Over the last ten years, a great deal has been written on the problem of whiplash biomechanics, but little study has been done on treatment of whiplash injuries. As the authors of a new study write, "Conventional treatment of patients with whiplash symptoms is disappointing." 1
This study examined the effectiveness of chiropractic treatment in patients with chronic whiplash pain. The mean time from injury to treatment was about 12 months. The authors began with 93 patients with chronic whiplash pain and divided them into three groups: Group I: patients with "neck pain radiating in a 'coat hanger' distribution, associated with restricted range of neck movement but with no neurological deficit." Group II: patients with "neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement." Group III: patients who described "severe neck pain but all of whom has a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes."
These patients also "described an unusual complex of symptoms," including "blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain." The patients underwent chiropractic treatment for 4.1 months, with a mean of 19.3 treatments per patient. The patients were graded before and after treatment on a four-point scale that described their symptoms: Grade A was the absence of symptoms. Grade B patients had symptoms described as a nuisance. Grade C patients had symptoms that were intrusive. Grade D patients had symptoms considered disabling.
The authors found that in Group I, 72% of the patients improved; in Group II, 94%; and in Group III, only 27% of the patients reported improvement. So, there seem to be certain factors that can increase or decrease the effectiveness of chiropractic with these patients.
The study discusses the ramifications of the findings: "Woodward et al2 found improvement in chronic symptoms in 26 of 28 patients (93%) following chiropractic treatment. Our results confirm the efficacy of chiropractic, with 69 of our 93 patients (74%) improving following treatment. "Our study suggests that such a group of nonresponders does exist, represented by group 3.
The defining characteristics of patients in this group were the full range of neck movement in association with neck pain, bizarre symptoms, female sex and ongoing litigation. The mean age of the group at 29.5 (16-43) was lower than that of the other two groups (mean 36.8, range 18-65). "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 who fail to respond to such treatment, highlights the need for a careful history and physical examination before commencing treatment."
The authors conclude: "Whiplash injuries are common. Chiropractic is the only proven effective treatment in chronic cases."
1.Khan S, Cook J, Gargan M, Bannister G. A symptomatic classification of whiplash injury and the implications for treatment. Journal of Orthopaedic Medicine 1999;21(1):22-25.
2.Woodward MN, Cook JCH, Gargan MF, Bannister GC. Chiropractic treatment of chronic whiplash injuries. Injury 1996;27:643-645.