It’s estimated that between 10-40% of people with neck injuries from an auto collision develop chronic symptoms.1 Determining what causes chronic whiplash symptoms could reduce that number. Previous research has explored a myriad of factors contributing to chronicity of whiplash including but not limited to: degree of pain sensitization, psychological risk factors, presence of neck and head pain, dizziness, and limited neck range of motion.
Researchers from Denmark sought to integrate those various factors into one risk assessment score that moves beyond the oft-criticized Quebec Task Force guidelines.2-3 The new grading system from the Danish Whiplash Study Group divides patients into 7 strata based on their severity of neck and head pain, cervical range of motion, and how many “nonpainful symptoms” patients exhibit. Nonpainful symptoms include dizziness, vision disturbances, tinnitus, fatigue, irritation, concentration disturbances, memory difficulties, sleep disturbances, and more.
Researchers then tested this new grading system on 141 patients with whiplash and a control group of 40 ankle-injured patients. Whiplash patients with worse symptoms initially were more likely to develop chronic symptoms and less likely to have recovered from their injury after 12 months. The number of high-risk patients who returned to work after one year was as low as 50% in strata 6 and 20% in strata 7.
These results demonstrate that this new grading system could predict chronic whiplash based on a) active neck mobility, b) combined pain score of headache and neck pain and c) a summation of nonpainful symptoms.
This risk assessment score could be combined with an assessment of pain sensitization and psychological distress to predict whether a patient may experience chronic conditions. The researchers argued that the risk assessment score could be easily used by general practitioners.
This study confirms that multiple factors can combine to contribute to whiplash chronicity. It also suggests that addressing these symptoms comprehensively could prevent persistent whiplash problems.
1. Treleaven J. Dizziness, unsteadiness, visual disturbances, and postural control: implications for the transition to chronic symptoms after a whiplash trauma. Spine 2011; 36(25S): S211-217.
2. Kasch H, Qerama E, Kongsted A, et al. The risk assessment score in acute whiplash injury predicts outcome and reflects biopsychosocial factors. Spine (2011): 26(25S): S263–S267.
3. Kivioja J , Jensen I , Lindgren U . Neither the WAD-classification nor the Quebec Task Force follow-up regimen seems to be important for the outcome after a whiplash injury. A prospective study on 186 consecutive patients . European Spine Journal 2008 ; 17: 930 – 5 .