The Effect of Socio-Demographic and Crash-Related Factors on the Prognosis of Whiplash

Harder, Susan; Veilleux, Martin; Suissa, Samy

doi:10.1016/s0895-4356(98)00011-0

Cited by 120 publications

(76 citation statements)

References 19 publications

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“…Therefore, it is plausible that mechanical demands on neck muscles in women are closer to their maximum moment-generating capacity. This may relate to the higher incidence of neck pain 16 and poorer recovery from whiplash injury 8 in women. In pathologic conditions, both men and women often have diminished neck strength.…”

Section: Discussionmentioning

confidence: 99%

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Three-Dimensional Isometric Strength of Neck Muscles in Humans

Vasavada¹,

Li²,

Delp³

2001

Spine

124

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Study Design. Three-dimensional moments were measured experimentally during maximum voluntary contractions of neck muscles in humans.Objectives. To characterize the maximum moments with attention paid to subject size and gender, to calculate moments at different locations in the neck, and to quantify the relative magnitudes of extension, flexion, lateral bending, and axial rotation moments.Summary of Background Data. Few studies of neck strength have measured moments in directions other than extension, and it is difficult to compare results among studies because moments often are resolved at different locations in the cervical spine. Further, it is not clear how subject size, gender, and neck geometry relate to variations in the moment-generating capacity of neck muscles.Methods. Maximum moments were measured in 11 men and 5 women with an average age of 31 years (range, 20 -42 years). Anatomic landmarks were digitized to resolve moments at different locations in the cervical spine.Results. When moments were resolved about axes through the midpoint of the line between the C7 spinous process and the sternal notch, the maximum moments were as follows: extension (men, 52 Ϯ 11 Nm; women, 21 Ϯ 12 Nm), flexion (men, 30 Ϯ 5 Nm; women, 15 Ϯ 4 Nm), lateral bending (men, 36 Ϯ 8 Nm; women, 16 Ϯ 8 Nm), and axial rotation (men 15 Ϯ 4; women, 6 Ϯ 3) Nm). The magnitudes of extension, flexion, and lateral bending moments decreased linearly with vertical distance from the lower cervical spine to the mastoid process.Conclusions. Moments in three dimensions were quantified with regard to subject size and location along the cervical spine. These data are needed to characterize neck strength for biomechanical analysis of normal and pathologic conditions.

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Section: Discussionmentioning

confidence: 99%

“…Subjects with neck pain often have decreased neck strength, 1,22 and strength training is associated with a decrease in pain. 2,11 Women have a higher incidence of neck pain 16 and a poorer recovery from whiplash injury, 8 suggesting the necessity of studying gender differences in strength.…”

mentioning

confidence: 99%

Three-Dimensional Isometric Strength of Neck Muscles in Humans

Vasavada¹,

Li²,

Delp³

2001

Spine

124

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“…A Canadian study also found that after just 1 year, 4% of patients had still not recovered; in this study 'the moment of closure of the claim for compensation' was used as the measure for recovery. 15 However, in a review, Barnsley et al concluded that after 1 year between 14% and 42% of patients who had been involved in MVAs still had neck-pain complaints. 10 It seems that the presented figures in the literature about the prognosis of whiplash highly depend on the definition used to constitute 'recovery', the jurisdiction system, and the setting in which the patients were selected.…”

Section: Introductionmentioning

confidence: 99%

Impact of motor vehicle accidents on neck pain and disability in general practice

Vos¹,

Verhagen²,

Passchier³

et al. 2008

Br J Gen Pract

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BackgroundHigh levels of continuous neck pain after a motor vehicle accident (MVA) are reported in cross-sectional studies. Knowledge of this association in general practice is limited. AimTo compare the differences in perceived pain and disability in patients with acute neck pain due to an MVA versus other self-reported causes. The secondary aim was to identify prognostic factors for continuous neck pain. Design of studyProspective cohort study with 1-year follow-up. SettingGeneral practices in Rotterdam and its suburban region. MethodPatients with non-specific acute neck pain were invited to participate. Questionnaires were collected at baseline and after 6, 12, 26, and 52 weeks. The numerical pain-rating scale (NRS) and the neck disability index (NDI) were measured. Regression analysis was used to identify prognostic factors for continuous neck pain. ResultsA total of 187 patients were included. The MVA subgroup (n = 42) was significantly younger (P = 0.007), reported more sick leave (P = 0.037), higher levels of headache (P<0.001) and higher NDI scores at baseline (P = 0.018) but lower scores for previous neck pain (P = 0.015) compared to the remaining cohort. At follow-up the MVA subgroup had higher scores for continuous neck pain (63% versus 40%) and at the NDI (11.0 versus 7.1). After multivariate analysis 'pain in the upper part of the neck' (odds ratio [OR] = 1.6), 'duration of complaints at baseline longer than 2 weeks' (OR = 5.3), and an 'MVA' (OR = 5.3) were significantly correlated with outcome. ConclusionIndividuals exposed to MVAs constitute a relevant subgroup of patients with neck pain. An MVA and a longer duration of complaints are prognostic factors for continuous neck pain.

