30% Complain of Chronic Neck Pain After Whiplash

A new article has been published regarding whiplash injuries that has very little (if any) scientific credibility. Normally, we do not report on such studies, but we must report on this one because it is sure to show up on some accident reconstructionist's report at some time, and its important that you are forewarned.

This article is titled, "Neurological sequelae of minor head and neck injuries," which sounds as if it might have some value. Unfortunately, the author is simply attempting to discredit anyone who claims to have a whiplash injury.

First of all, the study subjects were all referred to the author for "medico-legal reports." Although the exact meaning of this is not explained, it is clear from the author's tone that he performs "independent" medical exams. And it seems he has been performing this service for some time now; the first cases he refers to are from 1954.

In this "study," the author compared "112 cases referred for neck pain and headaches, usually following a rear end motor vehicle accident" and 50 patients with severe head and neck injuries and who had suffered amnesia for over 2 hours.

The author states that none of the severe head injury patients complained of neck pain, and concludes that the whiplash patients' symptoms are "better explained on the behavioural concept of chronic pain, learned pain behaviour and secondary gain."

The errors in this study are too numerous to mention, but here is a brief summary of the most egregious:

  1. Comparing severe head injury patients (22 (44%) of whom had post-traumatic amnesia for one week) to whiplash patients is absolutely meaningless. These are two completely different kinds of injury.
  2. The author states that headache—the most common symptom after a rear end collision—is not a symptom related to whiplash. "Headaches are a common symptom in life."
  3. The author is not even aware of the basic biomechanics of whiplash motion: "However, if the driver or passenger is restrained by an adequately fitting seat belt and there are neck rests in the vehicle, then the person would not move forward and hyperextend their neck. All patients except one in this series claim that they were wearing seat belts..." First, the literature on seat belts shows that they increase the risk of whiplash injury. Second, hyperextension is a rearward—not a forward—motion. Third, head restraints only work if properly adjusted, and all studies on the issue of head restraints show that only 10% of head restraints in the real world are properly adjusted.
  4. Many studies have shown that patients continue to complain of symptoms, even after their litigation is completed, and most authors believe this is because the patient still has pain. Not this author. "Why are some of these cases 'not cured by a verdict?' The neurotic personality of some of those involved, or stress factors as outlined, business failures, dissolution of marriage and custody battles during the time of the court case." And what scientific evidence does he provide for such a sweeping generalization? Nine of his 112 patients had been involved in a divorce or business failure during the course of their injury.
  5. Another flaw with this report is the age of the references included with the study. Of the 27 studies he references, they are an average of 21 years old, with the most recent being from 1994! The only engineering study he refers to is from 1955. The author has effectively eliminated any of the modern engineering data showing that even low speed collisions can cause hazardous motion of the cervical spine.

Ironically, in spite of such obvious bias, the statistical conclusion the author reaches confirms what many other studies have found:

"In conclusion, while 70% of minor head and neck injuries settle within a few weeks of a motor vehicle accident, about 30% continue to complain of headaches and/or neck pain."

As you can see, those who are opposed to the very idea of whiplash being a real condition will go to great lengths to prop up their viewpoint—in spite of the latest literature. Keep the above points in mind when you see this article referred to in the future.

Landy PJB. Neurological sequelae of minor head and neck injuries. Injury 1998;29(3):199-206.