Review
Whiplash: a review of a commonly misunderstood injury

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Abstract

Whiplash injury is a relatively common occurrence, but its mechanism and optimal treatment remain poorly understood. It is estimated that the incidence of whiplash injury is approximately 4 per 1,000 persons. The most common radiographic findings include either preexisting degenerative changes or a slight flattening of the normal lordotic curvature of the cervical spine. Computed tomography and magnetic resonance imaging are generally reserved for cases of neurologic deficit, suspected disc or spinal cord damage, fracture, or ligamentous damage. Biomechanics studies have determined that after rear impact C6 is rotated back into extension before movement of the upper cervical vertebrae. Thus, the lower cervical vertebrae were in extension while the upper vertebrae were in a position of relative flexion, producing an S shape in the cervical spine. It is believed that this abnormal motion pattern might play a role in the development of whiplash injuries. Historically, a soft cervical collar has been used early after the injury in an attempt to restrict cervical range of motion and limit the chances of further injury. More recent studies report rest and restriction of motion to be detrimental and to slow the healing process.

Section snippets

Whiplash symptoms

Patients presenting with whiplash injuries offer a significant challenge, as their symptoms are often out of proportion to objective findings. It is generally not possible to identify the injury in the acute phase even when expensive imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) are utilized 18, 19, 20, 21, 22. MRI of the brain and neck of patients within 2 days of whiplash injury revealed no differences between patients and controls (18). In another

Mechanism of whiplash injury

Whiplash injury most commonly results from an automobile accident in which the injured person is in a stationary vehicle that is struck from behind 28, 29. Historically, it was presumed that the rear impact caused the head and neck to be forced into a hyperextended position. The rear impact forces the vehicle to move forward, causing the seat to push forward on the torso and shoulders. As the head and neck are generally less constrained, the inertia causes the head to lag behind, which results

Treatment options for whiplash injury

Many treatment modalities have been used for patients suffering from whiplash injury. Unfortunately, many of these treatments have not undergone sufficient clinical trials to confirm their effectiveness 51, 52. Whiplash injuries are difficult to treat because the patient’s complaints are often subjective, and it is not usually possible to verify the source of the injury using clinical or radiographic methods 18, 19, 20, 21, 22. As with any treatment, the patients should first be well informed

Conclusion

Whiplash injury is a relatively common occurrence that is often either ignored or mistreated owing to a lack of understanding of the condition. It is important for physicians to understand the biomechanical basis of the injury and to accept that the patient may not have many objective findings. Numerous biomechanics studies have been performed to help describe and quantify the actual mechanism of injury involved in whiplash. It is the physician’s responsibility to identify patients suffering

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