What is Whiplash?
Whiplash is the term given to the sudden, forceful movement of the neck that can occur in a motor vehicle accident – usually in a forwards/backwards manner with an acceleration/deceleration-type mechanism.
Rather than try to go into detail about the anatomy and mechanism of whiplash, the purpose of this short blog is to highlight the differences in whiplash prevalence around the world (as suggested by our title – There’s no Whiplash in Lithuania. Nor in Greece, it turns out.) If you have ever had a whiplash injury, then you should read this!
Why is whiplash different depending on where you live?
What studies have found is that in both Lithuania and Greece, the incidence of people complaining of neck pain and symptoms following car accidents is less than in other countries (such as USA, Canada and the U.K.) especially when it comes to experiencing any chronic, ongoing symptoms. In Lithuania, a study of 202 people who had been in car accidents found that only 31 had short-term neck pain and only 2 people had neck pain for more than 1 month, which is a remarkably low number. It is suggested that the reason for some countries reporting less “whiplash-type symptoms” is due to factors such as:
• The potential for litigation or secondary/financial gain may be low
• Awareness of the term “whiplash” is low – it is not a common occurrence so has not become a mainstream word in their vocabulary
• The term “whiplash” does not have an associated expectation of chronic symptoms (neck pain, headaches etc..)
Compar
e that to Australia, where the word “whiplash” is commonly used, and automatically creates a negative association when you think of the word. There is a Whiplash Culture. If you’ve ever been in a car accident, how many people have asked you afterwards if you had a sore neck, or if you had any “whiplash”? Litigation is not uncommon in Australia. These factors combine to make Australia’s rates of whiplash higher than places like Lithuania. In Australia, the annual incidence of whiplash is estimated as 3.8 per 1000 population ¹. It has also been found that the severity of a whiplash injury is unrelated to the severity of impact².
So factors such as our EXPECTATIONS of pain and injury actually influence what pain we feel.
That’s a short way of putting it, but it is a real phenomenon that occurs in all types of pain and injury, not just whiplash. If we focus on (“dwell on”) and become hypervigilant with monitoring our symptoms, we amplify our pain. Multiple studies have found that pain is a subjective experience; it is dependent on our emotions, our expectations, our previous injury history, our external environment, our cultural upbringing etc..
Our EXPECTATION of recovery influences how quickly (or slowly) we recover.
One study showed that people who expected ‘to get better soon’ had a recovery rate that was 2.6 times greater than those with poor recovery expectations³.
This is important, as it shapes how we need to manage people with whiplash injuries, especially in the early/acute stages.
Take these examples:
Example 1: A patient presents to a therapist 3 days after having a car accident with some minor neck pain and headaches. The therapist immediately tells the patient how most whiplash injuries take at least 6 months to get better, and that a full recovery is not always achievable. He/she encourages the patient to seek legal advice with a view to litigation.
Example 2: The same patient presents to a different therapist 3 days after having a car accident, with the same symptoms as above. The therapist is reassuring that a full recovery is expected quite quickly, and promotes a focus on an active recovery.
This patient could have 2 very different outcomes depending on which therapist they saw, based on how the therapists shaped the patient’s expectations.
Are you getting the best, up-to-date, evidence-based Whiplash management from your Physiotherapist?
At Ahead Physiotherapy, our management of Whiplash-type injuries is consistent with the recent whiplash guidelines report released by the NSW State Insurance Regulatory Authority http://www.sira.nsw.gov.au/__data/assets/pdf_file/0005/80852/Whiplash-Guidelines.pdf which is shaped by research such as that mentioned in this blog.
Dr Robert Ferrari has written an interesting piece on the differences in whiplash around the world: http://www.bcmj.org/article/whiplash-social-disorder%E2%80%94how-so for those wanting to read more.
Other References:
1. Barnsley L, Lord S, Bogduk N. The pathophysiology of whiplash. Spine State of Art Reviews 1993;7:329-353
2. Minton R, Murray P, Stephenson W, et al. Whiplash injury—Are current head restraints doing their job? Accident Analysis Prevention 2000;32:177-185
3. Ferrari, R, Predicting Recovery from Whiplash Injury in the Primary Care Setting, AFP, Volume 43, No 8 Aug, 2014, p559-562.
4. Galasko CSB, Murray PA, Pitcher M. Prevalence and long-term disability following whiplash associated disorder. J Musculoskeletal Pain 2000;8:15-27.
5. Wallis BJ, Lord SM, Barnsley L, et al. Pain and psychological symptoms of Australian patients with whiplash. Spine 1996;21:804-810
6. Ferrari R., Kwan O., Russell A.S., Pearce J.M., Schrader H. The best approach to the problem of whiplash? One ticket to Lithuania, please. Clin Exp Rheumatol. 1999;17:321–326.
7. Partheni M., Constantoyannis C., Ferrari R., Nikiforidis G., Voulgaris S., Papadakis N. A prospective cohort study of the outcome of acute whiplash injury in Greece. Clin Exp Rheumatol. 2000;18:67–70.