Whiplash and Permanency – The Evidence
Permanency relating to bodily injury is an important part of documenting response to care in trauma victims especially when there is debate as to whether the injury should have been self-limiting. In a recent study, Poorbaugh, Brismée, Phelps, & Sizer Jr (2008) stated, “Considering that 14% to 42% of patients are left with chronic symptoms following whiplash injury, it is unlikely that only minor self-limiting injuries result from the typical rear-end impact” (p. 65).
“Late Whiplash Syndrome has been described as a disorder that is characterized by a constellation of clinical profiles including neck pain and stiffness, persistent headache, dizziness, upper limb paresthesia, and psychological emotional sequelae that persist more than 6 months after a whiplash injury...It is estimated that 6.2% of all Americans (approximately 15.5 million) currently suffer from Late Whiplash Syndrome” (Poorbaugh et al., 2008, p. 65-66).
There are many times that a patient will describe an increase in symptoms post trauma within 72 hours of the injury. The authors confirm this by stating, “Selected studies have demonstrated that the delay in the onset of whiplash symptoms can range from 1 hour to several days after the accident” (Poorbaugh et al., 2008, p. 66).
It is critical that clinicians understand that there are a myriad of structures in the cervical spine that are innervated and can be generators of pain resulting in disability. According to the authors of this study, “Because structures such as the intervertebral discs and zygapophyseal joints are extensively innervated, they could serve as primary pain generators in Late Whiplash Syndrome” (Poorbaugh et al., 2008, p. 66).
In conclusion, related to chronic whiplash and permanency the authors report, “There is no consensus on the optimal approach for evaluation and management of Late Whiplash Syndrome. The constellation of symptoms with which patients present must be evaluated using an in-depth history and thorough clinical exam” (Poorbaugh et al., 2008, p 81). Therefore, in the end, it is the clinical correlation of causality, bodily injury, objective evidence and persistent functional loss that complete the permanency picture.
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Reference:
Poorbaugh, K., Brismée, J. M., Phelps, V., & Sizer Jr, P. S. (2008). Late whiplash syndrome: A clinical science approach to evidence-based diagnosis and management. Pain Practice, 8(1), 65–89.