Bilal F Shanti*, Ihsan F Shanti and Zaynab IF Shanti

Omnia Pain Consultants, Scottsdale AZ, USA

*Corresponding Author: Bilal F Shanti, Omnia Pain Consultants, Scottsdale AZ, USA.

Received: January 28, 2023; Published: March 21, 2023

Abstract

Whiplash injuries or the group of whiplash-associated disorder (WAD) occur when there is shifting and movement of energy, during a crash or collision, from acceleration-deceleration mechanism transferred to the neck region. WAD is characterized by excessive extension-flexion movements, and/or excessive side bending of the head and neck, beyond the normal and regular range of motion.

Although motor vehicle collisions are the majority of trauma responsible for WAD, other causes also include contact sports injuries, falls, physical and domestic abuse, and other types of traumas.

The clinical picture and presentation are variable. In general, this includes neck pain, decreased range of motion of neck, headaches, arm or arms numbness, and other related symptoms and signs that depend on the extent of the insult. This possibly may include consequences of fractures, joint dislocations, and even traumatic brain injuries/post-concussional syndrome, with its subsequent clinical outcomes.

The trauma associated with WAD outcome can result in acute and chronic pain syndromes, functionality limitations and restrictions, psychological and psychosocial ramifications, financial crisis, unemployment, and in cases, prolonged disability. This causes a significant economic burden on country.

This review manuscript will review the latest in WAD etiologies, biomechanics, diagnosis, management, and prognosis. We base out review on relevant databases such as PubMed, Ovid-Medline, Embase, Web of Science, NIH website, Google Scholar, and the Cochrane Library. No Institutional Review Board permission was obtained since this manuscript does not directly involve animals or humans.

Keywords: Whiplash; Whiplash-Associated Disorder; Neck Pain; Chronic Neck Pain; Motor Vehicle Collision; Chronic Pain Syndrome; Chronic Pain; Neck Trauma

