comparisons. Results Adults with WAD demonstrated lower levels of PA (2151 vs. 4097 MET minutes/week, p<.001), and higher levels of sitting (343 vs. 232 min per day, p<.001) than healthy controls. Significant differences were found between all four categories on all five health outcomes (pain intensity, pain interference, disability, physical health, mental health). Low PA/High Sit had higher disability and lower physical and mental health when compared to MVPA/High Sit and MVPA/Low Sit. Low PA/Low Sit demonstrated higher pain intensity than other groups; higher pain interference and disability and lower physical and mental health when compared to MVPA/High Sit or MVPA/Low Sit. Conclusions Adults with WAD demonstrated lower levels of PA and higher levels of sitting. Achieving recommended levels of MVPA appeared to be associated with better health outcomes, regardless of sitting times. Both levels of PA and sitting need to be considered in management of WAD.

Fatty infiltrate and neck muscle volume in individuals with chronic whiplash associated disorders compared to healthy controls – a cross sectional case–control study

BackgroundThe underlying pathophysiological mechanisms of chronic Whiplash Associated Disorders (WAD) are not fully understood. More knowledge of morphology is needed to better understand the disorder, improve diagnostics and treatments. The aim was to investigate dorsal neck muscle volume (MV) and muscle fat infiltration (MFI) in relation to self-reported neck disability among 30 participants with chronic WAD grade II-III compared to 30 matched healthy controls.MethodsMV and MFI at spinal segments C4 through C7 in both sexes with mild- to moderate chronic WAD (n = 20), severe chronic WAD (n = 10), and age- and sex matched healthy controls (n = 30) was compared. Muscles: trapezius, splenius, semispinalis capitis and semispinalis cervicis were segmented by a blinded assessor and analyzed.ResultsHigher MFI was found in right trapezius (p = 0.007, Cohen’s d = 0.9) among participants with severe chronic WAD compared to healthy controls. No other significant difference was found for MFI (p = 0.22–0.95) or MV (p = 0.20–0.76).ConclusionsThere are quantifiable changes in muscle composition of right trapezius on the side of dominant pain and/or symptoms, among participants with severe chronic WAD. No other statistically significant differences were shown for MFI or MV. These findings add knowledge of the association between MFI, muscle size and self-reported neck disability in chronic WAD.Trial registrationNA. This is a cross-sectional case–control embedded in a cohort study.

Discussion on the Role of Floating Needle in Chronic Whiplash Injury

Discussion on the Role of Floating Needle in Chronic Whiplash Injury

Cervical Spine Platelet-Rich Plasma and Physiotherapy Increases Cervical Mobility and Isometric Strength in Chronic Whiplash Associated Disorder

Cervical Spine Platelet-Rich Plasma and Physiotherapy Increases Cervical Mobility and Isometric Strength in Chronic Whiplash Associated Disorder

The effectiveness of aerobic versus strengthening exercise therapy in individuals with chronic whiplash-associated disorder: a randomised single case experimental design study

Purpose Recent RCTs and meta-analyses compare the effectiveness of different types of exercise for chronic whiplash associated disorder (WAD). This study aimed to verify whether the results of these studies translate to statistically significant and clinically meaningful effects in individual participants. Materials and methods A series of replicated randomised single case experimental design studies (SCEDs) with A-B design (A: baseline, B: intervention). Eight participants with chronic WAD (8 female, mean [SD] age 47 [10] years) were randomised into one of four baseline durations (5, 8, 11, and 14 days) and to one of two eight-week exercise interventions (aerobic or strengthening). Daily measures of pain intensity, bothersomeness, and interference were collected during the baseline phase and the intervention phase. Results Visual analyses indicated that three participants in the aerobic exercise group meaningfully improved. No improvements were found in the strengthening group. Effect sizes favoured the aerobic exercise group, yet randomisation tests of pooled effects did not show a difference in between-intervention effectiveness. Conclusion Contrary to our expectations, three out of four participants were nearly pain-free at the end of the aerobic exercise intervention, whereas none of the participants in the strengthening group improved meaningfully. This suggests that aerobic exercise may be favourable for WAD. Implications for Rehabilitation Our results suggest that aerobic exercises are favourable over strengthening exercises and may be the preferred option for patients with chronic WAD. We found substantial variability in self-reported outcomes within participants, clinicians should be aware of this in the judgement of treatment effectiveness.

