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	Verhagen-A-P, Lanser-K, de-Bie-R-A, de-Vet-H-C.
INSTITUTION	Department of Epidemiology, University of Maastricht, The Netherlands.
TITLE	Whiplash: assessing the validity of diagnostic tests in a cervical sensory disturbance.
SOURCE	J-Manipulative-Physiol-Ther 1996 Oct, VOL: 19 (8), P: 508-12, ISSN: 0161-4754.
ABSTRACT	OBJECTIVE: To determine the ability of two diagnostic tests that examine sensory disturbance in whiplash patients to discriminate between 'extreme' groups. BACKGROUND: The neuromuscular theories have been accepted as explanations of the symptoms after a whiplash injury. Dutch manual therapists often use the diagnostic tests under study to diagnose and treat sensory disturbances after such an injury. The validity of a test needs to be assessed before its efficacy as a treatment in whiplash patients can be tested. The aim of this study was to validate two diagnostic tests and to initiate further research on the efficacy of a treatment of a sensory disturbance in whiplash patients. METHOD: Twelve subjects with chronic symptoms (> 3 months) after a whiplash injury (patient group) and 18 subjects without any head or neck problems (control group) were studied. The tests under study were the extension test and the coordination test. All researchers were blind to the characteristics of the subjects. RESULTS: The extension test and the coordination test were able to discriminate adequately between subjects with symptoms after a whiplash injury (patients) and subjects without any head or neck complaints (control subjects). Patients clearly show a smaller degree of extension compared with the control subjects and an increase of extension movement with external fixation. The sensitivity as well as the specificity of the coordination test were good (both > .80). CONCLUSION: These diagnostic tests seemed to be valid instruments for discriminating between whiplash patients with symptoms and healthy people. 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	Woltring-H-J, Long-K, Osterbauer-P-J, Fuhr-A-W.
INSTITUTION	Whiplash Analysis Incorporation, Phoenix, AZ 85018.
TITLE	Instantaneous helical axis estimation from 3-D video data in neck kinematics for whiplash diagnostics.
SOURCE	J-Biomech 1994 Dec, VOL: 27 (12), P: 1415-32, ISSN: 0021-9290.
ABSTRACT	To date, the diagnosis of whiplash injuries has been very difficult and largely based on subjective, clinical assessment. The work by Winters and Peles Multiple Muscle Systems--Biomechanics and Movement Organization. Springer, New York (1990) suggests that the use of finite helical axes (FHAs) in the neck may provide an objective assessment tool for neck mobility. Thus, the position of the FHA describing head-trunk motion may allow discrimination between normal and pathological cases such as decreased mobility in particular cervical joints. For noisy, unsmoothed data, the FHAs must be taken over rather large angular intervals if the FHAs are to be reconstructed with sufficient accuracy; in the Winters and Peles study, these intervals were approximately 10 degrees. in order to study the movements' microstructure, the present investigation uses instantaneous helical axes (IHAs) estimated from low-pass smoothed video data. Here, the small-step noise sensitivity of the FHA no longer applies, and proper low-pass filtering allows estimation of the IHA even for small rotation velocity omega of the moving neck. For marker clusters mounted on the head and trunk, technical system validation showed that the IHAs direction dispersions were on the order of one degree, while their position dispersions were on the order of 1 mm, for low-pass cut-off frequencies of a few Hz (the dispersions were calculated from omega-weighted errors, in order to account for the adverse effects of vanishing omega). Various simple, planar models relating the instantaneous, 2-D centre of rotation with the geometry and kinematics of a multi-joint neck model are derived, in order to gauge the utility of the FHA and IHA approaches. Some preliminary results on asymptomatic and pathological subjects are provided, in terms of the 'ruled surface' formed by sampled IHAs and of their piercing points through the mid-sagittal plane during a prescribed flexion-extension movement of the neck. Author.

