Whiplash Injury:

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(314) 481-5000
More than 3 million Americans suffer whiplash each year, which now accounts for 45% of chronic neck pain in adults. New car design prevents fatal crashes with a reduction in injuries occurring at higher speeds.  Unfortunately, the increased the stiffness of cars in lower velocity crashes increased whiplash injuries.

Approximately 3 million people in the United States suffer from whiplash annually, resulting in an estimated $43 billion in comprehensive costs. Studies report rises in whiplash injuries from a low of 7.2% in 1982 to 30% by 1997. As the incidence of whiplash has increased, so have the rates of disability: whiplash may account for as much as 45% of chronic neck pain in adults.   A significant portion of people who suffer from whiplash injuries seek some form of compensation.

Seat belt and shoulder harness use provides life-saving protection in most crashes, but increase the risk for whiplash injury:

The rise in seatbelt use in the US since the introduction of primary- and secondary-use laws has contributed to the increased incidence of whiplash injury. Increased stiffness of seat backs also has been a contributing factor. The relative risk of being injured in a crash was related to model year, the risk of being injured in a 1990s era model was 2.7 times that of being injured in a 1980s model.

A significant factor in the increase in whiplash claims has been the automotive industry’s attempt to manage the increasing crash energy recommended by the National Highway Traffic Safety Administration’s (NHTSA) New Car Assessment Program (NCAP) and the Insurance Institute for Highway Safety’s (IIHS) 40% offset deformable barrier crash tests.   To perform well on these crash tests, manufacturers have increased the stiffness of passenger cars by using stronger alloys of steel and aluminum and made other structural modifications, vehicle stiffness has increased by approximately 34%. While this has led to a reduction in injuries occurring at higher speeds (30-40 mph), it has increased the stiffness of cars in lower velocity crashes translating to greater occupant force transmission.  Airbags do not have any effect on whiplash injuries caused by rear impact collisions; they only deploy in frontal- or side-impact (or roll-over) collisions.
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(314) 481-5000

On measuring a whiplash injury:
ROM is an important prognostic factor and that it correlates well with ongoing impairment:

Reduced ROM allowed differentiation between non-symptomatic and long-term whiplash victims, with a sensitivity of 86.2% and a specificity of 95.3%.   After whiplash injury, cervical ROM had predictive value for outcome and correlates with long-term disability.

Malingering:
The method recommended by the AMA Guides for detecting malingering is significantly less sensitive than the method of applying a coefficient of variation (CV) statistics

Medicolegal relevance:
The 1993 Supreme Court ruling (Daubert v Merrell Dow) defined the landscape of medicolegal testimony of experts, making trial judges the gatekeepers of scientific expert testimony on the basis on 4 criteria:

1. Whether the theory or technique can be, and has been, tested.
2. Whether the theory or technique has been subjected to peer review.
3. The known or potential rate of error of the method used.
4. The degree of the methods or conclusion’s acceptance within the relevant scientific community.

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(314) 481-5000

References:

