Whiplash Cervical Acceleration Deceleration injury Cervical Sprain/ Strain injury Over the last ten years, a great deal has been written on the problem of whiplash biomechanics, but little study has been done on treatment of whiplash injuries. As the authors of a new study write, "Conventional treatment of patients with whiplash symptoms is disappointing." 1
This study examined the effectiveness of chiropractic treatment in patients with chronic whiplash pain. The mean time from injury to treatment was about 12 months.
The authors began with 93 patients with chronic whiplash pain and divided them into three groups:
Group I: patients with "neck pain radiating in a 'coat hanger' distribution, associated with restricted range of neck movement but with no neurological deficit."
Group II: patients with "neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement."
Group III: patients who described "severe neck pain but all of whom has a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes." These patients also "described an unusual complex of symptoms," including "blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain."
The patients underwent chiropractic treatment for 4.1 months, with a mean of 19.3 treatments per patient. The patients were graded before and after treatment on a four-point scale that described their symptoms:
Grade A was the absence of symptoms. Grade B patients had symptoms described as a nuisance. Grade C patients had symptoms that were intrusive. Grade D patients had symptoms considered disabling.
The authors found that in Group I, 72% of the patients improved; in Group II, 94%; and in Group III, only 27% of the patients reported improvement. So, there seem to be certain factors that can increase or decrease the effectiveness of chiropractic with these patients.
The study discusses the ramifications of the findings:
"Woodward et al2 found improvement in chronic symptoms in 26 of 28 patients (93%) following chiropractic treatment. Our results confirm the efficacy of chiropractic, with 69 of our 93 patients (74%) improving following treatment.
"Our study suggests that such a group of nonresponders does exist, represented by group 3. The defining characteristics of patients in this group were the full range of neck movement in association with neck pain, bizarre symptoms, female sex and ongoing litigation. The mean age of the group at 29.5 (16-43) was lower than that of the other two groups (mean 36.8, range 18-65).
"The results from this study provide further evidence that chiropractic is an effective treatment for chronic whiplash symptoms. However, our identification of a group of patients who fail to respond to such treatment, highlights the need for a careful history and physical examination before commencing treatment."
The authors conclude: "Whiplash injuries are common. Chiropractic is the only proven effective treatment in chronic cases."
-1) - Khan S, Cook J, Gargan M, Bannister G. A symptomatic classification of whiplash injury and the implications for treatment. Journal of Orthopaedic Medicine 1999;21(1):22-25.
-2) -Woodward MN, Cook JCH, Gargan MF, Bannister GC. Chiropractic treatment of chronic whiplash injuries. Injury 1996;27:643-645. | Low Back Treating Chronic Back Pain With Chiropractic
Low back pain is a very common condition, and one that is very expensive for our health care system. Experts estimate that chronic back pain costs the US about $100 billion each year in direct and indirect costs. As the authors of a new study write:
“One factor explaining these enormous costs is the high rate of recurrence and chronic disability related to low-back disorders…It has been suggested that only 10% of LBP patients generate more than 80% of the total costs related to LBP.”
Because of the enormous costs of treating chronic back pain, prevention is an important goal. This current study set out to examine the role of chiropractic in treating chronic low back pain. The authors studied 30 patients who had back pain for at least six months. All patients were subjected to a one-month control period that consisted of no treatment. This was included so that the researchers could observe the natural course of the back pain symptoms.
After this baseline period, half of the patients (Group 1) received intensive chiropractic treatment consisting of 12 treatments in one month, then no treatments for nine months. The other half of the patients (Group 2) received the same intensive treatment, but also received maintenance chiropractic treatments every 3 weeks for nine months. At the end of the nine-month period, both groups were again examined.
After analyzing the results, the authors found the following:
Pain levels were reduced in both groups of patients. The intensive month of chiropractic adjustments reduced pain, even without follow-up care.
Disability levels, however, showed a different response. For the patients with no continuing treatment, the disability levels returned to their pretreatment levels on the Oswestry. The Group 2 patients – who received maintenance care – continued to see improvement in disability scores over the whole nine months.
The authors conclude:
“This study appears to confirm previous reports showing that LBP and disability scores are reduced after spinal manipulation. It also shows the positive effects of preventive chiropractic treatment in maintaining functional capacities and reducing the number and intensity of pain episodes after an acute phase of treatment. Maintenance chiropractic care involving spinal manipulation combined with other treatment modalities (exercises, pain management program) should be investigated. Such combined interventions may have a critical influence on pain, disability, and return to work.”
-----Descarreaux M, Blouin JS, Drolet M, Papadimitriou S, Teasdale N. Efficacy of preventive spinal manipulation for chronic low-back pain and related disabilities: a preliminary study. Journal of Manipulative and Physiological Therapeutics 2004;27:509-514.
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