Neck Solutions Blog

Predictors of neck pain after motor vehicle collisions: a prospective survey.

From: J Orthop Surg (Hong Kong). 2011 Dec;19(3):317-21

Neck pain is the most frequent injury sustained by motor vehicle occupants in the USA. In developed countries, claims for whiplash injury cost billions of dollars each year. Neck pain after motor vehicle injury may involve the intervertebral discs, facet joints, and the spinal cord, and is associated with atypical manifestations of carpal tunnel syndrome.

No theory for whiplash based on physical damage has been widely accepted. The prevalence of neck pain in uninjured controls is similar. Changes in the incidence of whiplash has been noted after legislative changes. Such observations have led to the proposal of alternative theories implicating psychosocial factors in neck pain after motor vehicle collisions.

Non-physical factors attributing to the development of whiplash include compensation, litigation and legislation, blame, post-traumatic stress, and symptom expectation. Many related studies have been retrospective, have used insurance data that may be unreliable, have used secondary outcomes measures (return to work or case closure), and were prone to selection bias by only including patients seeking compensation.

The authors identified possible psychosocial predictors of neck pain in patients with acute injuries following motor vehicle trauma.

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Alteration in Sleep Quality in Patients with Mechanical Insidious Neck Pain and Whiplash-Associated Neck Pain

From: Am J Phys Med Rehabil. 2011 Dec 14. [Epub ahead of print]

This study aimed to determine differences in sleep quality between patients with mechanical neck pain, patients with whiplash pain, and healthy controls and to determine the relationship between the intensity of ongoing pain, disability, and sleep quality.

Nineteen patients with mechanical neck pain (4 men, 15 women; age, 40 ± 16 yrs), 22 with whiplash (4 men, 18 women; age, 38 ± 15 yrs), and 18 comparable controls (4 men, 14 women; age, 41 ± 13 yrs) completed the Pittsburgh Sleep Quality Index to assess sleep quality. A numerical pain rate scale (0-10) and the Neck Disability Index (0-50) were collected for assessing neck pain and disability.

Significant differences in sleep quality, sleep latency, sleep efficiency, sleep disturbances, use of sleeping medication, daytime dysfunction, and total Pittsburgh Sleep Quality Index score but not for sleep duration were found; patients with mechanical neck pain and whiplash pain exhibited higher scores in all components compared with healthy controls. Seventeen (77%) patients with whiplash and 13 (68%) with mechanical neck pain reported poor sleep quality (Pittsburgh Sleep Quality Index score, >8). Significant positive correlations between mean intensity of ongoing pain with sleep quality; sleep duration; sleep efficiency and total Pittsburgh Sleep Quality Index score were found in patients with whiplash pain; the higher the intensity of ongoing pain, the worse the sleep quality.

Sleep disturbances are a common finding in individuals with neck pain and are associated with the intensity of ongoing pain in whiplash. It seems essential to address the ongoing cycle of pain and sleep disturbances as an integral part of the treatment of patients with neck pain.

Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain: Design of a randomised controlled trial

From: BMC Musculoskelet Disord. 2011 Dec 2;12(1):274. [Epub ahead of print]

Most studies suggest that patients with Whiplash Associated Disorders report chronic neck symptoms one year after the injury. The main problems in whiplash patients with chronic neck pain are cervical dysfunction and abnormal sensory processing, reduced neck mobility and stability, impaired cervicocephalic kinaesthetic sense, in addition to local and possibly generalised pain. Cervical dysfunction is characterised by reduced function of the deep stabilising muscles of the neck.

Besides chronic neck pain, patients with whiplash associated disorders may suffer from physical inactivity as a consequence of prolonged pain. This influences physical function and general health and can result in a poor quality of life. In addition, whiplash associated disorders patients may develop chronic pain followed by sensitisation of the nervous system, a lowering of the threshold for different sensory inputs (pressure, cold, warm, vibration and electrical impulses). This can be caused by an impaired central pain inhibition – a cortical reorganisation. Besides central sensitisation, the group with whiplash associated disorders may have poorer coping strategies and cognitive functions, compared with patients with chronic neck pain in general.

Studies have shown that physical training, including specific exercises targeting the deep postural muscles of the cervical spine, is effective in reducing neck pain for patients with chronic neck pain, albeit there is a variability in the response to training with not every patient showing a major change. Physical behavioural-graded activity is a treatment approach with a focus on increasing general physical fitness, reducing fear of movement and increasing psychological function. There is insufficient evidence for the long-term effect of treatment of physical and cognitive behavioural-graded activity, especially in chronic neck pain patients. Educational sessions, where the focus is on understanding complex chronic pain mechanisms and development of appropriate pain coping and/or cognitive behavioural strategies, have shown reduced general pain.

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Physiotherapy rehabilitation for whiplash associated disorder II: a systematic review and meta-analysis of randomised controlled trials.

From: BMJ Open. 2011 Nov 14;1(2)

Road traffic accidents are the primary cause of whiplash, a soft tissue injury to the neck following an acceleration–deceleration mechanism of injury. The cumulative incidence of patients seeking healthcare post-whiplash from a road traffic accident has increased during the last 30 years to recent estimates of >3/1000 inhabitants in North America and Western Europe and 1.0–3.2/1000 inhabitants in Sweden. In the UK, insurance statistics indicate that 300 000 patients present per annum with whiplash associated disorders. Whiplash associated disorders are the resulting clinical presentations following the injury and can range in severity, clinical symptoms and physical findings. Many patients with whiplash associated disorders experience persistent pain and disability, with reports suggesting that 40–60% of those injured have chronic symptoms. The annual economic cost associated with management of whiplash associated disorders and associated time off work is estimated as $3.9 billion in the USA, and €10 billion in Europe.

Patients experiencing whiplash associated disorders may be regarded as a distinct group within the broader non-specific neck pain population, although following review of trial data (n=4 trials), recent evidence questions this distinction for a primary care population and has identified a need for further research. Whiplash associated disorders can be categorised as grades 0–IV, where a higher grade indicates increased severity. The classification system is widely used in clinical practice and guidelines. Patients with whiplash associated disorder II who experience neck pain accompanied by stiffness or tenderness, and musculoskeletal signs, for example a reduced range of available movement, form the major group of patients (93.4%) who might benefit from conservative management, commonly involving physiotherapy intervention. A recent best evidence synthesis recommended a focus of research to the most common whiplash associated disorder I and II classifications, excluding classification III and above (ie, patients with neurological signs and fracture and/or dislocation) and classification 0 (no complaint at the neck, and no physical signs) However, a classification of whiplash associated disorder I is less commonly seen by physiotherapists as there are no accompanying physical findings (neck pain, stiffness or tenderness but with no physical findings) and patients are known to recover within 6 months post-injury.

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