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Setting the Whiplash Record Straight

The authors of a recent critical review of the whiplash literature sums up the problem we face today:

"Over $29 billion per year is spent on whiplash injuries and litigation in the United States alone. It is not surprising, considering the financial stakes, that many medical experts have dedicated their professional careers to one side or another of the whiplash controversy. These experts increasingly are relying on medical and engineering literature to support both sides of the debate over the validity of whiplash syndrome."

Unfortunately, a percentage of these studies are flawed, resulting in conclusions that are not upheld by the larger body of whiplash literature. The researcher team, headed by Dr. Michael Freeman and Dr. Arthur Croft, carefully reviewed 700 studies "for specific statements that were considered to be contrary to the current authors' understanding of how the majority of the current literature characterizes the biomechanics, pathogenesis, and epidemiology of whiplash syndrome." The reviewers found 20 studies containing statements refuting the validity of whiplash injuries; all 20 of the studies were found to contain methodological flaws making such statements unsupportable.

The authors found nine different types of errors in the studies, and these are shown below, with the number and percentage of studies containing such flaws:

Furthermore, 50% of the studies contained 3 or 4 methodological errors each.

Significantly, the studies found to contain flaws are the same studies that are frequently presented in court by defense attorneys and expert witnesses as scientific evidence that whiplash is not real. Some of these studies include the one by Allen et al that claimed that whiplash was no different than everyday motions of the spine,² the Lithuanian study,⁵ the Quebec Task Force article,⁴ and one on the improbability of TMJ injury after rear-end collisions.³

"The results of the current literature review and critique suggest that the methodology used by authors attempting to refute the validity of whiplash syndrome is flawed generally. With only a few exceptions, however, the studies reviewed contained other facets that involved relatively sound methods and that contributed to the knowledge base of whiplash injuries and biomechanics."

The authors conclude that the following statements CANNOT be supported by any valid, existing study:

• Acute whiplash injuries do not lead to chronic pain.
• Chronic pain resulting from whiplash injuries is usually psychogenic.
• Whiplash injuries are unlikely to result in chronic pain in countries where there is no compensation for injury.
• Rear-impact collisions that do not result in vehicle damage are unlikely to cause injury.
• Whiplash trauma is biomechanically comparable with common movements of daily living.
• There is insufficient force generated at the TMJ during whiplash trauma to cause injury.
• TMJ injuries are not associated with whiplash trauma.
• There is a direct correlation between vehicle damage and the probability of developing chronic pain after whiplash trauma.
• Chronic pain following acute whiplash injury is caused or worsened by treatment and diagnostic testing.
• The risk of chronic neck pain among acutely injured whiplash victims is the same as the prevalence of chronic neck pain in the general population.

1. Freeman MD, Croft AC, Rossignol AM, et al. A review and methodologic critique of the literature refuting whiplash syndrome. Spine 1999;24(1):86-98.
2. Allen ME, Weir-Jones I, Motiuk DR et al. Acceleration perturbations of daily living: a comparison to whiplash. Spine 1994;19:1285-1290.
3. Heise AP, Laskin DM, Gervin AS. Incidence of temporomandibular joint symptoms following whiplash injury. Journal of Oral and Maxillofacial Surgery 1992;50:825-828.
4. Spitzer WO, Skovron ML, Salmi LR, et al. Scientific monograph of the Quebec task force on whiplash-associated disorders: Redefining ‘whiplash' and its management. Spine 1995;20(suppl 8):1-73.
5. Schrader H, Obelieniene D, Bovim G, et al. Natural evolution of late whiplash syndrome outside the medicolegal context. The Lancet 1996;347:1207-1211.

 

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