Whiplash, range of motion, and chiropractic

Journal of the American Chiropractic Association, Aug 2003 by Stember, Larry

A study by Kasch, et al. studied the relationship after acute whiplash injury between neck mobility and headaches, as well as neck pain and the speed of the car at the time of the collision.11 This study identified a significant inverse linear relationship that exists between neck mobility and neck pain intensity, as well as a significant inverse relationship between headache intensity and total CROM. In another study, Kasch, et al. followed 141 persons with acute whiplash injury to determine the sensitivity and specificity of five possible predictors for handicap following a whiplash injury. They were pain intensity, number of non-painful neurologic complaints, cervical mobility, workload during extension and flexion of the neck, and the results of a psychometric assessment.

Kasch's work demonstrated that CROM was the best single indicator of predicting long-term handicap for WAD patients. CROM had a sensitivity of 73 percent and a specificity of 91 percent, which increased to 9-4 percent and 99 percent when combined with pain intensity and other complaints. Those with reduced cervical mobility after one year were at risk of long-term problems by an increased factor of 2.5, and those with reduced mobility after six months were at risk by an increased factor of 2.1.12

These recent studies, which demonstrate cervical range of motion to be a high predictor of long-term WAD, are clinically important. Cervical range of motion is an objective, reproducible, and quantifiable clinical tool by which practitioners can isolate patients at high risk after they have sustained acute whiplash injury. The relevance of using cervical ROM as an indicator of permanent impairment is also further justified.

Chiropractic and Decreased CROM

These research findings, which document CROM as an initial predictor of long-term WAD, demonstrate the importance of early clinical evaluation to address the lack of full cervical range of motion. The importance of an acute whiplash patient seeing a biomechanical specialist who can properly assess cervical range of motion and follow through with an appropriate treatment plan is obvious to help minimize the likelihood of permanent injury. As chiropractic has been shown to increase range of motion in all cervical planes as well as to decrease pain, its relevance in treating the whiplash patient is clinically essential.13,14

A study by Cassidy, et al. demonstrated manipulation to be effective at both decreasing cervical pain and improving cervical range of motion.15 Manipulation early on after initial injury also helps reduce the likelihood of neuroplasticity and resulting chronic pain syndromes.16 In addition to restoring joint motion, it is also known that manipulative therapy has an antinociceptive effect by activating the descending pain inhibitory pathways communicated by the midbrain's penaqueductal gray.17

Research performed by Kannus demonstrated the importance of early joint mobilization.18 Early joint mobilization results in multiple positive factors including avoidance of cartilage deterioration, maintaining joint proprioception, reducing pain, and reducing swelling. Although Kannus does not mention chiropractic manipulation, chiropractic manipulative therapy provides the mobility to specific segments, which his research found to be important.