Whiplash

Progressive Degeneration of the Cervical Multifidus

By Frank M. Painter|May 8, 2019|Whiplash|

The Rapid and Progressive Degeneration of the Cervical Multifidus in Whiplash: An MRI Study of Fatty Infiltration

SOURCE: Spine (Phila Pa 1976). 2015 (Jun 15); 40 (12): E694–700

James M. Elliott, PhD, PT, D. Mark Courtney, MD, Alfred Rademaker, PhD, Daniel Pinto, PhD, PT, Michele M. Sterling, PhD, PT, and Todd B. Parrish, PhD

Department of Physical Therapy and Human Movement Sciences,
Feinberg School of Medicine,
Northwestern University,
Chicago, IL

STUDY DESIGN: Single-center prospective longitudinal study.

OBJECTIVE: To study the (1) temporal development of muscle fatty infiltrates (MFI) in the cervical multifidi after whiplash, (2) differences in multifidi MFI between those who recover or report milder pain-related disability and those who report moderate/severe symptoms at 3 months, and (3) predictive value of multifidi MFI outcomes.

SUMMARY OF BACKGROUND DATA: The temporal development of MFI on conventional magnetic resonance image has been shown to be associated with specific aspects of pain and psychological factors. The replication of such findings has yet to be explored longitudinally.

METHODS: Thirty-six subjects with whiplash injury were enrolled at less than 1 week postinjury and classified at 3 months using percentage scores on the Neck Disability Index as recovered/mild (0%–28%) or severe (≥30%). A fat/water magnetic resonance imaging measure, patient self-report of pain-related disability, and post-traumatic stress disorder were collected at less than 1 week, 2 weeks, and 3 months postinjury.

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Exposure to a Motor Vehicle Collision and the Risk

By Frank M. Painter|May 1, 2019|Chronic Neck Pain, Whiplash|

Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain: A Systematic Review and Meta-analysis

The Chiro.Org Blog

SOURCE: PM R. 2019 (Apr 25) [Epub]

Paul S. Nolet, DC, MS, MPH, Peter C. Emary, DC, MSc, Vicki L. Kristman, PhD, Kent Murnaghan, MA MISt,
Maurice P. Zeegers, PhD, Michael D. Freeman, MedDr, PhD

Care and Public Health Research Institute,
Maastricht University,
Maastricht, Netherlands.

OBJECTIVE: To summarize the literature that has examined the association between a motor vehicle collision (MVC) related neck injury and future neck pain (NP) in comparison with the population that has not been exposed to neck injury from an MVC.

LITERATURE SURVEY: Neck injury resulting from a MVC is associated with a high rate of chronicity. Prognosis studies indicate 50% of injured continue to experience NP a year after the collision. This is difficult to interpret due to the high prevalence of NP in the general population.

METHODOLOGY: We performed a systematic review of the literature using five electronic databases, searching for risk studies on exposure to a MVC and future NP published from 1998 to 2018. The outcome of interest was future NP. Eligible risk studies were critically appraised using the modified Quality in Prognosis Studies (QUIPS) instrument. The results were summarized using best-evidence synthesis principles, a random effects meta-analysis, meta-regression and testing for publication bias was performed with the pooled data.

SYNTHESIS: Eight articles were identified of which seven were of lower risk of bias. Six studies reported a positive association between a neck injury in an MVC and future NP compared to those without a neck injury in a MVC. Pooled analysis of the six studies indicated an unadjusted relative risk of future NP in the MVC exposed population with neck injury of 2.3 (95% CI [1.8, 3.1]), which equates to a 57% attributable risk under the exposed. In two studies where exposed subjects were either not injured or injury status was unknown, there was no increased risk of future NP.

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Who Gets Depressed? Who Stays Depressed?

By Frank M. Painter|July 24, 2017|Depression, Whiplash|

Whiplash-associated Disorders: Who Gets Depressed? Who Stays Depressed?

The Chiro.Org Blog

SOURCE: Eur Spine J. 2010 (Jun); 19 (6): 945–956

Leah A. Phillips, Linda J. Carroll,
J. David Cassidy, and Pierre Côté

Department of Public Health Sciences,
Alberta Centre for Injury Control and Research,
School of Public Health, University of Alberta,
4075 RTF, 8308 114 St, Edmonton, AB, T6G 2E1, Canada.

Depression is common in whiplash-associated disorders (WAD). Our objectives were to identify factors associated with depressive symptomatology occurring in the initial stages of WAD, and to identify factors predicting the course of depressive symptoms. A population-based cohort of adults sustaining traffic-related WAD was followed at 6 weeks, 3, 6, 9, and 12 months. Baseline measures (assessed a median of 11 days post-crash) included demographic and collision-related factors, prior health, and initial post-crash pain and symptoms. Depressive symptomatology was assessed at baseline and at each follow-up using the Centre for Epidemiological Studies Depression Scale (CES-D). We included only those who participated at all follow-ups (n = 3,452; 59% of eligible participants). Using logistic regression, we identified factors associated with initial (post-crash) depression. Using multinomial regression, we identified baseline factors predicting course of depression. Courses of depression were no depression; initial depression that resolves, recurs or persists, and later onset depression. Factors associated with initial depression included greater neck and low back pain severity, greater percentage of body in pain, numbness/tingling in arms/hand, dizziness, vision problems, post-crash anxiety, fracture, prior mental health problems, and poorer general health. Predictors of persistent depression included older age, greater initial neck and low back pain, post-crash dizziness, vision and hearing problems, numbness/tingling in arms/hands, anxiety, prior mental health problems, and poorer general health. Recognition of these underlying risk factors may assist health care providers to predict the course of psychological reactions and to provide effective interventions.

