Whiplash-associated disorder (WAD) presents a significant public health problem and socioeconomic burden. Although it is widely held that the majority of whiplash patients recover naturally within a few months after their injury, recent research suggests that recovery is more prolonged and incomplete than previously believed, with an estimated 50% of patients still complaining of neck pain one year after injury.
Whiplash injury can result in chronic neck pain in up to 20% patients. This can result in long-term disability, psychological distress and loss of function. Whiplash injury is best managed through a rehabilitative approach but in some cases injection treatments can help break the pain cycle and facilitate recovery.
In 1995, the Quebec Task Force (QTF) published its benchmark review of the scientific literature and expert opinion on whiplash. Whiplash is an acceleration deceleration mechanism of energy transfer to the neck, which may result in bony or soft tissue injuries (whiplash injury), which in turn may lead to a variety of clinical manifestations (whiplash-associated disorders or WAD).
Whiplash is a markedly heterogeneous and complex condition, with varied disturbances in motor, sensorimotor, and sensory function, as well as the presence of psychological distress.
One of the most common clinical characteristics of patients with whiplash is that of restricted cervical spine range of motion. Numerous studies have indicated that those persons with chronic WAD (>3 months) continue to display long-term changes in the cervical motor system.
Dysfunction of sensorimotor control is also a feature of both acute and chronic WAD. Loss of balance and disturbed neck-influenced eye movement control are present in chronic WAD. Sensorimotor disturbances seem to be greater in patients who report dizziness in association with their neck pain.
Whiplash can present with widespread sensory hypersensitivity (or decreased pain thresholds) to a variety of stimuli (pressure,thermal, electrocutaneous). These hypersensitive responses represent the presence of augmented central pain processing mechanisms.
Chronic whiplash pain is associated with psychological distress, including affective disturbances, anxiety, depression, and behavioral abnormalities such as fear of movement. Symptoms of posttraumatic stress have been shown to be present in a proportion of people following a whiplash injury.
Exercise programs: It appears that exercise programs are effective in reducing short-term pain intensity in both the acute and chronic stages of whiplash, although it does not appear that these programs influence long-term recovery. In contrast, there is some evidence that aggressive strengthening programs may be counterproductive.
Mobilization: There is strong evidence that immobilization with a soft collar during the acute phase of whiplash is less effective than active mobilization.
Chiropractic manipulation: Although there is some evidence that chiropractic manipulation may be of short-term benefit to patients with either subacute or chronic whiplash, the evidence is insufficient to determine the effectiveness of this treatment.
Botulinum toxin: There is contradictory evidence regarding the effectiveness of botulinum toxin injections during the chronic stage of whiplash, with some trials showing benefit, while others not.
Radiofrequency neurotomy: There is moderate evidence that radiofrequency neurotomy is effective in reducing pain in patients with chronic whiplash, although relief is not permanent.