A critical appraisal of the chronic whiplash syndrome

“It is incident to physicians, I am afraid, beyond all other men, to mistake subsequence for consequence.” Samuel Johnson from a review of Dr Lucas’s Essay on Waters (1734) Patients with protracted complaints after neck sprains (whiplash) continue to pose difficulties for physicians, expert witnesses, and the Courts. Strict definition is essential for clear and objective thinking. Courts are often misled by experts’ reference to publications that do not adhere to critical criteria. The term “whiplash” is confusingly used both as a shorthand for a description of the injury mechanism—a flexion-extension, or torsional movement”—and more correctly for symptoms better designated neck sprains.1 Much confusion can be avoided if patients suffering from an acute traumatic lesion of the cervical nerve roots (radiculopathy) or spinal cord (myelopathy) are excluded by definition.2 3 So too should patients with an acute annular disk tear, fracture, or dislocation of the facet joints and bony spine. Such cases have their own distinctive clinical features, and accompanying abnormalities on x ray films and MRI. It is those patients without these pathologies who have suffered injury to the muscles, ligaments, and soft tissues, who are correctly labelled acute neck sprains (whiplash). The lesion is akin to a sprain with or without contusions in other areas of the body—the pulled hamstring, calf muscle, or groin sprain of football or athletics. A sprain is a mechanical stretching of muscular and ligamentous soft tissues with or without local bruising (contusion). It causes pain, stiffness, oedema, and variable local tenderness and muscle spasm. Such injuries and their symptoms, resolve within about 2–6 weeks.4 The duration is prolonged only if definable complicating factors come into play. Symptoms of sports injuries, when treated with rest and analgesia followed by increasing exercise, subside within days or a few weeks, generally without complications. …