Morphology and composition of the ventral neck muscles in individuals with chronic whiplash related disorders compared to matched healthy controls: a cross-sectional case–control study

BackgroundObjectiveStudies of cross-sectional area (CSA) (morphology) and muscle fat infiltration (MFI) (composition) in ventral neck muscles is scarce in patients with chronic whiplash associated disorders (WAD), especially for men and those with severe WAD compared with matched healthy controls. The aim was to compare CSA and MFI of sternocleidomastoid (SCM), longus capitis (LCA) and longus colli (LCO) in patients with chronic right-sided dominant moderate (Neck Disability Index: NDI < 40) or severe WAD (NDI ≥ 40), compared to age- and sex-matched healthy controls.MethodsCross-sectional case–control study with blinded investigators. Thirty-one patients with chronic WAD (17 women and 14 men, mean age 40 years) (SD 12.6, range 20–62)) and 31 age- and sex-matched healthy controls underwent magnetic resonance imaging of ventral neck muscles segmental level C4.ResultsUnique to the severe group was a larger magnitude of MFI in right SCM (p = 0.02) compared with healthy controls. There was no significant difference between the groups with regards to the other muscles and measures.ConclusionsIndividuals with severe right-sided dominant WAD have a higher MFI in the right SCM compared to healthy controls. No other differences were found between the groups. The present study indicates that there are changes in the composition of muscles on the side of greatest pain.

A clinical test to assess isometric cervical strength in chronic whiplash associated disorder (WAD): a reliability study

BackgroundCervical spine muscle weakness is well demonstrated in individuals with chronic neck pain. There is a lack of literature evaluating clinically applicable means of assessing isometric cervical strength in chronic whiplash associated disorder (WAD). This study assessed the reliability of self-resisted isometric cervical strength testing using a handheld dynamometer. The relationship between strength and neck pain-related disability and kinesiophobia was also investigated.MethodsTwenty subjects with chronic WAD performed maximum-effort isometric cervical flexion, extension, side flexion, and rotation against a hand held dynamometer. The dynamometer was held by the subject, who provided self-resistance. Subjects completed two sessions of testing on one day with two different examiners, and one session on a subsequent day with one of the original examiners. Subjects completed the Neck Disability Index (NDI) and Tampa Scale for Kinesiophobia (TSK) prior to the first testing session.ResultsIntraclass correlation coefficients (ICC) for directional strength measures were fair to high (0.71–0.88 for intra-rater and 0.79–0.91 for inter-rater). Total strength (sum of all directional strengths) ICCs were high for both intra-rater (ICC = 0.91) and inter-rater (ICC = 0.94) measures. All statistical tests for ICCs demonstrated significance (α < 0.05). Agreement was assessed using Bland Altman (BA) analysis with 95% limits of agreement. BA analysis demonstrated difference scores between the two testing sessions that ranged from 3.0—17.3% and 4.5—28.5% of the mean score for intra and inter-rater measures, respectively. Most measures did not meet the a priori standard for agreement. A moderate to good inverse relationship was demonstrated between kinesiophobia (TSK score) and six out of seven strength measures (α < .05). No significant correlation was found between neck disability (NDI) and cervical strength in any direction.ConclusionThis study demonstrated fair to high reliability of self resisted isometric cervical strength testing in the chronic WAD population. All directional strength measures except flexion demonstrated a significant inverse relationship with kinesiophobia. No cervical strength measures were correlated with neck disability. These results support testing cervical strength in this manner to reliably assess change over time within individual patients. The value of such measurement requires further consideration given the lack of correlation between cervical strength and disability. Further research is required to establish normative values and enhance clinical utility.

