Whiplash Injury Mild, But Frequent
But Some Experts Say Whiplash More Likely To Lead to Disability
Agreed, says Richard A. Rubenstein, MD, board-certified neurologist who has participated in more than 200 depositions -- many of them lawsuits over whiplash injuries.
"The recovery profile of acute whiplash injury is indeed equivalent to an ankle sprain and like it, in the majority of cases, the pain improves and resolves over days, weeks, or months," he tells WebMD. "Saying that pain is mild and that 90% of cases heal within one year creates the impression that persistent symptoms that don't heal are part of chronic whiplash syndrome, and Kasch studied only acute injuries. And the consensus of the neurologic community is that this chronic syndrome falls into completely different diagnostic criteria."
That distinction may help explain why whiplash injuries sometimes wind up in court, while sprained ankles don't. Those cases often involve these more severe chronic cases -- and hence, the popular opinion that whiplash is a more serious condition.
But another expert is critical of the finding, and cites larger, long-term studies that find whiplash often does cause lasting debilitation -- beyond what could be evaluated in a one-year trial like Kasch's.
"The problem with this study and others like it is that when you look at whiplash patients, it's important to look at the type of patient being evaluated," says Christopher J. Centeno, MD, editor-in-chief of the Journal of Whiplash and Related Disorder. "This study looked at acute injuries, but a better study would be to study patients with chronic whiplash and those with chronic ankle injuries. If that was done, I think you'd see a real distinction in the length and severity of pain."
Cenento, who is board-certified in physical medicine and rehabilitation and is hosting the nation's first international symposium on whiplash injuries later this year, cites a Swedish study published last summer that tracked disability rates among those treated for whiplash in an emergency room with those treated at the same facility for other conditions. Some 17 years after the initial injury, the whiplash patients were six times more likely to have long-term disability than those treated for other emergencies.
And another Swedish study examining future health complaints among rear-ended car accident victims found that those with whiplash injuries were nearly four times as likely to have continued pain seven years later compared with those who sustained other types of injuries in similar accidents, but no trauma to their necks.
Both of these findings may suggest that initial treatment may play a key role in avoiding long-term problems.
"More practitioners understand how to treat whiplash with pain intervention techniques than they used to, but unfortunately, many don't, which can lead to future problems," Centeno tells WebMD. "The take-home message is that you really need to find people who know how to treat this injury."