Whiplash (medicine)

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Whiplash is the common name for a hyper extension/flexion injury to the cervical, thoracic or lumbar spines. The injury is referred to as "whiplash" due to the neck or back being thrown forwards and/or backwards at a rapid speed. This causes the fibres of the neck muscles to tear, resulting in pain and often a decreased range of movement.

Whiplash is a commonly associated with motor vehicle accidents, usually when the vehicle has been hit in the rear, ^[1] however the injury can be sustained in many other ways.

1 Cause
2 Symptoms
3 Diagnosis
- 3.1 Québec Task Force
- 3.2 Québec Task Force grades of disorder
4 Consequences
5 Prevention
- 5.1 Whiplash protection
6 References
7 Further reading
8 External links

[edit] Cause

A whiplash injury can be the result of impulsive stretching of the spine, as the head snaps forward and then back again causing a whiplash injury.^[2] The Insurance Institute for Highway Safety defines whiplash as: "a range of neck injuries that are related to sudden distortions of the neck."^{[citation needed]} It takes about 100 milliseconds for an occupant's body to catch up to the car when it is hit, and it is during this time that the damage occurs.^{[citation needed]}

Whiplash can be caused by any motion similar to a rear-end collision in a motor vehicle, such as may take place on a roller coaster or other rides at an amusement park, sports injuries such as skiing accidents, other modes of transportation such as airplane travel or from being hit or shaken.^[3] Shaken baby syndrome can result in a whiplash injury.^[2]

[edit] Symptoms

Symptoms reported by sufferers include: pain and aching to the neck and back, referred pain to the shoulders, sensory disturbance (such as pins and needles) to the arms & legs and headaches. Symptoms can appear directly after the crash, but often are not felt until days afterwards.^[1]

[edit] Diagnosis

Reliably diagnosing a whiplash injury or disorder is not difficult for a trained doctor. If a patient cannot achieve the full motion, or has excessive range of motion, the probable ultimate cause is the whiplash motion.^{[citation needed]}

[edit] Québec Task Force

The Québec Task Force (QTF) was a task force sponsored by Société d'assurance automobile du Québec (SAAQ), the public auto insurer in the province of Quebec, Canada. The QTF submitted a report on Whiplash-associated disorders (WAD) in 1995, which made specific recommendations on prevention, diagnosis and treatment of WAD. The recommendations have become the base for Guideline on the Management of Claims Involving Whiplash-Associated, a guide to classifying WAD and guidelines on managing the disorder. The full report titled Redefining "Whiplash" was published in the April 15, 1995 issue of Spine.^[4]

[edit] Québec Task Force grades of disorder

Four grades of Whiplash-Associated Disorder were defined by the Quebec Task Force on Whiplash-associated disorders (WADs):

Grade 1: complaints of neck pain, stiffness or tenderness only but no physical signs are noted by the examining physician.
Grade 2: neck complaints and the examining physician finds decreased range of motion and point tenderness in the neck.
Grade 3: decreased range of motion plus neurological signs such as decreased deep tendon reflexes, weakness, insomnia and sensory deficits.
Grade 4: neck complaints and fracture or dislocation, or injury to the spinal cord.^[4]

[edit] Consequences

The consequences of whiplash range from mild pain for a few days, to severe disability caused by restricted head movement or of the cervical spine, sometimes with persistent pain. The injury can exacerbate pre-existing conditions, such as spondylosis and other degenerative changes.^{[citation needed]}

[edit] Prevention

When travelling in an automobile a properly adjusted headrest can reduce the severity of the injury.^[2] The top of the headrest should be in line with the top of the occupant's head. Maintaining an adequate separation from the vehicle in front while driving and pressing your back against the seat while facing forward if a collision appears imminent might also be advisable.^[5] This helps prevent the neck being forced backwards, and decreases the risk of whiplash.

[edit] Whiplash protection

The focus of preventive measures has been on the design of car seats, primarily through the introduction of headrests. So far the injury reducing effects of head restraints has been relatively low, approximately 5-10 %, because car seats have become stiffer in order to increase crash-worthiness of cars in high-speed rear-end collisions which in turn increases the risk of whiplash injury in low-speed rear impact collisions. Improvements in the geometry of car seats through better design and energy absorption could offer additional benefits. Active devices move the body in a crash in order to shift the loads on the car seat.^[1]

Some car manufacturers have begun to implement various whiplash protection devices in their products in order to reduce the risk for and severity of injury, such as

Mercedes-Benz A-Class Active Head Restraint (AHR)^[6] ^[1],
Ford, Nissan, Opel, Peugeot and Saab - Active Head restraint (SAHR)^[7] ^[1],
Volvo and Jaguar - Whiplash Protection System/Whiplash Prevention System (WHiPS)^[8], and
Toyota - Whiplash Injury Lessening (WIL).^[1]

Whether or not such devices offer any substantial benefit over vehicles without them remains controversial. In a test undertaken by the Swedish National Road Administration and a insurance company (Folksam), one test showed that a whiplash protection device was no guarantee against injury and that the degree of protection varies between vehicles both with and without whiplash protection devices.^[9]