Latest Chiropractic Research
Chiropractic treatment of chronic "whiplash" injuries
M.N. Woodward, J.C.H. Cook, M.F. Gargan and G.C. Bannister
University Department of Orthopaedic Surgery, Bristol, UK
Forty-three per cent of patients will suffer long-term symptoms following "whiplash" injury, for which no conventional treatment has proven to be effective. a retrospective study was undertaken to determine the effects of chiropractic in a group of 28 patients who had been referred with chronic "whiplash" syndrome. The severity of patients' symptoms was assessed before and after treatment using the Gargan and Bannister (1990) classification. Twenty-six (93%) patients improved following chiropractic treatment (U=34, P<0.001). The encouraging results from this retrospective study merit the instigation of a prospective randomized controlled trial to compare conventional with chiropractic treatment in chronic "whiplash" injury. Copyright 1996 Elsevier Science Ltd.
Injury, Vol 27, No 9, 643-645, 1996.
A systematic Review of Conservative Treatments for Acute Neck Pain Not Due to Whiplash
Howard T. Vernon, DC, PhD, B. Kirn Humphreys, DC, PhD, and Carol A. Hagino, MBA
Objective: to identify the evidence base of clinical trials of conservative treatments for acute neck pain not due to whiplash injury.
Design and Setting: A comprehensive literature search was performed in MEDLINE, CINHAHL, AMED, MANTIS. Index to Chiropractic Literature, Alt Health Watch, the Cochrane Database of Systematic Reviews, the Cochran Controlled Trials Registry, and several EBSCO Information Services databases. Systematic retrieval and evaluation procedures were used.
Results: the search generated 1980 citations. Four trials (5 publications) were accepted according to the inclusion/exclusion criteria. Three trials used a form of spinal manual therapy. One of these trials used only one manipulation and reported immediate effects on pain, with real manipulation producing significantly greater pain reduction than control procedure. The other 2 of these trials reported on outcomes over 1 to 3 weeks. In 1 trial, the group receiving manipulation showed significantly greater pain reduction at 1 week than did the group receiving only medication. In the other trial, the group receiving transcutaneous electrical nervenstimulation (TENS) had a significantly greater level of pain reduction at 3 weeks. In the fourth trial, exercise was compared to passive physiotherapy; however, outcomeswere not reported until 6 to 12 months, so the results cannot be compared to the natural history of acute neck pain not due to whiplash.
Conclusion: there is limited evidence of the benefit of spinal manipulation and transcutaneous electrical nerve stimulation in the treatment of acute neck pain not due t whiplash injury. There is a dearth of hight-quality clinical trials of conservative treatments for this condition.
(JMPT Ther 2005;28:443-448)
Chiropractic management of "intractable" chronic whiplash syndromeLeiza AlpassRedland House Clinic, 118 Redland Road, Redland, Bristol BS6 6QT, UKElsevier CASE REPORT Clinical Chiropractic (2004) 7, 16-23
Hyperflexion/extension injuries are common and often result in neck and low back pain. As a neuromusculoskeletal complaint, chiropractors, as primary healthcare clinicians, are increasingly providing treatment in such cases. In the case described, a 22-year-old female 3 years after a "whiplash" type injury complaining of chronic neck pain and stiffness and frontal headaches. The neck pain had commenced 24 hours after a road traffic accident (RTA) and had remained severe for 2 weeks, during which time a soft collar was worn. The neck pain and stiffness had persisted and had worsended in the 6 months leading up to persentation. In addition, frontal headaches had also developed.
This case demonstrates that chronic "whiplash" injury patients can respond well to appropriate conservative management, even in the presence of poor prognostic indicators. The management protocol in this case consisted of chiropractic spinal manipulative therapy, soft tissue work and post -isometric relaxation (PIR) techniques to address biomechanical somatic dysfunction. In addition, active rehabilitation exercises, self-stretches and proprioceptive exercises were utilised to address postural and muscle imbalance. On the seventh treatment, the patient reported no neck pain, on headaches and unrestricted cervical spinerange of motion. At 4 months follow-up the patient continued to be free of headaches and neck stiffness and reported only mild, intermittent neck pain. This case demonstrates the use of chiropractic management of chronic "whiplash" type injuries.