Whiplash Injuries Don’t Respond Well to Treatment

Chronic whiplash injury can develop after forced flexion-extension of the neck, which is often caused by an automobile accident. In some cases, this disabling condition can persist for moths. (Cynics often say it persists until the insurance company pays compensation.) In a study reported last year in the journal Spine, Danish researchers gave people with whiplash injury one of three different treatments – immobilization with a rigid ‘collar’ followed by mobilization, advice to “act-as-usual”, or an active mobilization program.

Over 450 patients were randomly assigned to one of these treatments. Follow-up was done after 3, 6, and 12 months to assess headache, neck pain intensity, disability, and work capacity. After 12 months, almost half the patients reported that neck pain was still considerable, and half had disability; 14% were still off-work.

Overall, there was poor adherence to treatment regimes, and frequent use of treatments other than those prescribed; a considerable number of patients were lost to follow-up.

The most important finding was, in fact, a negative – there were no significant differences between the three treatment regimes. For those that stuck to their recommended treatments, the neck collar group had a slightly poorer outcome. This led the researchers to recommend that “use of a stiff collar should be discouraged as a standard approach”.

Maybe the cynics were half-right all along – litigation after poor outcomes have been attributed to subconscious resentment rather than actual money-grubbing.