Features and impact of dysphagia, dysphonia and laryngeal hypersensitivity in whiplash associated disorder – a qualitative study

Purpose Investigation into dysphagia, dysphonia and laryngeal hypersensitivity after whiplash is limited, offering minimal insight into specific features and impact. This study aimed to explore these symptoms. Materials and methods A qualitative interpretive description design was used. Eleven participants with chronic Whiplash Associated Disorder and self-reported swallowing, voice and/or throat-related problems completed baseline symptom questionnaires and were offered a videofluroscopic swallow study to investigate baseline swallowing biomechanics. Semi-structured interviews were conducted to explore features of swallowing, voice and laryngeal sensory complaints and analysed using thematic analysis. Results There were high baseline levels of self-reported neck, pain- and throat-related disability and psychological distress. There was no evidence of baseline deficits in swallow biomechanics. Thematic analysis revealed 5 themes: (1) A range of features of dysphagia and dysphonia exist after whiplash with varied clinical course; (2) Activity and participation in swallow and voice activities have changed; (3) There are psychological and emotional impacts; (4) Features of laryngeal hypersensitivity co-exist and (5) There are barriers to management. Conclusions Swallow, voice and laryngeal sensory problems after whiplash were described, with impacts on quality of life and barriers to management. These insights broaden understanding of post-whiplash sequalae, indicating the need for better detection. Implications for rehabilitation Dysphagia, dysphonia and laryngeal hypersensitivity are under-recognised consequences of whiplash. Individuals presenting with dysphagia, dysphonia and laryngeal sensory symptoms after whiplash experience significant implications to wellbeing, activity and participation. Improved understanding of these symptoms may facilitate better detection and subsequent referral to speech-language pathology. Greater understanding into the functional and psychosocial implications of these symptoms may guide more effective post-whiplash assessments and informed rehabilitation.

At Least 5-Year Outcomes of Whiplash-Induced Chronic Neck Pain Following Response to Intra-Articular Facet Joint Corticosteroid Injection.

ObjectiveTo investigate whether the response to intra-articular facet joint corticosteroid injection can determine the long-term prognosis (at least 5 years after injury) of whiplash injury-related neck pain sustained 3–12 months after injury.MethodsOf 65 patients who visited a university hospital for persistent whiplash injury-induced axial neck pain sustained 3–12 months after injury (numeric rating scale score ≥3) and had received intra-articular facet joint corticosteroid injection, 40 completed the telephone interview. We divided the patients into “good response group” (≥50% pain reduction at 1 month after the injection) and “poor response group” (<50% pain reduction at 1 month after the injection). We asked participants regarding the presence and degree of neck pain, its impact on work, and the use of oral pain medication or injection treatment.ResultsA follow-up at least 5 years after the injury found that the number of patients with persistent whiplash injury-related neck pain was significantly lower in the good response group than in the poor response group. The number of patients taking oral pain medications prescribed by a medical doctor or receiving injection treatments in a pain clinic or hospital for neck pain was lower in the good response group than in the poor response group. The number of patients who answered that their work was affected by neck pain was lower in the good response group than in the poor response group.ConclusionThe response to intra-articular corticosteroid injection might be helpful in determining at least 5-year outcomes of chronic whiplash injury-induced pain.

The Pathophysiology and Mechanism of Acute and Chronic Whiplash Injury: A Narrative Review

The Pathophysiology and Mechanism of Acute and Chronic Whiplash Injury: A Narrative Review

The relationship between forward head posture and neck pain disability in chronic whiplash-associated disorders

PURPOSE: To investigate the association between forward head posture (FHP) and neck pain disability in patients with chronic whiplash associated disorders (WAD). METHODS: This study was a secondary analysis based on data from a randomized controlled study. The study involved patients with chronic WAD reporting their disability using the Neck Disability Index (NDI). FHP was measured with a goniometer. Analyses of correlations and logistic regressions were performed controlling for age, gender, duration of symptoms, WAD-grade (the Quebec Task Force on Whiplash-Associated Disorders classification), bodily pain (the Short-Form 36 Health Survey (SF-36) and kinesiophobia, an irrational fear of physical movement and activity (the Tampa Scale of Kinesiophobia (TSK-SV). RESULTS: The inclusion criteria was fulfilled by 113 patients (81 women, 32 men). Mean age 48.1 years. Mean duration of symptoms 9.7 years. There was no significant correlation between FHP and neck pain disability (rs = 0.004, p = 0.968). A logistic regression analysis showed no significance for FHP neither with (p = 0.418) nor without (p = 0.991) control for age, gender, duration of symptoms, WAD-grade, kinesiophobia and bodily pain. In the multiple model kinesiophobia (p = 0.013) and bodily pain (p = &lt; 0.001) were the only significant predictors. Kinesiophobia was also significantly correlated with both neck pain disability (rs = 0.467, p &lt; 0.001) and FHP (rs = 0.202, p = 0.047), thus being a confounder to the possible correlation between these variables. CONCLUSIONS: There is no significant correlation between neck pain disability and FHP for patients with chronic WAD. Results suggest that physiotherapists should increase their focus on kinesiophobia, since it is associated with both FHP and neck pain disability.