References

1. Blincoe LJ., et al. "The economic and societal impact of motor vehicle crashes, 2010. (Revised) (Report No. DOT HS 812 013). Washington, DC: National Highway Traffic Safety Administration (2015).
2. https://www.populationu.com/us/arizona-population (2022).
3. Arizona Department of Transportation. Motor Vehicle Crash Facts for the State of Arizona (2021).
4. Rashier A., et al. "Whiplash: Synopsis of Causation UK Ministry of Defence (2008).
5. Crowe HE. “Injuries to the cervical spine. Paper presented at the meeting of the Western Orthopedic Association, San Francisco (1928).
6. Severy DM., et al. "Controlled automobiles rear-end collisions, an investigation of related engineering and mechanical phenomenon”. Canadian Services Medical Journal 11 (1955): 729-759.
7. Carroll LJ., et al. "Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders”. Spine (Phila Pa 1976)4 (2018): S83-92.
8. Pastakia K and Kumar S. “Acute whiplash associated disorders (WAD)”. Open Access Emerg Med 3 (2011): 29-32.
9. Elliott JM., et al. "Advancements in Imaging Technology: Do They (or Will They) Equate to Advancements in Our Knowledge of Recovery in Whiplash?” Journal of Orthopaedic and Sports Physical Therapy10 (2016): 862-873.
10. Holm LW., et al. "The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders”. Journal of Manipulative and Physiological Therapeutics2 (2009): S61-69.
11. Sterner Y., et al. "Early interdisciplinary rehabilitation programme for whiplash associated disorders”. Disability and Rehabilitation10 (2001): 422-429.
12. Tenenbaum A., et al. "Gender differences in care-seeking behavior and healthcare consumption immediately after whiplash trauma”. PLoS One4 (2017): e0176328.
13. Kullgren A and Krafft M. “Gender Analysis on Whiplash Seat Effectiveness: Results from Real World Crashes”. IRCOBI Conference - Hanover (Germany) (2010).
14. Deans GT., et al. "Neck sprain-a major cause of disability following car accidents”. Injury 1 (1987): 10-12.
15. Tanaka N., et al. "Pathology and Treatment of Traumatic Cervical Spine Syndrome: Whiplash Injury”. Advances in Orthopedics (2018):
16. Benoist M and Rouaud JP. “Whiplash: myth or reality?” Joint Bone Spine4 (2002): 358-362.
17. Kivioja J., et al. "Systemic immune response in whiplash injury and ankle sprain: elevated IL-6 and IL-10”. Clinical Immunology 101 (2001): 106-112.
18. Uhrenholt L., et al. "Cervical spine lesions after road traffic accidents: a systematic review”. Spine 27 (2002): 1934-1941.
19. Taylor JR and Taylor MM. “Cervical spinal injuries: an autopsy study of 109 blunt injuries”. Journal of Musculoskeletal Pain 4 (19996): 61-79.
20. Barnsley L., et al. "Whiplash injury”. Pain 58 (1994): 283-307.
21. Barnsley L., et al. "The prevalence of chronic cervical zygapophysial joint pain after whiplash”. Spine 20 (1995): 20-26.
22. Lord SM., et al. "Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study”. Spine 21 (1996): 1737-1744.
23. Radanov BP., et al. "Common whiplash: Psychosomatic or somatopsychic?”Journal of Neurology, Neurosurgery and Psychiatry 4 (1994): 486-490.
24. Al-Khazali HM., et al. "Neck pain and headache after whiplash injury: a systematic review and meta-analysis”. Pain5 (2020): 880-888.
25. Rashier A., et al. "Whiplash: Synopsis and Causation”. British Ministry of Defence (2008).
26. Spitzer WO. “Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: Redefining ‘whiplash’ and its management”. Spine 20 (1995): 1-73.
27. Radanov BP., et al. "Cognitive deficits in patients after soft tissue injury of the cervical spine”. Spine (Phila Pa 1976) 2 (1992): 127-131.
28. Gerdle B., et al. "Va ̊rdprogram fo ̈r Whiplashrelaterade besva ̈r”. Stockholm: Sma ̈rt och Rehabiliteringscentrum, Universitetssjukhuset i Linko ̈ping och RTP (1998).
29. Tenenbaum A., et al. "The Quebec classification and a new Swedish classification for whiplash-associated disorders in relation to life satisfaction in patients at high risk of chronic functional impairment and disability”. Journal of Rehabilitation Medicine 34 (2002): 114-118.
30. Jónsson H., et al. "Hidden cervical spine injuries in traffic accident victims with skull fractures”. Journal of Spinal Disorders 3 (1991): 251-263.
31. Jónsson H., et al. “Findings and outcome in whiplash-type neck distortions”. Spine (Phila Pa 1976)24 (1994): 2733-2743.
32. Macnab I. “Acceleration injuries of the cervical spine”. Journal of Bone and Joint Surgery 46A (1964): 1797-1798.
33. Wickstrom J., et al. “The Cervical Sprain Syndrome: Experimental acceleration injuries”.
34. Taylor JR. “The Pathology of Whiplash: Neck Sprain”. BCMJ5 (2002): 252-256.
35. Taylor JR and Twomey LT. “Acute Injuries to Cervical Joints. An autopsy study of neck sprain”. Spine 18 (1993): 1115-1122.
36. Chen H-B., et al. “Biomechanics of Whiplash injury”. Chinese Journal of Traumatology5 (2009): 305-314.
37. Krafft M., et al. “Soft Tissue Injury of the Cervical Spine in Rear-End Car Collisions”. Journal of Traffic Medicine 3-4 (1997): 89-96.
38. Luan F., et al. “Qualitative Analysis of Neck Kinematics During Low-Speed Rear-End Impact”. Clinical Biomechanics (Bristol, Avon)9 (2000): 649-657.
39. Kaneoka K., et al. “The human cervical spine motion during rear-impact collisions”. A proposed cervical facet injury mechanism during whiplash trauma. Journal of Whiplash and Related Disorders 1.1 (2002): 85-97.
