Neck Pain - Whiplash

Chiropractic treatment of chronic 'whiplash' injuries Injury Volume 27, Issue 9, November 1996, Pages 643-645
M. N. Woodward, J. C. H. Cook, M. F. Gargan and G. C. Bannister University Department of Orthopaedic Surgery, Bristol, UK

FROM ABSTRACT
Forty-three percent of patients will suffer long-term symptoms following 'whiplash' injury, for which no conventional treatment has proven to be effective. A retrospective study was undertaken to determine the effects of chiropractic in a group of 28 patients who had been referred with chronic 'whiplash' syndrome. The severity of patients' symptoms was assessed before and after treatment using the Gargan and Bannister (1990) classification.

Twenty-six (93%) patients improved following chiropractic treatment. The encouraging results from this retrospective study merit the instigation of a prospective randomized controlled trial to compare conventional with chiropractic treatment in chronic 'whiplash' injury.

The Gargan and Bannister Whiplash ClassificationGROUP SYMPTOMS
A None
B Nuisance
C Intrusive
D Disabling

THESE AUTHORS ALSO NOTE:
43% of those injured in whiplash will experience long-term symptoms.
"If [whiplash] patients are still symptomatic after 3 months then there is almost a 90% chance that they will remain so."
"No conventional treatment has proven to be effective in these established chronic cases."

The 28 chronic whiplash patients in this study were treated by chiropractor J. Cook, using "specific spinal manipulation, proprioceptive neuromuscular facilitation, and cryotherapy." The treatment was evaluated by an independent orthopedic surgeon, M. Woodward, who was blinded as to the treatment.

"Spinal manipulation is a high-velocity low-amplitude thrust to a specific vertebral segment aimed at increasing the range of movement in the individual facet joint, breaking down adhesions and stimulating production of synovial fluid."

The 28 patients in this study had initially been treated with anti-inflammatories, soft collars and physiotherapy. These patients had all become chronic, and were referred for chiropractic at an average of 15.5 months (range was 3 – 44 months) after their initial injury. 27/28 (96%) patients were classified as category C or D symptoms at the time of initial chiropractic treatment. Following chiropractic 93% of the patients had improved: 16/28 (57%) by one symptom group and 10/28 (36%) by two symptom groups.

DISCUSSION
"The whiplash syndrome is a cause of long-term symptoms for which conventional medicine has failed to discover an effective treatment." Chiropractic has been shown to be advantageous compared to conventional medicine in the treatment of low back pain.

"The results of this retrospective study would suggest that benefits can occur in over 90% of patients undergoing chiropractic treatment for chronic whiplash injury." [Very Important]

Complications from cervical manipulations are rare, and when they are reported in the literature, they often "arose as a result of spinal manipulation performed by non-chiropractors, who had been misrepresented in the literature as being trained chiropractors." [Important]
KEY POINTS FROM DAN MURPHY

1) 43% of those injured in whiplash will experience long-term symptoms. In this study, at least one patient had ongoing symptoms 3 years 8 months following whiplash injury.

2) "If [whiplash] patients are still symptomatic after 3 months then there is almost a 90% chance that they will remain so."

3) "No conventional treatment has proven to be effective in these established chronic cases."

4) "Spinal manipulation is a high-velocity low-amplitude thrust to a specific vertebral segment aimed at increasing the range of movement in the individual facet joint, breaking down adhesions and stimulating production of synovial fluid."

5) In this study, chiropractic improved the symptom category of 93% chronic whiplash patients. This is particularly important considering that 96% of these patients had intrusive symptoms that handicapped their work and leisure activities and required frequent use of pain drugs, or they were severely disabled, having lost jobs and required continued medical interventions with constant use of pain drugs.

6) "The whiplash syndrome is a cause of long-term symptoms for which conventional medicine has failed to discover an effective treatment."

7) Chiropractic has been shown to be advantageous compared to conventional medicine in the treatment of low back pain.

8) Complications from cervical manipulations are rare, and when they are reported in the literature, they often "arose as a result of spinal manipulation performed by non-chiropractors, who had been misrepresented in the literature as being trained chiropractors." [Important]