Ultrasound-Guided Percutaneous Needle Electrolysis in a Patient With Cervicogenic Headache After a Chronic Whiplash: A Case Report

Background Cervicogenic headaches are a common condition after traffic accidents. The loss of cervical range of motion and pain are frequently observed. Case Presentation A 49-year-old woman presented to our clinic with cervical spine stiffness and a high level of self-perceived disability in the cervical disability and headache questionnaires. Manual therapy and conventional treatments were applied for 4 months and showed poor results. Outcome and Follow-up The addition of ultrasound-guided percutaneous needle electrolysis of the obliquus capitis inferior muscle was suggested. After 4 treatment sessions, improvements in the range of motion, pain, and self-reported disability were observed. The benefits were maintained after 3 months of treatment. Discussion This Case Report shows how the addition of ultrasound-guided percutaneous needle electrolysis to manual therapy treatments improved symptoms and signs of chronic neck pain associated with headache. JOSPT Cases 2022;2(2):88–92. doi:10.2519/josptcases.2022.10579

Values-based cognitive behavioural therapy for the prevention of chronic whiplash associated disorders: A randomized controlled trial.

BackgroundWhiplash is a common traffic‐related injury with up to 50% of those affected continuing to experience symptoms one‐year post‐injury. Unfortunately, treatments have not proven highly effective in preventing and treating chronic symptomatology. The overall aim of this study was to test the effectiveness of an early values‐based cognitive‐behavioural therapeutic intervention (V‐CBT) delivered within 6 months post‐injury in preventing chronic symptomatology compared to wait list controls.MethodsThe study was a two‐armed randomized controlled trial. Participants (n = 91) experienced pain, disability and at least one psychological risk factor (e.g. enhanced pain‐catastrophizing) after a whiplash trauma no later than 6 months prior. Participants were randomized to 10 sessions of V‐CBT starting 1 week (group A) or 3 months (group B) post‐randomization. The primary outcome was pain‐related disability, while secondary outcomes were pain intensity, neck‐pain related disability, depression, anxiety, PTSD symptoms, pain‐catastrophizing and kinesiophobia. These were evaluated at baseline and at 3, 6, 9 and 12 months post‐randomization.ResultsAt 3 months, group A demonstrated clinically important effects on all outcomes that were significantly better than group B (waitlist). When group B received the intervention at 6 months, they also demonstrated clinically important effects on all outcomes. However, there was a significant difference at 12 months for the primary outcome, in which group B increased their disability levels, while group A remained stable.ConclusionsWhile this indicates that an intervention window for early prevention of disability after whiplash injury may exist, this needs to be tested in a truly early intervention.SignificanceAn early Values‐based Cognitive Behavioural Therapeutic intervention delivered within 6 months post‐injury (mean days 117) was effective in reducing pain‐related disability and psychological distress compared to the control group that received the intervention later after a three months wait‐list period. The effects were sustained at 12 months follow‐up. The early intervention was significantly more effective in reducing pain‐related disability compared to the control group, indicating that an intervention window for early prevention of disability after whiplash injury may exist.

Risk factors for developing chronic whiplash disorders.

Whiplash injury is one of the most common injuries in traffic accidents. Most of the injured recover within three months, however, a significant number have symptoms much longer. The aim of this study was to determine the basic epidemiological characteristics of whiplash (gender, age, collision type, the type of participants in an accident, clinical signs) on Bosnia and Herzegovina roads and identify risk factors for chronic symptoms. The subjects of this retrospective study were traffic accident whiplash patients who were diagnosed, treated and monitored in a single hospital center. The initial examination was performed on the day or the day after the accident and follow-up examinations after four weeks, three months, and six months. Out of the 241 patients in this study, 14.1% had symptoms over six months after the trauma. 54.7% of the injured belong to the third and fourth decade and close to 80% were younger than 50 years. In addition to neck pain, the most common symptoms were limited neck mobility (69.7%), muscle spasms (63.5%), palpable pain of neck muscles (56%), headache (43.6%), nausea (23.7%). Statistical analysis showed a positive impact of age, Quebec Task Force (QTF) grade II, and more injury severity and cervical spine degenerative changes on prolonged recovery. The overwhelming majority of the injured belong to the working population. QTF2+ score is a useful indicator for prolonged recovery and chronic symptoms. Age, QTF score and degenerative changes of the cervical spine indicate an increased risk for poor recovery and chronic symptoms.

