Whiplash, Pain/functional loss, Treatment evidence page 18-23

Question 1

What is the incidence of whiplash every year in the USA?

Answer 1

1 million every year, 1/1000 of the general population.

Question 2

What is the usual mechanism of whiplash?

Answer 2

stationary motor vehicle being struck from behind. Trunk of body moves forward, unsupported head moves backward into hyperextension. If stop suddenly, head goes into hyperflexion. If vehicle in front hit, compression will cause victim’s head to hit roof of their own car, causing axial compression maybe.

Question 3

What percentage of whiplash accidents are considered to be low speed? Above what mph can injury occur?

Answer 3

84%. Above 5mph

Question 4

How close does the headrest have to be to the head to help prevent whiplash?

Answer 4

within 8-10cm distance between them.

Question 5

Does whiplash pain usually have a rapid onset or slow onset?

Answer 5

slow

Question 6

What does current evidence favor for treatment of whiplash?

Answer 6

early mobilization and resumption of activity, not drug treatment.

Question 7

What percentage of patients reporting whiplash symptoms following the accident will be symptom free in 3-4 weeks? What percentage will have symptoms persisting for many years? What percentage may require surgery because of disc herniation?

Answer 7

80% symptom free in 3-4 weeks
10 to 40% symptoms for years
16% may require surgery

Question 8

True/False: If the impact of the accident is from the front then prognosis is worse?

Answer 8

False: It is better if the impact is from the front.

Question 9

What are 7 factors that lead to poor outcomes in whiplash injuries?

Answer 9

High Pain > 5.5
Neck pain immediate
HA immediate
Concurrent LBP immediate
NDI > 14.5/50
No Seatbelt
Catastophysing behavior

Question 10

What are 3 ways commonly used to measure pain? Which is the most detailed?

Answer 10

1. Visual Analogue Scale
2. Numeric Analogue Scale
3. McGill
   McGill is the most detailed.

Question 11

What are 3 tests used to measure functional loss?

Answer 11

1. Neck Disability Index
2. Patient Specific Functional Scale
3. SF-36

Question 12

True/False: There is strong evidence for repetitive magnetic stimulation for treatment of chronic mechanical neck disorder.

Answer 12

False. Evidence is limited

Question 13

True/False: There is strong evidence for low level laser for treatment of chronic mechanical neck disorder.

Answer 13

True

Question 14

True/False: There is strong evidence for continuous use of a soft collar for treatment of acute whiplash.

Answer 14

False. Evidence suggests this is not beneficial

Question 15

What kind of treatment is recommended with strong evidence for chronic mechanical neck disorder with headache?

Answer 15

Strengthening & stretching, craniocervical flexion.

Question 16

True/False: There is strong evidence for low level laser therapy for treating chronic myofascial pain

Answer 16

False. Evidence suggeststhis is not beneficial.

Question 17

What are 3 treatment options for radicular chronic neck disorder that have strong evidence for them?

Answer 17

Intermittent traction (mechanical good)
Epidural injections
Acupuncture

Question 18

What are the 6 predictors from Cleland’s Clinical Prediction Rules that suggest thoracic spine manipulation may be helpful in treating cervical disorders? If 5 are present, what percent of patients will show improvement? If 4 are present? 3?

Answer 18

1. Symptoms