• Freeman MD, Croft AC, Rossignol AM, Centeno CJ, Elkins WL. Chronic neck pain and whiplash: a case-control study of the relationship between acute whiplash injuries and chronic neck pain. Pain Res Manag. 2006;11(2):79-83.
• Zaloshnja E, Miller T, Council F, Persaud B.   Comprehensive and human capital crash costs by maximum police-reported injury severity within selected crash types. 48th Annual Proceedings of the Association for the Advancement of Automotive Medicine. Key Biscayne, Fl, 2004:251-264.
• Jakobsson L, Norin H, Isaksson-Hellman I. Parameters influencing the risk of AIS 1 neck injuries in frontal and side impacts. Proceedings. International Research Council on the Biomechanics of Impact (IRCOBI) Conference. Montpellier, France, 2000.
• Holm L, Cassidy JD, Sjogren Y, Nygren A. Impairment and work disability due to whiplash injury following traffic collisions. an analysis of insurance material from the Swedish Road Traffic Injury Commission. Scand J Public Health. 1999;27(2):116-123.
• Richter M, Otte D, Pohlemann T, Krettek C, Blauth M. Whiplash-type neck distortion in restrained car drivers: frequency, causes and long-term results. Eur Spine J. 2000;9(2):109-117.
• Versteegen GJ, Kingma J, Meijler WJ, ten Duis HJ. Neck sprain in patients injured in car accidents: a retrospective study covering the period 1970-1994. Eur Spine J. 1998;7(3):195-200.
• Satoh S, Naito S, Konishi T, Yoshikawa M, Morita N, Okada T, Kageyama T, Matsuzaki I. An examination of reasons for prolonged treatment in Japanese patients with whiplash injuries. J Musculoskel Pain. 1997;5(2):71-84.
• Viano DC. Influence of seat back angle on occupant dynamics in simulated rear end impacts. 1992;SAE Paper 922521:157-164.
• Viano DC. Seat influences on female neck responses in rear crashes: a reason why women have higher whiplash rates. Traffic Inj Prev. 2003;4(3):228-239.
• Viano DC. Seat properties affecting neck
• responses in rear crashes: a reason why whiplash has increased. Traffic Inj Prev. 2003;4(3):214-227.
• Versteegen GJ, Kingma J, Meijler WJ, ten Duis HJ. Neck sprain after motor vehicle accidents in drivers and passengers. Eur Spine J. 2000;9(6):547-552.
• Krafft M. A comparison of short- and long-term consequences of AIS 1 neck injuries, in rear impacts. International IRCOBI Conference on the Biomechanics of Impact. Goteborg, Sweden, 1998:235-248.
• Krafft M. When do AIS 1 neck injuries result in long-term consequences? Vehicle and human factors. Traffic Inj Prev. 2002;3(2):89-97.
• Rondinelli RD, Genovese E, Katz RT, Mayer TG, Mueller K, Ranavaya M, Brigham CR. Guides to the Evaluation of Permanent Impairment. 6th ed: American Medical Association; 2008.
• Swanson J, Rockwell T, Beuse N, Summers L, Summers S, Park B. Evaluation of stiffness measures from the U.S. New Car Assessment Program Proceedings 18th International Technical Conference on the Enhanced Safety of Vehicles (ESV). Nagoya, Japan, 2003.
• Croft AC, Freeman MD. Auto insurers and their new role in whiplash prevention–new rules, new risks, new tests. Forum. 2005;35(3):9-13.
• Croft AC, Philippens MM. The RID2 biofidelic rear impact dummy: a pilot study using human subjects in low speed rear impact full scale crash tests. Accid Anal Prev. 2007;39(2):340-346.
• Lemmen P, Gupta A, Lakshminarayana A, et al. Seat optimization considering reduction of neck injuries for female and male occupants m applications of the EvaRID model and a loading device representing a 50th percentile female. The 23rd International Technical Conference on the Enhanced Safety of Vehicles (ESV). Seoul, Republic of Korea: 2013.
• White AA, Johnson RM, Panjabi MM, Southwick WO. Biomechanical analysis of clinical stability in the cervical spine. Clin Orthop Rel Res. 1975;109:85-95.
• Kasch H, Bach FW, Jensen TS. Handicap after acute whiplash injury: a 1-year prospective study of risk factors. Neurology. 2001;56(12):1637-1643.
• Kasch H, Qerama E, Kongsted A, Bach FW, Bendix T, Jensen TS. Deep muscle pain, tender points and recovery in acute whiplash patients: a 1-year follow-up study. Pain. 2008;140(1):65-73.
• Kasch H, Qerama E, Kongsted A, Bendix T, Jensen TS, Bach FW. Clinical assessment of prognostic factors for long-term pain and handicap after whiplash injury: a 1-year prospective study. Eur J Neurol. 2008;15(11):1222-1230.
• Dall’Alba PT, Sterling MM, Treleaven JM, Edwards SL, Jull GA. Cervical range of motion discriminates between asymptomatic persons and those with whiplash. Spine. 2001;26(19):2090-2094.
