Objective: Chiropractic manipulation has been shown to be effective in the treatment of many patients with chronic whiplash symptoms. Our aim was to identify, prior to commencing treatment, which patients would benefit from such manipulation.
Results: Three groups of patients were recognized on the basis of their symptoms at presentation. Group 1 contained 50 patients (54%) and consisted of those with neck pain radiating in a "coat-hanger" distribution, associated with a restricted range of neck movement but wit h no neurological deficit. Group 2 contained 37 patients (34%) who had neurological symptoms or signs in association with neck pain and a restricted range of neck movement. These symptoms consisted of tingling, numbness, pins and needles in a dermatomal distribution in the arm or hand as well as both hypo and hyperaesthesia. Group 3 contained 11 patients (12%) who described severe neck pain but all of whom had a full range of neck movement and no hard focal neurological symptoms. In addition it was noted that these patients commonly described an unusual complex of symptoms. These included blackouts, visual disturbance, nausea, and vomiting and chest pain, along with a non-dermatomal distribution of pain. There was a statistically significant difference in outcome between the three groups (p<0.001) with only groups 1 and 2 improving following chiropractic manipulation.
Conclusion: The results from this study provide further evidence that chiropractic is an effective treatment for chronic whiplash symptoms. However, our identification of a group of patients who fail to respond to such treatment highlights the need for a careful history and physical examination before commencing treatment. The finding that patients in Group 3 had severe pain in the absence of physical signs, frequently complained of bizarre symptoms and were predominantly young females, raises the possibility that there is a significant non-organic component to their symptoms and the logical approach to this is to treat the psychological component of their whiplash injury before the physical.
Outcome: We anticipate improved targeting of chiropractic treatment in the management of chronic whiplash symptoms resulting in improved efficacy of such treatment.
Khan S, Cook J, Gargan M, Bannister G. A symptomatic classification of whiplash injury and the implications for treatment. [Abstract] World Congress on Whiplash-Associated Disorders 1999;p. 238.