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“…Significant factors in this regard include previous whiplash injury, previous neck symptoms or headache, previous psychological problems, occurrence of acute eye symptoms, multiple symptoms, female gender and older age, work disability limited selfconfidence and limited education [13,14,28,39,53,88,90,118,127,142,173,185,187,195,209,212,[248][249][250]257]. The importance of various vehicle-and impact-related factors has also been studied [61,94,113,114,132,133,141,260] Studies of the roles of all these prognostic factors in the development of long-term symptoms in whiplash patients have produced inconsistent results, since several of the factors considered in the above, as well as in other studies and reviews, have not been found to be related to unfavourable prognosis.…”

Section: Other Prognostic Factorsmentioning

confidence: 99%

Whiplash injuries and associated disorders: new insights into an old problem

Rydevik¹,

Szpalski²,

Aebi³

et al. 2008

Eur Spine J

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SummaryThe Medical Task Force of the Swedish Society of Medicine and the Whiplash Commission has come to the following main conclusions:The term ''whiplash'' is so generally accepted that it should continue to be used, but the term ''whiplash trauma'' should only be used to refer to indirect cervical spine trauma. By deleting WAD grades 0 and IV from the classification system introduced in 1995 by the Quebec Task Force (QTF), the diagnosis of whiplash injury will be more exact and more realistically defined, which will reduce the risk of misunderstanding.The reported incidence of whiplash injuries in Sweden varies depending on the particular investigation cited, and ranges between 1.0 and 3.2/1000 per year. Whiplash injuries represent approximately 1/3 of all claims submitted after traffic injuries to insurance companies in Sweden, and give rise to a medical disability rate of 10% or more. Various studies of how the possibility of an insurance claim influences the course of a whiplash injury have produced quite different results, but generally there is no evidence of significant differences in outcome between those who have and have not sought claim.Ligament injuries can rarely be demonstrated acutely after whiplash trauma, and radiologically verified instability later in the course of the injury is also rare. Experimental studies have shown that whiplash trauma can lead to loads on discs and facet joints that might result in injury of these structures, but there is no scientific evidence to verify such injuries in patients with whiplash injury. Certain studies indicate that a dysfunction in the nervous system may exist in a small proportion of patients with whiplash injury.A series of physiological changes occurs in both the peripheral and the central nervous systems after whiplash injury, comprising peripheral as well as central sensitisation. There is no scientific evidence that such physiological changes are specific to the pain associated with whiplash injury; similar changes have been shown to occur in association with various other pain conditions, acute as well as long-term.It is likely that any previous mental ill-health and the patient's current mental state are both important for the clinical development and course of whiplash injury. To minimise the risk of long-term problems among people with acute whiplash injury, concurrently occurring acute stress disorder (ASD) and/or post-traumatic stress disorder (PTSD) should be diagnosed and treated. It is also important to diagnose and adequately treat possible sleep disorder, depression, or anxiety among people with whiplash injury.Neck problems in terms of pain and stiffness, either with or without objective clinical findings such as decreased range of motion and tenderness at palpation (WAD grades I and II), are most common. Symptoms usually appear within the first day and up to a few days after whiplash trauma. Headache commonly occurs, along with pain in the shoulders and the thoracic spine. Neurological symptoms are present in approximately 20% of pat...

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The Effect of Socio-Demographic and Crash-Related Factors on the Prognosis of Whiplash

Cited by 120 publications

References 19 publications

Three-Dimensional Isometric Strength of Neck Muscles in Humans

Three-Dimensional Isometric Strength of Neck Muscles in Humans

Impact of motor vehicle accidents on neck pain and disability in general practice

Whiplash injuries and associated disorders: new insights into an old problem

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