• Antonaci F, Bulgheroni M, Ghirmai S, et al. 3D kinematic analysis and clinical evaluation of neck movements in patients with whiplash injury. Cephalalgia. 2002;22(7):533-542.
• Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14(7):409-415.
• Hooper RA, Frizzell JB, Faris P. Case series on chronic whiplash related neck pain treated with intraarticular zygapophysial joint regeneration
• injection therapy. Pain Physician. 2007;10(2):313-318.
• Lamb SE, Gates S, Underwood MR, et al.. Managing Injuries of the Neck Trial (MINT): design of a randomised controlled trial of treatments for whiplash associated disorders. BMC Musculoskelet Disord. 2007;8:7.
• Rebbeck TJ, Refshauge KM, Maher CG, Stewart M. Evaluation of the core outcome measure in whiplash. Spine. 2007;32(6):696-702.
• Prushansky T, Handelzalts S, Pevzner E. Reproducibility of pressure pain threshold and visual analog scale findings in chronic whiplash patients. Clin J Pain. 2007;23(4):339-345.
• Stewart M, Maher CG, Refshauge KM, Bogduk N, Nicholas M. Responsiveness of pain and disability measures for chronic whiplash. Spine. 2007;32(5):580-585.
• Carroll A, Barnes M, Comiskey C. A prospective randomized controlled study of the role of botulinum toxin in whiplash-associated disorder. Clin Rehabil. 2008;22(6):513-519.
• Pereira MJ, Jull GA, Treleaven JM. Self-reported driving habits in subjects with persistent whiplash-associated disorder: relationship to sensorimotor and psychologic features. Arch Phys Med Rehabil. 2008;89(6):1097-1102.
• Geldman M, Moore A, Cheek L. The effect of pre-injury physical fitness on the initial severity and recovery from whiplash injury, at six-month follow-up. Clin Rehabil. 2008;22(4):364-376.
• Nieto R, Miro J, Huguet A. Disability in subacute whiplash patients: usefulness of the neck disability index. Spine. 2008;33(18):E630-E635.
• Elliott J, Sterling M, Noteboom JT, Darnell R, Galloway G, Jull G. Fatty infiltrate in the cervical extensor muscles is not a feature of chronic, insidious-onset neck pain. Clin Radiol. 2008;63(6):681-687.
• Chien A, Eliav E, Sterling M. Whiplash (grade II) and cervical radiculopathy share a similar sensory presentation: an investigation using quantitative sensory testing. Clin J Pain. 2008;24(7):595-603.
• Gabel CP, Burkett B, Neller A, Yelland M. Can long-term impairment in general practitioner whiplash patients be predicted using screening and patient-reported outcomes? Int J Rehabil Res. 2008;31(1):79-80.
• Juul-Kristensen B, Clausen B, Ris I, et al. Increased neck muscle activity and impaired balance among females with whiplash-related chronic neck pain: a cross-sectional study. J Rehabil Med. 2013;45(4):376-384.
• Daubert v. Merrell Dow Pharmaceuticals, Inc. 509 U.S. 579 (1993).
• Dvir Z, Prushansky T, Peretz C. Maximal versus feigned active cervical motion in healthy patients: the coefficient of variation as an indicator for sincerity of effort. Spine. 2001;26(15):1680-1688.
• Gargan M, Bannister G, Main C, Hollis S. The behavioural response to whiplash injury. J Bone Joint Surg Br. 1997;79(4):523-526.
• Pettersson K, Brandstrom S, Toolanen G, Hildingsson C, Nylander PO. Temperament and character: prognostic factors in whiplash patients? Eur Spine J. 2004;13(5):408-414

Call to Schedule:
(314) 481-5000
NSAIDS or nonsteroidal anti-inflammatory drugs are common medications that reduce inflammation and relieve fever and pain by blocking enzymes and proteins made by the body. They are usually available over the counter without a prescription. Given its relatively safe profile, NSAIDS have enjoyed widespread availability and consumer use. However, this does not mean NSAIDS are harmless.

In a study conducted by the Copenhagen University Hospital Gentofte, researchers have found a strong link between an increased risk of cardiac arrest and NSAID use. The researchers analyzed over 28,000 patients in Denmark who suffered a cardiac arrest within a 10 year period. The results were shocking. The patients who suffered an episode of a cardiac arrest showed a history of NSAID uses 30 days prior to the episode. Furthermore, the study broke down the kind of NSAID present before the episode and tallied the corresponding risk. In the study, Ibuprofen was linked to a 30 percent increase in cardiac arrest risk, while diclofenac was linked to a whopping 50 percent rise in the risk.

The researcher believe that there is a place for NSAIDS in the treatment of pain and inflammation but given the insidious risk involve in its use, patients should be extra cautious when considering taking it in the long run.

Common painkillers linked to greater risk of cardiac arrest