Spine University s Guide to Whiplash and Whiplash-Associated Disorders
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Introduction It s estimated that there are as many as one million reported cases of whiplash every year in the United States. Most cases are caused by motor vehicle accidents. These accidents can be either low-speed or high-speed, but both can put enough force on the neck muscles to cause whiplash. What is whiplash? In official terms, whiplash has been defined by the Quebec Task Force on Whiplash-Associated Disorders as, "an acceleration-deceleration mechanism of energy transferred to the neck that results in soft tissue injury that may lead to a variety of clinical manifestations including neck pain and its associated symptoms." In other words, it s an injury that happens when there is a sudden change in energy (speed) and this change causes the neck to jerk back and forth violently, resulting in pain in the neck and other symptoms associated with whiplash. Doctors have also identified whiplash-associated disorders (WAD), which are the problems that result from having whiplash headaches, backaches, and so on. What causes whiplash and WAD? Usually whiplash is caused by car accidents, but it can be caused falls from a sizeable height, being shaken (small children, in particular), sporting accidents, and even by amusement park rides that start and stop suddenly, or a sudden change in speeds and/ or direction. These accidents don t just cause whiplash. An obvious injury that could be caused by such accidents are fractures (breaks) in the neck. If this occurs, the injury isn't considered to be a whiplash-associated disorder (WAD). Doctors don t entirely agree on the causes of WAD. They think it could be due to a sprain of the soft tissue (body tissue that is not bone): the joints, ligaments (tough tissue that connect bones and holds them together), and/or the neck muscles. As scientists research more about whiplash and WAD, they are trying to find out what the minimum amount of force is that a neck has to go under before it can result in WAD. What types of studies are being done to clarify the causes of WAD? There are three types of studies or trials that investigate medical issues: Phase 1 is a study where researchers try to find a hypothesis (statement) that will explain what causes the problems. Phase 2 studies involve trying to find what facts might predict the outcome of a study. Phase 3 studies determine, confirm, deny, or partially confirm if the hypothesis and/or the predictors were right. Studies can also be based in different areas. For example, whiplash studies could be done in the emergency room as the patients first come in with the neck pain. Or, the study could be done according to insurance claims how many people make claims as a result of having whiplash. There are many issues to take into account as well when determining if a patient has whiplash. They include: Factors such as age, weight, economic states called demographic and socioeconomic factors Health issues before the accident The actual accident (speed, direction, use of safety devices, such as seatbelts, headrests) Anxiety, coping strategies, called psychological and social factors 3
Compensation system and laws how people may be financially compensated as a result of the accident Genetic and cultural factors Looking at nine studies that took place in five countries (Sweden, the United Kingdom, the Netherlands, the United States, and Canada), and keeping all the above-mentioned factors, researchers can get a good all-around look at whiplash and WAD. Emergency Room Visits Patients who came into emergency rooms in Sweden for treatment of whiplash and/or WAD were studied. Researchers in Sweden found that more patients were beginning to come into the emergency with symptoms of WAD than ever before. The incidence rose from 83 visits for every 100,000 emergency room visits of all patients in the mid-1980s to 302 per 100,000 visits in 1997 to 1998. A study in the Netherlands also looked at emergency visits and they found an increase of 10 times over 20 years. In the United Kingdom, although there were no comparisons, a study in the UK found in 1983 to 1984, almost 28 per 100,000 emergency room visits were for WAD. Insurance Claims Two Canadian studies looked at the number of claims that were made for insurance purposes as a result of WAD. These studies also found a significant increase in the number of people with WAD: from 70 making claims for WAD out every 100,000 claims in one province in 1993 (Quebec) to almost 600 claims out of every 100,000 claims in 1995 in another province, Saskatchewan. Six months earlier in Saskatchewan, which had adopted a no fault insurance program, there were only 417 claims per 100,000. What was interesting in that last number is that patients could make no-fault claims for both treatment and disability costs and it was still lower than six months later. Different Factors in WAD According to research, women are at slightly higher risk for WAD than men. Younger people also seemed to be a slightly higher risk than older people. Other issues, such as where a person sits in a car, were evaluated. A Phase 2 study showed that drivers and front passengers were at higher risk than back seat passengers. This result was similar to a Phase 1 study that found people who were in back seats or in cars with tow-bars weren t at higher risk of WAD. Another Phase 1 study looked at the restraints, seatbelts, and the restraints didn t seem to make a difference although this changes according to child size and age because of the differences in car and booster seats for each group. Studies have investigated the head rests that are supposed to eliminate or reduce the risk of whiplash and WAD. In one study, women drivers had a lower rate of WAD but only if their car had good rated head restraint. Some cars have activated systems where the headrests can't be adjusted by the driver or passenger. If the car is in an accident, the head rests automatically activate, along with the seat back, to protect the driver and passengers. One study found that if people had these, their rate of WAD was 43 percent lower than those who had the manual headrests. Studies that have looked into psychological, social, genetic, and cultural factors didn t find any differences in risks. There was a difference in areas that had different types of insurance systems. In places where the insurance system had changed from one where patients could receive compensation for pain and suffering to so-called no-fault insurance where patients received higher health care, income replace- 4
ment, and other benefits, but no compensation for pain and suffering, there was a 40 percent lower rate of filings for insurance claims and/ or seeking health care for WAD. When looking at the male/female divide, there isn t much of one in terms of complaints of WAD. Women in general, have more neck pain than men even if no accident has occurred. If neck pain before an accident plays a role in WAD, and if women historically have more neck pain than men in general, it would stand to reason that more women would have WAD than men. According to research age is a factor as well. The younger the patients, the higher the risk of WAD, with the 18- to 23-year-old groups having the highest rates. Of course, like most medical issues, other health factors can play a role in whiplash and WAD. Three studies looked at how often WAD occurred in association to certain factors. Using the Canadian province Saskatchewan, researchers looked at the patients health before the collision and after. The complaints after injury included: Headaches: 86 percent of women compared with a bit more than 78 percent of men Low back pain: almost 65 percent of women, just slightly less than 62 percent of men Painful jaw movement: 20 percent of women, slightly more than 13 percent of men Other studies looked at health complaints that seemed to linger after the injury but researchers didn t find any connection between how patients thought and how long their complaints of WAD lasted. Some studies looked at other psychological issues, such as coping mechanisms. Here, the researchers did find that patients who had trouble coping with pain did feel differently about how pain affected their lives. The researchers didn t find any connection between the severity of the coping with the severity of the pain. A big issue in chronic pain is called catastrophizing. This is a situation where people will assume the worst will happen (in this case pain) if they do a specific thing. This can affect quality of life, but it also often greatly affects work. Researchers found that people who have WAD have a higher risk of having anxiety and depression. Conclusion Research shows that there is an increasing number of people going to emergency rooms and making insurance claims for whiplashassociated disorders that are caused by motor vehicle accidents. This climb has been steadily rising over the past 30 years. Researchers haven't figured out if the increase in WAD is because there are more accidents that are causing them or because more patients are looking for medical help after being hurt. There is another possibility for this increase. Patient records and the way healthcare professionals record injuries and the effects of injuries has changed over the past few decades. Perhaps they are being recorded more accurately and WAD is being recognized more often. 5
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