40. Kaneoka K., et al. “Motion Analysis of cervical vertebrae during whiplash loading”. Spine8 (1999): 763770.
41. Panjabi MM., et al. “Capsular ligament stretching during in vitro whiplash simulations”. Journal of Spinal Disorders 3 (1998): 227-232.
42. Pearson AM., et al. “Facet joint kinematics and injury mechanisms during simulated whiplash”. Spine4 (2004): 390397.
43. Siegmund GP., et al. “Mechanical evidence of cervical facet capsule injury during whiplash cadaveric study using combined shear compression and extension loading”. Spine 19 (2001): 2095 2101.
44. Brault JR., et al. “Cervical muscle response during whiplash: evidence of a lengthening muscle contraction”. Clinical Biomechanics (Bristol, Avon) 15 (2000): 426-435.
45. Vasavada AN., et al. “Musculotendon and fascicle strains in anterior and posterior neck muscles during whiplash injury”. Spine 32 (2007): 756-765.
46. Macpherson PC., et al. “Contraction-induced injury to single fiber segments from fast and slow muscles of rats by single stretches”. American Journal of Physiology 271 (1996): C1438-1446.
47. Tominaga Y., et al. “Neck ligament strength is decreased following whiplash trauma”. BMC Musculoskeletal Disorders 7 (2006): 103.
48. Panjabi MM. “Hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction”. European Spine Journal 15 (2006): 668-676.
49. Taylor JR., et al. “Dorsal root ganglion injuries in 109 blunt trauma fatalities”. Injury 5 (1998): 335-339.
50. Yao HD., et al. “Deformation of dorsal root ganglion due to pressure transients of venous blood and cerebrospinal fluid in the cervical vertebral canal”. Journal of Biomechanics 76 (2018): 16-26.
51. Fundaun J., et al. “Nerve pathology and neuropathic pain after whiplash injury: a systematic review and meta-analysis”. Pain7 (2022): e789-e811.
52. Alpar EK., et al. “Management of chronic pain in whiplash injury”. The Journal of Bone and Joint Surgery. British Volume 6 (2002): 807-811.
53. Farrell SF., et al. “Small fiber pathology in chronic whiplash-associated disorder: A cross-sectional study”. European Journal of Pain 6 (2020): 1045-1057.
54. Dydyk AM., et al. “StatPearls Publishing; Treasure Island (FL): Disc Herniation (2022).
55. Sharrak S and Al Khalili Y. “Cervical Disc Herniation”. In: StatPearls. Treasure Island (FL): StatPearls (2022).
56. Pettersson K., et al. “Disc pathology after whiplash injury. A prospective magnetic resonance imaging and clinical investigation”. Spine (Phila Pa 1976) 3 (1997): 283-287.
57. Taylor JR. “The Pathology of Whiplash: Neck Sprain”. BCMJ 5 (2002): 252-256.
58. Hoffman JR., et al. “The National Emergency X-Radiography Utilization Study Group. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma”. The New England Journal of Medicine 343 (2000): 94-99
59. Tintinalli JE., et al. “Emergency Medicine, A Comprehensive Study Guide. 5^th edition”. New York, NY: McGraw-Hill (2000): 1792-1800.
60. Fleming B. “Whiplash: The role of imaging- To X-ray or not?” BCMJ 5 (2002): 248-251.
61. Olive O., et al. “Muscle activity during low-speed rear impact”. Chinese Journal of Traumatology 2 (2019): 80-84.
62. Fundaun J., et al. “Nerve pathology and neuropathic pain after whiplash injury: a systematic review and meta-analysis”. Pain7 (2022): e789-e811.
63. Nederhand MJ., et al. “Cervical muscle dysfunction in chronic whiplash-associated disorder grade 2: the relevance of the trauma”. Spine (Phila Pa 1976) 10 (2016): 1056-1061.
64. Ishitsuka Y., et al. “Toxicological Property of Acetaminophen: The Dark Side of a Safe Antipyretic/Analgesic Drug?” Biological and Pharmaceutical Bulletin 2 (2020): 195-206.
65. Chandrasekharan NV., et al. “COX-3, a cyclooxygenase-1 variant inhibited by acetaminophen and other analgesic/antipyretic drugs: cloning, structure, and expression”. Proceedings of the National Academy of Sciences of the United States of America 21 (2002): 13926-13931.
66. Gerriets V., et al. “Acetaminophen”. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing (2022).
67. Ghanem CI., et al. “Acetaminophen from liver to brain: New insights into drug pharmacological action and toxicity”. Pharmacological Research 109 (2016): 119-131.
68. Parisien M., et al. “Acute inflammatory response via neutrophil activation protects against the development of chronic pain”. Science Translational Medicine 644 (2022): eabj9954.
69. FitzGerald GA and Patrono C. “The coxibs, selective inhibitors of cyclooxygenase-2”. The New England Journal of Medicine 345 (2001): 433-
70. Warner TD and Mitchell JA. “COX-2 selectivity alone does not define the cardiovascular risks associated with non-steroidal anti-inflammatory drugs”. The Lancet 9608 (2008): 270-273.
71. White WB. “Cardiovascular effects of the cyclooxygenase inhibitors”. Hypertension3 (2007): 408-418.
72. Schmidt M., et al. “Non-steroidal anti-inflammatory drug use and risk of atrial fibrillation or flutter: population-based case-control study”.The British Medical Journal 343 (2011):
73. ADAPT Research Group. “Cardiovascular and cerebrovascular events in the randomized, controlled Alzheimer's disease anti-inflammatory prevention trial (ADAPT)”. PLoS Clinical Trials7 (2006): e33.