Advanced magnetic resonance imaging of chronic whiplash patients: a clinical practice-based feasibility study

BackgroundWhiplash injury is common following road traffic crashes affecting millions worldwide, with up to 50% of the injured developing chronic symptoms and 15% having a reduced working capability due to ongoing disability. Many of these patients receive treatment in primary care settings based upon clinical and diagnostic imaging findings. Despite the identification of different types of injuries in the whiplash patients, clinically significant relationships between injuries and chronic symptoms remains to be fully established. This study investigated the feasibility of magnetic resonance imaging (MRI) techniques including quantitative diffusion weighted imaging and measurements of cerebrospinal fluid (CSF) flow as novel non-invasive biomarkers in a population of healthy volunteers and chronic whiplash patients recruited from a chiropractic clinic for the purpose of improving our understanding of whiplash injury.MethodsTwenty chronic whiplash patients and 18 healthy age- and gender matched control subjects were included [mean age ± SD (sex ratio; females/males), case group: 37.8 years ± 9.1 (1.22), control group: 35.1 years ± 9.2 (1.25)]. Data was collected from May 2019 to July 2020. Data from questionnaires pertaining to the car crash, acute and current symptoms were retrieved and findings from clinical examination and MRI including morphologic, diffusion weighted and phase-contrast images were recorded. The apparent diffusion coefficient and fractional anisotropy were calculated, and measurement and analysis of CSF flow was conducted. Statistical analyses included Fisher’s exact test, Mann Whitney U test and analysis of variance between groups.ResultsThe studied population was described in detail using readily available clinical tools. No statistically significant differences were found between the groups on MRI.ConclusionsThis study did not show that MRI‐based measures of morphology, spinal cord and nerve root diffusion or cerebrospinal fluid flow are sensitive biomarkers to distinguish between chronic whiplash patients and healthy controls. The detailed description of the chronic whiplash patients using readily available clinical tools may be of great relevance to the clinician. In the context of feasibility, clinical practice-based advanced imaging studies with a technical setup similar to the presented can be expected to have a high likelihood of successful completion.

Are Reports of Pain, Disability, Quality of Life, Psychological Factors, and Central Sensitization Related to Outcomes of Quantitative Sensory Testing in Patients Suffering From Chronic Whiplash Associated Disorders?

Chronic whiplash associated disorders (CWAD) are characterized by long-lasting symptoms of neck pain occurring after an acceleration-deceleration injury. Central sensitization (CS) has been suggested as the possible underlying mechanism for these symptoms, and is characterized by changes in the central nervous system. Besides CS, psychological factors are believed to play an important role in the experience of (chronic) pain. Investigatingthe relationships between self-reported pain, disability, quality of life, psychological factors, and symptoms of CS; and electrical-based quantitative sensory testing (QST) outcomesin CWAD patients. Secondly, to investigate the differences in QST between CWAD patients and pain-free controls. Seventy-two individuals with CWAD and 55 pain-free controls underwent electrical stimuli-based QST. Detection and pain thresholds (EPT), temporal summation (TS), and conditioned pain modulation were examined. Spearman correlation and linear mixed models analyses were performed to assess, respectively, the hypothesized associations and group differences in QST. The Pain Catastrophizing magnification subscale correlated with the left wrist EPT (r=-0.332; P=0.004), and the Pain Anxiety Symptom Scale-20 with the left wrist (r=-0.325; P=0.005) and ankle (r=-0.330; P=0.005) EPT. TS at the ankle correlated with the CS inventory (r=0.303; P=0.010), Short Form 36 pain subscale (r=-0.325; P=0.005), and Illness Perception Questionnaire revised consequences subscale (r=0.325; P=0.005). EPTs left (P=0.011) and right wrist (P=0.023) were lower in the CWAD group, but conditioned pain modulation and TS did not differ between groups. QST outcomes relate to psychological constructs, rather than to self-reported pain intensity and distribution. Local hyperalgesia was found in individuals with CWAD, but no differences in endogenous pain facilitation nor inhibition.

