Re: Whiplash injury

Issue: BCMJ, vol. 44, No. 8, October 2002, Page 420 Letters
By: Michael Livingston, MD

The recent June and July/August 2002 whiplash injury articles in the [BCMJ 2002;44(5):236-263 and 2002;44(6):296-321] interested me as I spent some 30 years treating MVA musculoligamentous neck sprains[1] as one would other sprains, and researching this common problem.

Why does whiplash injury incidence vary so much worldwide and why is it so high here in BC?[2]

Around 1992, I noticed that whiplash injury was described frequently in the American literature after 1953,[3] but not described among British patients in the UK major journals for the next 30 years.[4] Normally a new syndrome described on one side of the Atlantic surfaces on the other side within 3 years. In whiplash injury it did not. Why did British patients, particularly in traffic-dense London, not complain of whiplash symptoms sufficiently to draw researchers’ attention? Why had no researcher commented on the difference between the two countries?

Next, I learned of Melville’s Canadian study in which he observed 92 drivers using ordinary road vehicles in a car-crashing derby who experienced “several thousand collisions mechanically comparable to the rear-end accidents so common on our streets today.” Melville noted their white helmeted heads “flail through a great range of movement…”[5] Yet, checking with the pit steward and the insurance company, he found no reported injuries. Melville’s observations were ignored.

More recently, Obelieniene and colleagues noted the absence of chronic whiplash symptoms following MVA’s in Lithuania[6] while Partheni and colleagues found 91% of 130 Greek whiplashed patients who received little or no therapy were symptom free in 1 month. None developed chronic disability.[7]

Partheni commented: “Perhaps by not receiving (and then failing to respond to) multiple therapies, no anxiety is created. Patients do not change their activities to any extent, or stop work, and will not develop poor posture or poor physical fitness. Whiplash victims in Greece do not hear frightful diagnoses that mean to them chronic disability. In other countries, however, the media and medical community attention to whiplash enforces the notion that it causes chronic pain.”[7] In effect, Partheni answers our earlier question. Ferrari, too, showed whiplash to be primarily a social disorder.[8] If we physicians, therapists, authors, and lawyers balanced psychosocial aspects of whiplash with physical ones, I suggest we would help our patients more. Readers wishing to look deeper into whiplash injury might enjoy reading the work of Malleson[9] and Livingston,[10] available in our excellent BC Medical Library.

—Michael Livingston, MD
Vancouver

References

1. Farbman AA. Neck sprain. Associated factors. JAMA 1973;223:1010-1015.PubMed Citation 
2. Allen M. Whiplash claims and costs in British Columbia. BC Med J 2002;44:241-242.Full Text 
3. Gay Jr, Abbott KH. Common whiplash injuries of the neck. JAMA 1953;152:1698-1704. 
4. Livingson M. Whiplash injury and peer copying. J Roy Soc Med 1993;86;535-536.PubMed Abstract 
5. Melville PH. Research in car crashing. CMAJ 1963;89:275. 
6. Obelieniene D, Schrader H, Bovim G, et al. Pain after whiplash: A prospective controlled inception cohort study. J Neurol Neurosurg Psychiatry 1999;26:279-283.PubMed Abstract 
7. Partheni M, Miliaras G, Constantoy Annis C, et al. Whiplash injury. J Rheumatol 1999;26:1206-1207.PubMed Citation 
8. Ferrari R. Whiplash is a social disorder—How so! BC Med J 2002;44:307-311.Full Text 
9. Malleson A. Whiplash and Other Useful Illnesses. Montreal: McGill-Queen’s University Press, 2002. 
10. Livingston M. Common Whiplash Injury: A Modern Epidemic. Springfield, IL. Charles C. Thomas, 1999. 

Michael Livingston, MD. Re: Whiplash injury. BCMJ, Vol. 44, No. 8, October, 2002, Page(s) 420 - Letters.


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