The Journal of Orthopaedic Medicine
Volume 21(l), 1999, pp. 22-25
S Khan, J Cook, M Gargan G Bannister
University Department of Orthopaedic Surgery, Bristol, UK
FROM INCLUDED ABSTRACT
Objective:
To determine which patients with chronic whiplash will benefit from chiropractic treatment.
Design:
Retrospective review by structured telephone interviews of 93 consecutive patients seen in chiropractic clinic.
Setting:
Independent chiropractic clinic in a large city.
Subjects:
93 patients, 68 female.
Main outcome measure:
Gargan and Bannister grading pre and post treatment.
Results:
Three groups of patients were recognized.
Group 1 consisted of patients with isolated neck pain associated with a restricted range of neck movement.
Group 2 consisted of patients with neurological symptoms or signs associated with a restricted range of movement.
Group 3 comprised patients who described severe neck pain but all of whom had a full range of neck movement. Patients in this group often described an unusual group of symptoms, with a bizarre, non- dermatomal pain distribution.
Conclusion:
Whiplash injuries are common.
Chiropractic is the only proven effective treatment in chronic [whiplash] cases.
Our study enables patients to be classified at initial assessment in order to target those patients who will benefit from such treatment.
THESE AUTHORS ALSO NOTE:
Whiplash injuries result from indirect injury to the cervical spine and produce a syndrome comprising of headache, neck and interscapular pain, peripheral paraesthesia or a combination of these.
The accumulated literature suggests 57% of injured patients will make a full recovery. [Implying that 43% do not make a full recovery].
The resolution of symptoms will have occurred within two years of injury.
Eight (8%) of patients will remain disabled by their symptoms.
“Conventional treatment of patients with whiplash symptoms is disappointing.”
“In chronic cases, no conventional treatment has proved successful.”
The authors cite a retrospective study from the journal Injury in 1996, that demonstrated that chiropractic treatment benefited 26 of 28 patients (93%) suffering from chronic whiplash syndrome.
Their aim was to refine the indications for treatment of chronic whiplash syndrome with chiropractic.
This study reviewed 100 consecutive patients who were referred for chiropractic treatment for chronic whiplash symptoms. Seven (7) patients were lost to follow up, therefore 93 patients were assessed.
Initial symptoms, range of neck movement, and focal neurological signs of specific myotomes, dermatomes, or peripheral nerves were documented. Pain drawings were recorded.
All patients underwent spinal manipulation, a high velocity, low amplitude thrust to a specific vertebral segment by15 year chiropractor J. Cook.
Patients underwent a mean of 19.3 treatments (range 1 - 53), over a period of 4.1 months.
Author SK contacted each patient to determine whether chiropractic treatment had been of any benefit. This was assessed using the Gargan and Bannister classification of whiplash symptoms:
Absent symptoms = Grade A
Nuisance symptoms = Grade B
Intrusive symptoms = Grade C
Disabling symptoms = Grade D
Of the seven patients who were lost to follow up, five were in group 1 and two were in group 2. Their records of chiropractic treatment showed that all seven had undergone successful treatment and been discharged with resolved or improved symptoms, but as this could not be confirmed by telephone they were omitted from our study.
The patients in this study were referred for chiropractic treatment after a mean of 1.2-7 months (0-82) after injury.
Group 1 contained 50 patients (50/93 = 54%) and consisted of those with neck pain radiating in a ‘coat-hanger’ distribution, associated with a restricted range of neck movement but with no neurological deficit.
| Before Treatment: |
| B = 15 |
| C = 24 |
| D = 11 |
| After Treatment: | |||
| D = 0 | C = 0 | B = 8 | A = 7 |
| D = 0 | C = 4 | B = 15 | A = 5 |
| D = 2 | C = 2 | B = 7 | A = 0 |
In this group:
36 patients (72%) gained benefit from chiropractic spinal manipulation
12 (24%) became asymptomatic
and 12 (24%) improved by 2 grades
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Group 2 contained 32 patients (34/93 = 34%) who had neurological signs and / or symptoms in association with neck pain and a restricted range of neck movement, including tingling, numbness, pins and needles in a dermatomal distribution in the arm or hand as well as both hypo and hyperaesthesia.
| Before Treatment: |
| B = 4 |
| C = 23 |
| D = 5 |
| After Treatment: | |||
| D = 0 | C = 0 | B = 2 | A = 2 |
| D = 0 | C = 0 | B = 13 | A = 10 |
| D = 0 | C = 2 | B = 3 | A = 0 |
In this group, 30 patients (94%) responded positively to chiropractic manipulation with 12 (38%) becoming asymptomatic and 13 (43%) improving by 2 grades.