Chronic Whiplash Syndrome: Associated Disorders and Physiotherapy Management – A Literature Review

Purpose: The purpose of the current literature review is to present the Whiplash Associated-Disorders through diagnosis, scales, physical examination and to identify the most suitable physiotherapy management of these conditions. The long-term effectiveness of physiotherapy interventions is also examined.&#x0D; Methods: Sixteen randomized controlled trials (RCTs) and seven case-control and cohort studies related to chronic WAD fulfilled the inclusion and exclusion criteria. The design, diagnosis, population, methodology, results, methodological quality and physiotherapy management were examined. The PEDro Scale and the Newcastle-Ottawa Scale were used for the examination of the methodological quality.&#x0D; Results: The methodological quality of the studies used, were high. Significantly important on minimizing the symptoms of chronic WAD were the combination of Exercise therapy &amp; Advice both at 6 and 12 months follow up. Other interventions such as Exercise therapy, Interdisciplinary approach and Multimodal physiotherapy treatment, Spinal Manual therapy and Advice were not equally effective in the long-term.&#x0D; Conclusion: The most suitable intervention for the physiotherapy management of chronic WAD, with long-term effectiveness was the combination of Exercise &amp; Advice, which was established with various outcome measures, such as NDI, VAS, NRI and SF-36. On the contrary, Exercise therapy, Interdisciplinary approach and Multimodal physiotherapy treatment, Spinal Manual therapy and Advice were not that effective on minimizing the symptoms of chronic WAD in the long-term.

Impaired neck motor control in chronic whiplash and tension-type headache.

The purpose of this study is twofold, first to present a new method based on head laser tracking designed to measure head or hand movements and second to further investigate if patients suffering from chronic whiplash or tension-type headache have impaired motor control of neck muscles. A new laser tracking instrument was designed to measure the ability of a test person to track a reference point moving on the wall by a laser fixed to the forehead or held in the hand. The reference point to be tracked moves in runs of a circle or a square at three different speeds 10, 20, or 30cm/s. We used a 1×1×1m setup geometry to provide head movements well below pain release. Groups of 22 patients diagnosed with chronic whiplash-associated disorder grade 2, 19 patients diagnosed with chronic tension-type headache, and 37 control persons were compared. A small but highly significant dyscoordination of head movements was observed in both patient groups and in whiplash also of the hand. Our study presents a new method based on laser tracking for precision quantitative measurements of head or hand movements during standardized conditions. The results confirm that motor control of head movements is impaired in both chronic whiplash and tension-type headache, and in whiplash also of the hand. This suggests involvement of the central nervous system in the pathology of these diseases.

Experiences of responsiveness to exercise in people with chronic whiplash: A qualitative study

Exercise is recommended in clinical guidelines for the treatment of chronic whiplash associated disorders (WAD). However, randomised controlled trials have shown similar effects for comprehensive exercise programs and advice. To date, there is no clear understanding of why some individuals with WAD appear to respond to exercise whilst others do not. The aim of this study was to explore the experiences and self-reported characteristics of people with chronic whiplash identifying as ‘responders’ and ‘non-responders’ to exercise. Semi-structured interviews were conducted with 13 people with chronic whiplash (patients) and seven treating physiotherapists. Patients were asked whether they responded to the exercise program, and what contributed to this. Physiotherapists were asked to share their experiences about the characteristics of people that appear to respond to exercise, and those that do not. An interpretive descriptive approach was selected to facilitate the generation of discipline-specific knowledge. Four themes were generated from patient and physiotherapist interviews, including: (1) the therapeutic relationship, (2) exercise experiences and beliefs, (3) self-efficacy and acceptance, (4) physical and psychological determinants of responsiveness. Responsiveness to exercise is complex and multifaceted. Clinicians may seek to identify the presence of discrete physical impairment(s) (e.g., range of motion restriction), and where present, determine whether targeted exercise results in an immediate and positive response. Clinicians may also focus their efforts on developing aspects of the therapeutic relationship identified as important to patients, such as hope, partnership and rapport.