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Chiropractic Research Review

Whiplash Injury: Classification and Perspectives on Treatment

Whiplash injuries resulting from indirect injury to the cervical spine can produce a variety of frustrating symptoms, including headache, neck and interscapular pain, and peripheral paraesthesia.

While the accumulated literature suggests that more than half of whiplash patients will recover within two years of injury, conventional treatment of this condition remains disappointing and patients are often forced to endure considerable pain and disability.

This study was designed to determine which patients with chronic whiplash could benefit from chiropractic intervention. One hundred consecutive chiropractic referrals for chronic whiplash symptoms formed the study group, with seven lost to follow-up. The remaining 93 patients (25 male, 68 female) were divided into three symptom groups:

Group 1: Patients with "neck pain radiating in a 'coat hanger' distribution, associated with restricted range of neck movement but with no neurological deficit";

Group 2: patients with "neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement"; and

Group 3: patients who described a variety of symptoms (blackouts, visual disturbances, etc.) in addition to "severe neck pain, but with full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes."

All patients underwent an average of 19.3 adjustments over the study period (average: 4.1 months) in the form of high-velocity, low-amplitude thrusts to a specific vertebral segment. Patients were asked to report their symptoms, which were recorded by grades according to a previously published whiplash outcome measure. Results showed that groups 1 and 2 (but not group 3) improved following chiropractic manipulation. Specifically,

* Group 1: 72% of patients gained "some benefit," with 24% becoming asymptomatic and 24% improving by two symptom grades following manipulation.

* Group 2: 94% of patients responded to treatment, with 38% becoming asymptomatic and 43% improving by two symptom grades.

* Group 3: Only 27% of patients improved following treatment; none became asymptomatic, and only one patient improved by two symptom grades.

The authors summarize their findings by stating: "The results from this study provide further evidence that chiropractic is an effective treatment for chronic whiplash symptoms. However, our identification of a group of patients
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who fail to respond to such treatment highlights the need for a careful history and physical examination before commencing treatment."

Khan S, Cook J, Gargan M, et al. Asymptomatic classification of whiplash injury and the implications for treatment. Journal of Orthopaedic Medicine 1999:21(1), pp22-25.
Reprints: Contact the American Association of Orthopaedic Medicine, (800) 992-2063.

Chiropractic Research Review

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