74. Farkouh ME., et al. “Cardiovascular outcomes in high risk patients with osteoarthritis treated with ibuprofen, naproxen or lumiracoxib”. Annals of the Rheumatic Diseases6 (2007): 764-770.
75. Baraf HSB., et al. “Gastrointestinal side effects of etoricoxib in patients with osteoarthritis: results of the etoricoxib versus diclofenac sodium gastrointestinal tolerability and effectiveness (EDGE) trial”. The Journal of Rheumatology2 (2007): 408-420.
76. Van Staa T-P., et al. “Does the varied use of NSAIDs explain the differences in the risk of myocardial infarction?” Journal of Internal Medicine 5 (2008): 481-492.
77. Fosbøl EL., et al. “Risk of myocardial infarction and death associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) among healthy individuals: a nationwide cohort study”. Clinical Pharmacology and Therapeutics2 (2009): 190-197.
78. Gislason GH., et al. “Increased mortality and cardiovascular morbidity associated with use of nonsteroidal anti-inflammatory drugs in chronic heart failure”. Archives of Internal Medicine2 (2009): 141-149.
79. Derry S., et al. “Topical analgesics for acute and chronic pain in adults - an overview of Cochrane Reviews”. Cochrane Database of Systematic Reviews 5 (2017): CD008609.
80. Van Tulder MW., et al. “Muscle relaxants for nonspecific low back pain: a systematic review within the framework of the Cochrane Collaboration”. Spine (Phila Pa 1976) 28 (2003): 1978- 1992.
81. Schnitzer TJ., et al. “A comprehensive review of clinical trials on the efficacy and safety of drugs for the treatment of low back pain”. Journal of Pain and Symptom Management 28 (2004): 72-95.
82. Cashin AG., et al. “Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis”. BMJ 374 (2021):
83. Pettersson K and Toolanen G. “High-dose methylprednisolone prevents extensive sick leave after whiplash injury. Prospective, randomized, double-blind study”. Spine 9 (1998): 984-989.
84. Ghasemi M., et al. “Oral prednisolone in the treatment of cervical radiculopathy: A randomized placebo-controlled trial”. Journal of Research in Medical Sciences 1 (2013): S43-46.
85. Verhagen AP. “Physiotherapy management of neck pain”. Journal of Physiotherapy 1 (2021): 5-11.
86. Gross A., et al. “Manipulation and mobilization for neck pain contrasted against an inactive control
    or another active treatment”. Cochrane Database of Systematic Reviews 9 (2015):
87. Rushton A., et al. “Physiotherapy rehabilitation for whiplash associated disorder II: a systematic review and meta-analysis of randomized controlled trials”. BMJ Open 1 (2011):
88. Mercer C., et al. “Developing clinical guidelines for the physiotherapy management of whiplash associated disorder (WAD)”. International Journal of Osteopathic Medicine2-3 (2007): 50-54.
89. Shaw L., et al. “A systematic review of chiropractic management of adults with Whiplash-Associated Disorders: recommendations for advancing evidence-based practice and research”. Work 3 (2010): 369-394.
90. Whittingham W and Nilsson N. “Active range of motion in the cervical spine increases after spinal manipulation (toggle recoil)”. Journal of Manipulative and Physiological Therapeutics9 (2001): 552-555.
91. Haavik-Taylor H and Murphy B. “Cervical spine manipulation alters sensorimotor integration: A somatosensory evoked potential study”. Clinical Neurophysiology 2 (2007): 391-402.
92. Kim D., et al. “Intensive Motion Style Acupuncture Treatment (MSAT) Is Effective for Patients with Acute Whiplash Injury: A Randomized Controlled Trial”. Journal of Clinical Medicine 7 (2020): 2079.
93. Cameron ID., et al. “A randomized trial comparing acupuncture and simulated acupuncture for subacute and chronic whiplash. E1659-E1665”. Spine 26 (2011): E1659-E1665.
94. Stuart S., et al. “Acupuncture for whiplash-associated disorder following road traffic collision: a physiotherapy service evaluation”. Acupuncture in Medicine4 (2020): 272-278.
95. Wong JJ., et al. “Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration”. The Spine Journal 12 (2016): 1598-1630.
96. Bussières AE., et al. “The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline”. Journal of Manipulative and Physiological Therapeutics 8 (2016): 523-564.e27.
97. Fernández de las Peñas C., et al. “Manual treatment of post-whiplash injury”. Journal of Bodywork and Movement Therapies2 (2005): 109-119
98. Jaeger B. “Myofascial trigger point pain”. Alpha Omegan. 2013 Spring-Summer 106.1-2 (2013): 14-22.
99. Freeman MD., et al. “Chronic whiplash, and central sensitization; an evaluation of the role of a myofascial trigger point in pain modulation”. Journal of Brachial Plexus and Peripheral Nerve Injury 4 (2009): 2.
100. Nystrom NA and Freeman MD. “Central Sensitization Is Modulated Following Trigger Point Anesthetization in Patients with Chronic Pain from Whiplash Trauma. A Double-Blind, Placebo-Controlled, Crossover Study”. Pain Med1 (2018): 124-129.
101. Byrn C., et al. “Subcutaneous sterile water injections for chronic neck and shoulder pain following whiplash injuries”. Lancet8843 (1993): 449-452.

Citation

Citation: Bilal F Shanti., et al. “Whiplash Injuries: A Systemic Review". Acta Scientific Neurology 6.4 (2023): 51-67.

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Copyright: © 2023 Bilal F Shanti., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.