5. AUTHOR	Byrn-C, Olsson-I, Falkheden-L, Lindh-M, Hosterey-U, Fogelberg-M, Linder-L-E, Bunketorp-O.
INSTITUTION	Department of Anaesthesia, Sahlgrenska Hospital, University of Gothenburg, Sweden.
TITLE	Subcutaneous sterile water injections for chronic neck and shoulder pain following whiplash injuries (see comments).
SOURCE	Lancet 1993 Feb 20, VOL: 341 (8843), P: 449-52, ISSN: 0140-6736.
CM	Comment in: Lancet 1993 Feb 20; 341(8843):470; Comment in: Lancet 1993 Apr 3; 341(8849):905.
ABSTRACT	In many cases of whiplash injury symptoms persist and do not respond to treatment. There is uncontrolled evidence to suggest that intracutaneous injections of sterile water might help. Since that route may be unacceptable to patients the subcutaneous route is used in the randomised trial reported here. 40 patients with whiplash syndrome, mean age 46 years (24-73) were given subcutaneous injections of 0.3-0.5 ml sterile water or saline over tender and trigger points in the neck and shoulder. A maximum of three treatments were given during the first two months of the study and the patients were followed up for 8 months. The accidents had occurred 4-6 years previously. X-ray examinations revealed no traumatic spinal lesions. Neck mobility and pain levels were evaluated by a physiotherapist immediately before and after the first treatment and after 1, 3, and 8 months. After 3 months, the mean total mobility of the cervical spine had increased by 39 degrees in the sterile water group and 6 degrees in the saline group (p < 0.05). Minimum and maximum levels of pain in the weeks just before treatment were evaluated by a visual analogue scale from 0 to 10. After 3 months the minimum pain level had fallen from 2.2 to 1.4 in the sterile water group but was not reduced in the saline group (p < 0.02); the maximum had fallen from 8.1 to 3.8 in the sterile water group and from 8.3 to 7.5 in the saline group (p < 0.001). After 3 months, 19 of 20 patients in the sterile water group assessed their condition as generally improved but only 6 in the saline group felt that they had got better. After 8 months there were still significant differences for minimum pain score and for mobility but not for maximum pain or for self-assessment of improvement. Author.

6. AUTHOR	Morris-F.
INSTITUTION	Accident and Emergency Department, Oldchurch Hospital, Essex, England.
TITLE	Do head-restraints protect the neck from whiplash injuries?
SOURCE	Arch-Emerg-Med 1989 Mar, VOL: 6 (1), P: 17-21, ISSN: 0264-4924.
ABSTRACT	Over an 11-month period a study was made of all patients presenting to an accident and emergency department who had sustained whiplash as a result of rear-bumper impacts. The patients were analysed with respect to the presence of head-restraints in their vehicles. A significant increase in the incidence of whiplash was found in patients whose vehicles did not have head-restraints fitted. Legislation requiring all passenger cars to have head-restraints fitted as standard would have a major impact in reducing the number of whiplash injuries sustained in rear bumper impacts. Author.

7. AUTHOR	Hertz-H, Meng-A, Rabl-V, Kern-H.
INSTITUTION	I. Universitatsklinik fur Unfallchirurgie, Wien.
TITLE	(Treatment of whiplash injuries of the cervical spine with acupuncture). TT 'Zur Behandlung des Schleudertraumas der HWS mit Akupunktur'.
SOURCE	Aktuelle-Traumatol 1983 Aug, VOL: 13 (4), P: 151-3, ISSN: 0044-6173.
ABSTRACT	30 patients with whiplash injuries were treated with aural- acupuncture. The points were chosen according to a special programme. Acupuncture proved an effective form of therapy for treatment of accident patients with whiplash injuries, representing a valuable supplement to the field of rehabilitation. Author.

8. AUTHOR	Taillard-W, Albassir-A.
TITLE	(Orthopaedic treatment of whiplash injuries of the cervical spine (author's transl)). TT Orthopedie et traumatismes cervicaux par projection.
SOURCE	Radiol-Clin (Basel) 1975, VOL: 44 (4), P: 236-50.
ABSTRACT	Short review of the different types of propulsion injuries of the cervical spine in acute and chronic cases. The basic principles of the therapy as well as the different techniques of physiotherapy, orthesis and surgical treatment and described. Author.

9. AUTHOR	Wiesner-H, Mumenthaler-M.
TITLE	(Whiplash injuries of the cervical spine. A catamnestic study). TT Schleuderverletzungen der Halswirbelsaule. Eine katamnestische Studie.
SOURCE	Arch-Orthop-Unfallchir 1975, VOL: 81 (1), P: 13-36, ISSN: 0003-9330.
ABSTRACT	Whiplash injuries of the cervical spine are due to the rapid sequence of movements in opposite direction. They are mainly following rear- end collisions where the trunk is pushed rapidly forward. Very important forces act therefore on the different segments of the cervical spine and lead to lesions of the perispinal soft tissues, of the ligaments, of the disks and the bony structures. In 24 tables, the signs and symptoms in 104 personal cases observed for a period which lasted more than 4 years are described. Amongst the clinical signs there are cervical strain, cervico brachial pain, headaches, radicular signs as well as symptoms of concussion and cercial medullar lesion. Radiological findings are discrete; functional X- rays sometimes show local diminution of motility in a single segment. The treatments, amongst these immobilisation and local heat, are discussed. The unusually long duration of local disturbance is stressed. Signs of neurasthenia are part of the typical findings and do not at all mean a secondary neurotic development. Author.

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