March 13, 2003 - Whereas whiplash injury often thought lead to severe disability, a new study suggests pain level is no more than seen with other sprains. But experts question these findings -- and suggest that getting the right treatment early may be key.
In what is believed to be the first study specifically to compare whiplash to another injury, Danish researchers say that the neck injury -- endured by one in five motorists in rear-end collisions, according to the American Academy of Orthopaedic Surgeons -- typically causes mild pain similar to that of ankle sprains. These findings are published in the March issue of Neurology.
"There is a preconceived notion, in general, that whiplash injury is a more severe injury," lead researcher Helge Kasch, MD, PhD, of Aarhus University Hospital in Denmark, tells WebMD. "But our findings show that victims of ankle injuries and whiplash seem similarly disabled by their injuries in the first week."
Interestingly, the 140 whiplash and 40 ankle-injured patients studied reported a similar level of pain in their lower back resulting from their respective injuries. Kasch credits this high frequency among those with ankle sprains to investigators specifically asking about total body symptoms. However, the whiplash patients complained of higher levels of "non-painful" symptoms such as forgetfulness, dizziness, and irritability, and typically took longer to recover.
The two injuries were compared because whiplash is essentially a neck sprain, occurring when the soft tissue of the neck is damaged -- usually as the result of a sudden extension and flexing like that of a rear-end car accident. Whiplash may also injure joints, discs, ligaments, and nerves near the neck, and is typically treated with pain and other medications and a cervical collar for several weeks. Some patients also need physical therapy or are treated with heat.
All of the whiplash patients studied by Kasch were injured in rear-end automobile collisions averaging 25 mph -- although whiplash can result in accidents at much lower speeds. The ankle sprains occurred in various mishaps not related to sports or car accidents. Patients with both injuries were asked to rate their pain levels on a 100-point scale at one week after initial treatment in a hospital emergency room, and again at one, three, six, and 12 months later. Ankle-sprain pain was initially rated an average of 15 (with 100 being the highest), and usually fell to zero within a month. Whiplash patients initially rated their pain at around 20, but it dropped to only 14 after a year. Still, both ratings indicate a low level of pain.
"Acute whiplash injury is a benign condition with high recovery rate, and in general, there is a high frequency of pain but its intensity is low," Kasch tells WebMD. "After one year, 90% of whiplash patients recovered." By comparison, all the ankle-injured had recovered in that time and returned to work.
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."