A critical appraisal of the chronic whiplash syndrome

Abstract

Patients with protracted complaints after neck sprains (whiplash) continue to pose diYculties for physicians, expert witnesses, and the Courts.Strict definition is essential for clear and objective thinking. Courts are often misled by experts' reference to publications that do not adhere to critical criteria. The term "whiplash" is confusingly used both as a shorthand for a description of the injury mechanism-a flexion-extension, or torsional movement"-and more correctly for symptoms better designated neck sprains.

Chiropractic management of ‘intractable’ chronic whiplash syndrome

“…9 Most RTAs are not fatal and result in a sprain/strain type injuries to the muscles, ligaments, soft tissues, intervertebral discs and facet joints of the cervical spine. 10 This leads to local tissue inflammation, oedema, muscle spasm, stiffness 11 and nociception as a result of altered cervical facet joint biomechanics 12 together with proprioceptive dysfunction. 13 In more severe cases, radicular arm pain, due to nerve root traction or discal lesion, may also be present or, indeed, myelopathy, as a result of spinal cord damage.…”

Aspects of the failed back syndrome: role of litigation

“…Invasive treatments include: (1) epidural spinal cord stimulation, 14,15 (2) laminectomy, foraminotomy, fusion, and other approaches to removal or decompression of protruding disk fragments, 16,17 ; (3) chirotherapy completed by rehabilitation of thè active motion apparatus', chemonucleolysis or percutaneous nucleotomy 18 (4) percutaneous rhizolysis 19 (5) intraspinal therapy: methylprednisolone 14,20 or intrathecal morphine, 21 (6) facet joint injection and facet nerve block, 22 (7) lumbosacral distraction spondylodesis, 23 and (8) osteopathy, chiropractic manipulation, acupuncture, transcutaneous nerve stimulators etc.…”

“…Many have unsettled compensation claims, many follow accidents, neuraldestructive or surgical techniques: a situation comparable to the chronic whiplash syndrome. 4,5 De®nitioǹ Disabling back pain and/or sciatica of apparently disabling severity despite extensive therapy' 6 is a reasonable but descriptive de®nition. Pain for more than 3 months is an arbitrary criterion used in some studies.…”

The myth of chronic whiplash syndrome

“…No connection has been found between the timing of compensation and resolution of symptoms. 11,51 Seeking economic compensation has been found to be a bad prognostic sign, but this does not establish that most litigants are malingerers. 47 Time spent waiting for a hearing and delays in the medical and legal assessments can prolong and intensify concern.…”