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Whiplash-Associated Disorders

As mentioned previously, it once once believed that whiplash injuries were a fabrication and that there was nothing to suggest that there was anything actually wrong with those who were claiming to suffer from them – primarily since there was no way of seeing any damage using the available scanning methods. When more and more people began to exhibit such symptoms, most commonly after being the driver or passenger of a vehicle that had been the subject of a rear-end impact, it became clear that a good deal more research was required. Similar symptoms exhibited by patients involved in train crashes ini the 19th century had led to a condition of ‘railway spine’ being described prior to the use of the term ‘whiplash’.

Quebec Task Force (QTF)

The Quebec Task Force (QTF) was set up to collate and investigate the existing clinical and empirical information relating to whiplash injuries and to make recommendations regarding future managment of whiplash injuries, in terms of diagnosis, treament, rehabilitation and prevention. The recommendations of the QTF were compiled into a report called “WHIPLASH ASSOCIATED DISORDERS (WAD) – REDEFINING WHIPLASH AND ITS MANAGEMENT” which was published in the Spine journal in April 1995. The task force was funded by SAAQ (Société d’assurance automobile du Québec) – a major motor insurer. It was able to draw on their database of motor insurance claims involving whiplash-type injuries as a result.

The Quebec Task Force defined ‘whiplash’ as the mechanism of injury rather than the injury itself. Their definition of ‘whiplash’ was:

“an acceleration-deceleration mechanism of energy transfer to the neck. The impact may result in bony or soft tissue injuries, which may in turn lead to a variety of clinical manifestations (Whiplash-Associated Disorders)”

The QTF made many recommendations in its report, some of which have been called into question and subject to further review in light of subsequent findings. Much of the criticism levelled at the QTF centres around the fact that most of the recommendations were sometimes vague and generally based on consensus rather than hard evidence. This was to a degree unavoidable given that the Quebec Task Force’s own conclusion in terms of available evidence at the time was that it was “sparse and generally of unacceptable quality”. Out of over 10,000 papers evaluated for inclusion in the study most were rejected as not being relevant or of sufficient scientific merit – only 62 were eventually found to be usable and many of these were slightly off-topic.

Grades of Whiplash-Associated Disorder

Arguably the most useful and most widely-adopted information emanating from the report was the system of classification for different grades of Whiplash-Associated Disorders or WADs. These have been widely accepted and encompassed and they are as follows:

  • Grade 0: – No neck pain, stiffness, and no physical signs of neck injury.
  • Grade 1: – Neck complaint consisting of pain, stiffness or tenderness only, no physical signs of neck injury.
  • Grade 2: – Neck complaint and musculoskeletal signs, such as decreased range of motion and point tenderness in the neck.
  • Grade 3: – Neck complaint and neurological signs such as decreased or absent deep tendon reflexes, weakness and sensory deficits.
  • Grade 4: – Neck complaint and fracture or dislocation, or injury to the spinal cord.

Effective treatment of WADs

Due to the dearth of scientific information described above, very little evidence existed as to the effectiveness (efficacy) of any specific treatments for Whiplash-Associated Disorders, although some recommendations were given regarding patient care based largely on limited studies and consensus.

A summary of these recommendations can be found below, it is non-exhaustive and is tailored to lower WAD grades and common practical treatments:

  • Medication: – not required in Grade 1, non-steroidal anti-inflammatory drugs (NSAIDs) and non-narcotic (non-opioid) analgesics may be used short-term in Grades 2 & 3 in the first 3 weeks after injury. In cases of chronic pain, minor tranquilizers and antidepressants may be used.
  • Collars: – should not be used at all in Grade 1, and not for more than 72 hours after the injury was sustained in Grade 2 or 3 as they may delay recovery by promoting inactivity.
  • Bed rest: – not recommended in Grade 1, should not exceed 4 days in Grade 2
  • Exercise: – Range of Motion (ROM) exercises should be started immediately and continued unless symptoms are aggravated.
  • Heat, Ice, TENS etc: – optional for Grades 2&3 but emphasis should be on return to usual activites.
  • Manipulation: – can be helpful short-term but should be limited to qualified practitioners.
  • Posture: – maintaining good posture reduces stress and strain and should be adopted in any case.
  • Cervical pillows: – not required.

More information on treating whiplash injury can be found in the Whiplash Treatment section.