[This is a remarkable response, considering that these patients had neurological involvement.]
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Group 3 contained 11 patients (11/93 = 12%) who described severe neck pain but all of whom had a full range of neck movement and no neurological symptoms or signs in a specific myotome or dermatome. In addition it was noted that these patients commonly described an unusual complex of symptoms, including blackouts, visual disturbance, nausea, vomiting and chest pain, along with non-dermatomal distribution of pain.
| Before Treatment: |
| B = 1 |
| C = 6 |
| D = 4 |
| After Treatment: | |||
| D = 0 | C = 1 | B = 0 | A = 0 |
| D = 0 | C = 5 | B = 1 | A = 0 |
| D = 2 | C = 1 | B = 1 | A = 0 |
In this group, only 3 of the 11 patients (27%) improved following treatment, with no patient becoming asymptomatic and only one improved by 2 grades.
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THESE AUTHORS STATE:
“Our results confirm the efficacy of chiropractic, with 69 of our 93 patients (74%) improving following treatment.”
“… whilst the majority of patients did benefit from such [chiropractic] treatment, a particular group of patients failed to respond,” represented by our group 3.
[Actually 3/11 = 27% did show improvement.]
“Whilst other studies have suggested that neurological signs (our classification Group 2) have a poorer prognosis, this was not the case amongst our patients. Indeed, such patients showed the greatest improvement in disability.”
“Several recent papers have provided much evidence to support the conclusion that chronic pain from a whiplash injury is organic, and that this organic pain causes the psychological distress often associated with chronic symptoms, rather than being a result of it.”
“The results from this study provide further evidence that chiropractic is an effective treatment for chronic whiplash symptoms.”
KEY POINTS FROM THIS ARTICLE
1) “Chiropractic is the only proven effective treatment in chronic [whiplash] cases.”
2) The accumulated literature suggests 57% of injured patients will make a full recovery. [Implying that 43% do not make a full recovery].
3) The resolution of whiplash symptoms can take two years after injury.
4) Eight (8%) of whiplash patients will remain disabled by their symptoms 2 years after injury.
5) “Conventional treatment of patients with whiplash symptoms is disappointing.”
6) “In chronic [whiplash] cases, no conventional treatment has proved successful.”
7) A retrospective study from the journal Injury in 1996 demonstrated that chiropractic treatment benefited 26 of 28 patients (93%) suffering from chronic whiplash syndrome.
8) The chiropractic treatment in this study was a mean of 19.3 treatments (range 1 - 53), over a period of 4.1 months.
9) 72% of whiplash patients with neck pain radiating in a ‘coat-hanger’ distribution, associated with a restricted range of neck movement but with no neurological deficit, gained benefit from chiropractic spinal manipulation
10) 94% of whiplash patients with neurological signs and / or symptoms in association with neck pain and a restricted range of neck movement, including tingling, numbness, pins and needles in a dermatomal distribution in the arm or hand as well as both hypo and hyperaesthesia, responded positively to chiropractic manipulation.
11) 27% of whiplash patients with severe neck pain but with a full range of neck movement and no neurological symptoms or signs in a specific myotome or dermatome, improved following treatment. These patients also commonly described an unusual complex of symptoms, including blackouts, visual disturbance, nausea, vomiting and chest pain, along with non-dermatomal distribution of pain.
12) “Whilst other studies have suggested that neurological signs (our classification Group 2) have a poorer prognosis, this was not the case amongst our patients. Indeed, such patients showed the greatest improvement in disability.”
13) “Chronic pain from a whiplash injury is organic, and this organic pain causes the psychological distress often associated with chronic symptoms, rather than being a result of it.”
14) “The results from this study provide further evidence that chiropractic is an effective treatment for chronic whiplash symptoms.”
Gargan and Bannister are very well known for their continued publishing of long-term somatic and psychological whiplash outcomes. Their contribution to this article on chiropractic for chronic whiplash gives the study tremendous credibility, as did their contribution to the 1996 article they reference from the journal Injury.
