Whiplash, Cervical - Medical Research Abstracts

1. AUTHOR	Olson-V-L.
INSTITUTION	Health East-St John's Hospital, Maplewood, Minn, USA.
TITLE	Whiplash-associated chronic headache treated with home cervical traction.
SOURCE	Phys-Ther 1997 Apr, VOL: 77 (4), P: 417-24, ISSN: 0031-9023.
ABSTRACT	The subject of this case report was a 56-year-old woman who sustained a whiplash-associated disorder as a result of a motor vehicle accident. Within a few hours after the accident, she developed a headache, which became chronic, creating disability and hindering the quality of her life. In the following year, a variety of diagnostic tests, medications, and physical therapy were unsuccessful in determining the cause of her complaints or in relieving them. After this year, she expressed anger, frustration, and a reluctance to undergo additional physical therapy. By listening to her explain how she coped with her problem and observing that she lacked the ability to reduce her cervical lordosis, the therapist developed and implemented a home program of supine cervical traction and exercise. After 30 days of treatment, she was able to reduce and control her headache. This treatment and the approach used to develop the treatment may benefit other patients who have whiplash-associated chronic headache. Author.

2. AUTHOR	Gennis-P, Miller-L, Gallagher-E-J, Giglio-J, Carter-W, Nathanson-N.
INSTITUTION	Bronx Municipal Hospital Center, Department of Emergency Medicine, NY
TITLE	The effect of soft cervical collars on persistent neck pain in patients with whiplash injury (see comments).
SOURCE	Acad-Emerg-Med 1996 Jun, VOL: 3 (6), P: 568-73, ISSN: 1069-6563.
CM	Comment in: Acad-Emerg-Med 1996 Jun; 3(6):563-4.
ABSTRACT	OBJECTIVE: To assess the efficacy of soft cervical collars in the early management of whiplash-injury-related pain. METHODS: A controlled, clinical trial was conducted in an urban ED. Adults with neck pain following automobile crashes indicated their initial degrees of pain on a visual analog scale. Patients with cervical spine fractures or subluxation, focal neurologic deficits, or other major distracting injuries were excluded. Patients were assigned to receive a soft cervical collar or no collar based on their medical record numbers. Pain at > or = 6 weeks postinjury was coded as none, better, same, or worse, and analyzed as 3 dichotomous outcomes: recovered (pain = none); improved (pain = none or better); and deteriorated (pain = worse). RESULTS: Of 250 patients enrolled, 196 (78%) were available for follow-up. Of these patients, 104 (53%) were assigned to the soft cervical collar group, and 92 (47%) to the control group. These groups were similar in age, gender, seat position in the car, seat belt use, and initial pain score. Pain persisted at > or = 6 weeks in 122 (62%) patients. The groups showed no difference in follow-up pain category (p = 0.59). There was no significant difference between the 2 groups in complete recovery (p = 0.34), improvement (p = 0.34), or deterioration (p = 0.60). The study had a power of 80% to detect an absolute difference of at least 20% in recovery, 17% in improvement, and 7% in deterioration (2-tailed, alpha = 0.05). CONCLUSIONS: Most patients with whiplash injuries have persistent pain for at least 6 weeks. Soft cervical collars do not influence the duration or degree of persistent pain. Author.

3. AUTHOR	Fitz-Ritson-D.
TITLE	Phasic exercises for cervical rehabilitation after "whiplash" trauma.
SOURCE	J-Manipulative-Physiol-Ther 1995 Jan, VOL: 18 (1), P: 21-4, ISSN: 0161-4754.
ABSTRACT	OBJECTIVE: To assess whether "phasic" exercises, including rapid eye- head-neck-arm movements, can benefit patients with chronic cervical injuries. DESIGN: A randomized, controlled, double blind study involving 30 chronic patients, who were allocated to either group 1 or group 2. The study period was for 8 wk. SETTING: The study was conducted in a private practice. PATIENTS: Thirty chronic motor vehicle accident patients who continued to experience increased pain /soreness/stiffness of the cervical musculature with sports /activities requiring rapid head neck movements were selected for the study. INTERVENTION: Group 1 patients (n = 15) had standard exercises (stretching/isometric/isokinetic) and chiropractic therapy. Group 2 patients (n = 15) had "phasic" exercises and chiropractic therapy. Patients in both groups exercised for a minimum of four times weekly, for 8 wk. MAIN OUTCOME MEASURE: Pre and Post Pain and Disability Index was administered to both groups. RESULTS: Group 1, which had standard exercises and chiropractic therapy, improved by 7.4% (p > .05). Group 2, which had "phasic" exercises and chiropractic therapy, improved by 48.3% (p > .001). Confounders were identified, which explains the minimal improvement of group 1 and the remarkable results of group 2. CONCLUSIONS: It would appear that any rehabilitation program for chronic neck-injured patients should involve exercises that address the following: eye-head-neck-arm coordinated movements, coordination of the entire vertebral column,/ and return the "phasic" component of the musculature to functional levels. Additional studies will address the effect of these exercises on the strength, range of motion and pain improvement of the cervical spine in normal, acute and chronic patients. Author.

4. AUTHOR	McKinney-M-B.
INSTITUTION	Altnagelvin Area Hospital, Londonderry, Northern Ireland.
TITLE	(Treatment of dislocations of the cervical vertebrae in so-called "whiplash injuries"). TT Behandlung der HWS-Distorsionen bei sog. "Schleuderverletzungen".
SOURCE	Orthopade 1994 Aug, VOL: 23 (4), P: 287-90, ISSN: 0085-4350.
ABSTRACT	It is estimated that between 15 and 30% of car occupants will suffer neck pain after accidents, and many will remain symptomatic for a prolonged period. This has often been attributed to the effect of associated litigation as a financial deterrent to recovery. Conventional treatment uses an old orthopaedic principle of rest until the symptoms resolve and analgesia is widely accepted, although its use is unlikely to influence the ultimate outcome. Mobilization programmes have become popular, particularly with physiotherapists, but they are often based upon personal experience and are largely scientifically untested. An improvement in both the cervical range of movement and a reduction in the severity of neck pain was claimed in a study in 1986 using early mobilization. In an attempt to identify which features of physiotherapeutic practice appeared to correspond with improved outcome, I studied the outcomes of differing treatment regimens in acute whiplash patients in three randomized groups and showed that after 1 and 2 months there was a significant improvement in cervical movements and in the patients' perception of their neck pain severity, in actively mobilized patients, including those who were instructed about postural correlation and mobilization techniques. The benefit conferred on this group was still evident 2 years post injury. It therefore seems that self-reliance with exercises used when symptoms are troublesome and postural advice can play a significant role in the recovery process. Author.

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