Acute Whiplash Injuries: Therapy [Clinical Review]

The greatest concern when the physician is confronted with a whiplash injured patient is to rule out serious injury. The second concern is to manage the patient in such a way to avoid chronicity. When reviewing the natural history of acute whiplash injuries (AWI) one will find 24% to 70% of patients develop long-term symptoms with as many as 16% becoming severely impaired (1). The need to identify and intervene in those patients with tendencies to become chronic is essential. This was clearly demonstrated by a recent review of the literature that found "persuasive evidence that the clinical outcome at two years can be predicted at three months" (2).

The difficulty in choosing the proper intervention is the lack of information in the published scientific literature. At least 24 treatment interventions have been identified in the literature or consensus documents as potential treatments for AWI. Few of these interventions are supported by good quality randomized controlled trials (RCT). The few RCTs available are further diluted between acute, subacute and chronic patients. Consequently much of the following information is based on lesser quality RCTs, cohort studies, case series and expert opinion. More so than most conditions, whiplash injuries test the doctor’s knowledge and skills as well as the ability to work with the patient to arrive at a satisfactory outcome.

Two interesting findings from a recent study were that 40% of medical doctors “have negative feelings about these patients” (AWI) compared to 1.1% of chiropractors; 31% of medical doctors do not believe therapy affects the natural history compared to 2.2% of chiropractors with similar beliefs (3). These findings may explain, in part, the lack of research in this area.