Whiplash: as described by Spitzer is an acceleration-deceleration mechanism of energy transfer to the neck which may result from rear-end or side-impact, predominantly in motor vehicle collisions, but also from diving accidents, and from other mishaps. The energy transfer may result in bony or soft-tissue injuries (whiplash injury), which in turn may lead to a variety of clinical manifestations (Whiplash-Associated Disorders or WAD). (Spitzer WO. 1995) Whiplash patients can have the following symptom presentation: dizziness, deafness, tinnitus, headache, memory loss, dysphagia, temporo-mandibular joint pain.(Spitzer WO. 1995) Clinical studies have documented that the cervical zygapopysial joints might be the source of neck pain after whiplash. (Sapir DA & Gorup JM. 2001) Whiplash has been classified by the Quebec Task Force into different grades levels to assist in its diagnosis and management. Below is a modified version of the Classification Grading of WAD by The Quebec Task Force:
Table 1 QTF WAD Classification:
Grade 0 No complaints about the neck, no physical signs.
Grade I Neck complaint of pain stiffness, or tenderness only. No physical signs. Significant symptoms delayed hours or to next day. Generally no x-ray needed (unless the patient is head injured, intoxicated, confused or history can’t exclude possibility of serious injury)
Grade II A Neck complaints and Musculoskeletal signs (normal ROM but has focal pain and tenderness.) Symptoms usually start early in minutes to a few hours. X-ray needed Grade II B Neck complaints and musculoskeletal signs (limited range of motion and focal pain and tenderness present. The greatest risk for long-term symptoms was seen among the group of patients with both point tenderness and limited range of motion. X-ray needed. (Hartling L, Brison RJ, Ardern C, & Pickett W. 2001) Symptoms usually start early in minutes to a few hours.
Grade III Neck complaints and neurological sign(s) (decreased or absent deep tendon reflexes, weakness, and sensory deficits). Symptoms usually start immediately and radiate to shoulder and arm. X-ray needed.
Grade IV Neck complaints and fracture dislocation. Symptoms can start instantly, focal neck tenderness can be found, radiation variable. This paper does not discuss the treatment of Grade IV WAD Neck Pain Literature Review
The Bone and Joint Decade Task Force on Neck Pain, an international collaboration of academic and clinical researchers in the US, Canada and Sweden will publish the next comprehensive systematic review on neck pain near the end of 2007 (see http://www.nptf.ualberta.ca/ ). The Task Force is expected to recommend a different classification system/ characterization of neck pain to better address bio-psychosocial factors contributing to neck pain and disability. Whiplash can also be classified as non specific neck pain, uncomplicated neck pain or mechanical neck disorder. © 2007 Canadian Institute for the Relief of Pain and Disability & Massage Therapists’ Association of British Columbia 17