Advanced magnetic resonance imaging of chronic whiplash patients: a clinical practice-based feasibility study

Background Whiplash injury is common following road traffic crashes affecting millions worldwide, with up to 50% of the injured developing chronic symptoms and 15% having a reduced working capability due to ongoing disability. Many of these patients receive treatment in primary care settings based upon clinical and diagnostic imaging findings. Despite the identification of different types of injuries in the whiplash patients, clinically significant relationships between injuries and chronic symptoms remains to be fully established. This study investigated the feasibility of magnetic resonance imaging (MRI) techniques including quantitative diffusion weighted imaging and measurements of cerebrospinal fluid (CSF) flow as novel non-invasive biomarkers in a population of healthy volunteers and chronic whiplash patients recruited from a chiropractic clinic for the purpose of improving our understanding of whiplash injury. Methods Twenty chronic whiplash patients and 18 healthy age- and gender matched control subjects were included [mean age ± SD (sex ratio; females/males), case group: 37.8 years ± 9.1 (1.22), control group: 35.1 years ± 9.2 (1.25)]. Data was collected from May 2019 to July 2020. Data from questionnaires pertaining to the car crash, acute and current symptoms were retrieved and findings from clinical examination and MRI including morphologic, diffusion weighted and phase-contrast images were recorded. The apparent diffusion coefficient and fractional anisotropy were calculated, and measurement and analysis of CSF flow was conducted. Statistical analyses included Fisher’s exact test, Mann Whitney U test and analysis of variance between groups. Results The studied population was described in detail using readily available clinical tools. No statistically significant differences were found between the groups on MRI. Conclusions This study did not show that MRI‐based measures of morphology, spinal cord and nerve root diffusion or cerebrospinal fluid flow are sensitive biomarkers to distinguish between chronic whiplash patients and healthy controls. The detailed description of the chronic whiplash patients using readily available clinical tools may be of great relevance to the clinician. In the context of feasibility, clinical practice-based advanced imaging studies with a technical setup similar to the presented can be expected to have a high likelihood of successful completion.

Chronic Whiplash Syndrome: Associated Disorders and Physiotherapy Management – A Literature Review

Purpose: The purpose of the current literature review is to present the Whiplash Associated-Disorders through diagnosis, scales, physical examination and to identify the most suitable physiotherapy management of these conditions. The long-term effectiveness of physiotherapy interventions is also examined. Methods: Sixteen randomized controlled trials (RCTs) and seven case-control and cohort studies related to chronic WAD fulfilled the inclusion and exclusion criteria. The design, diagnosis, population, methodology, results, methodological quality and physiotherapy management were examined. The PEDro Scale and the Newcastle-Ottawa Scale were used for the examination of the methodological quality. Results: The methodological quality of the studies used, were high. Significantly important on minimizing the symptoms of chronic WAD were the combination of Exercise therapy & Advice both at 6 and 12 months follow up. Other interventions such as Exercise therapy, Interdisciplinary approach and Multimodal physiotherapy treatment, Spinal Manual therapy and Advice were not equally effective in the long-term. Conclusion: The most suitable intervention for the physiotherapy management of chronic WAD, with long-term effectiveness was the combination of Exercise & Advice, which was established with various outcome measures, such as NDI, VAS, NRI and SF-36. On the contrary, Exercise therapy, Interdisciplinary approach and Multimodal physiotherapy treatment, Spinal Manual therapy and Advice were not that effective on minimizing the symptoms of chronic WAD in the long-term.

Impaired neuro-motor control in chronic whiplash and tension-type headache

BackgroundThe purpose of this study is to support the hypothesis that the neuro-motor control of the neck muscles is impaired in the diseases of chronic whiplash and tension-type headache. This hypothesis is based on a previous study, and if confirmed, it indicates that the central nervous system may be part of the pathophysiology of these diseases. For further verification, we designed a laser tracking method for standardized and quantitative measurements of movements of head and hand. The hand was included as a presumed normal reference to the head movements.MethodsA new laser tracking instrument was designed to monitor the ability of a test-person to track a reference point on the wall by a laser fixed to the forehead or held in the hand. The reference point moves in runs of a circle or a square at three different speeds 10, 20 or 30 cm/sec thus providing 6 runs for both head and hand per test-person. We used a 1x1x1 m set-up geometry. The data of each run was processed on-line. Groups of 22 patients diagnosed with chronic whiplash associated disorder, 19 patients diagnosed with chronic tension-type headache and 37 control persons were compared.FindingsA small but highly significant dyscoordination of head movements was observed in both patients groups, and in whiplash also of the hand. InterpretationOur study confirms the hypothesis that the neuro-motor control of the neck muscles is impaired in both chronic whiplash and tension-type headache. In our view this observation implicates that the central nervous system may be involved in the primary pathology of both these diseases. Accordingly, we suggest a provisional term 'cervical dyssynergia' for these diseases, and suggest further studies along this paradigm.