From the FULL TEXT Article:

Introduction

The biopsychosocial model of health posits that in addition to biomedical factors, psychological, and sociological factors play important roles in the diagnosis, treatment, and recovery from illness and disease. [11] According to the Quebec Task Force on whiplash-associated disorders, whiplash is defined as an acceleration–deceleration mechanism of energy transferred to the neck as a result of a motor vehicle collision, and the resulting injury or cluster of symptoms is referred to as whiplash-associated disorders (WAD). [20] WAD is a disorder where the interplay between biological and psychosocial factors appears to have an important effect on recovery. [8]

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Low Speed Frontal Crashes and Low Speed Rear Crashes

By Frank M. Painter|May 29, 2017|Whiplash|

Low Speed Frontal Crashes and Low Speed Rear Crashes: Is There a Differential Risk for Injury?

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SOURCE: Annu Proc Assoc Adv Automot Med. 2002; 46: 79–91

Croft AC, Haneline MT, Freeman MD

Spine Research Institute of San Diego,
San Diego, California, USA.

We compared male and female subjects in crash tests in which each subject experienced both frontal and rear impacts. Crash speed and other crash parameters were held constant. We believe this was the first experiment using an independent variable of crash vector and dependent variables of head linear acceleration and volunteer qualitative tolerance.

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Mild Traumatic Brain Injury After Motor Vehicle Collisions: What Are the Symptoms and Who Treats Them?

By Frank M. Painter|January 29, 2017|Chronic Neck Pain, Whiplash|

Mild Traumatic Brain Injury After Motor Vehicle Collisions: What Are the Symptoms and Who Treats Them? A Population-Based 1-Year Inception Cohort Study

The Chiro.Org Blog

SOURCE: Arch Phys Med Rehab 2014 (Mar); 95 (3 Sup): S286–294

Jan Hartvigsen, PhD, Eleanor Boyle, PhD, J. David Cassidy, PhD, DrMedSc, Linda J. Carroll, PhD

Institute of Sports Science and Clinical Biomechanics,
University of Southern Denmark, Odense, Denmark;
Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark.

OBJECTIVE: To describe the 1-year course of symptoms following mild traumatic brain injury (MTBI) sustained in a motor vehicle collision as well as patterns of care-seeking.

DESIGN: One-year follow-up of a population-based inception cohort.

SETTING: The province of Saskatchewan, Canada, with a population of about 1,000,000 inhabitants.

PARTICIPANTS: Persons (N=1716) sustaining an MTBI during a car collision between November 1997 and December 1999.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: We report the prevalence of sleep disturbances, tiredness, dizziness, forgetfulness, vision problems, hearing problems, headache, neck pain, mid back pain, and low back pain at 6 weeks and 3, 6, 9, and 12 months postcollision. At the same time points, we report self-reported care-seeking from registered health care professionals.

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A Population-based, Incidence Cohort Study of Mid-back Pain After Traffic Collisions

By Frank M. Painter|December 11, 2016|Traffic Collisions, Whiplash|

A Population-based, Incidence Cohort Study of Mid-back Pain After Traffic Collisions: Factors Associated with Global Recovery

The Chiro.Org Blog

Eur J Pain. 2015 (Nov); 19 (10): 1486–1495 ~ FULL TEXT

M.S. Johansson, E. Boyle, J. Hartvigsen,
M. Jensen Stochkendahl, L. Carroll, and
J.D. Cassidy

Department of Sports Science and Clinical Biomechanics,
Faculty of Health,
University of Southern Denmark,
Odense, Denmark.

BACKGROUND: Traffic collisions often result in a wide range of symptoms included in the umbrella term whiplash-associated disorders. Mid-back pain (MBP) is one of these symptoms. The incidence and prognosis of different traffic injuries and their related conditions (e.g. neck pain, low back pain, depression or others) has been investigated previously; however, knowledge about traffic collision-related MBP is lacking. The study objectives were to describe the incidence, course of recovery and prognosis of MBP after traffic collisions, in terms of global self-reported recovery.

METHODS: Longitudinal data from a population-based inception cohort of all traffic injuries occurring in Saskatchewan, Canada, during a 2-year period were used. Annual overall and age-sex-specific incidence rates were calculated, the course of recovery was described using the Kaplan-Meier technique, and associations between participant characteristics and time-to-self-reported recovery were explored in 3,496 MBP cases using Cox proportional hazards models.

RESULTS: The yearly incidence rate was 236 per 100,000 population during the study period, and was highest in women and in young persons. The median time-to-first reported recovery was 101 days (95% CI: 99-104) and about 23% were still not recovered after 1 year. Participant’s expectation for recovery, general health, extent of severely affecting comorbidities and having experienced a previous traffic injury were some of the prognostic factors identified.

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