A new study published in the Journal of Orthopaedic Medicine1 not only points out the superiority of chiropractic care for chronic whiplash patients, but also examines which chronic whiplash patients respond best to chiropractic care. The authors begin the paper by explaining that:
"Conventional treatment of patients with whiplash symptoms is disappointing.
"A retrospective study by Woodward et al., demonstrated that chiropractic treatment benefited 26 of 28 patients suffering from chronic whiplash syndrome."2
The question was not whether chiropractic was beneficial for acute whiplash patients, but to determine "which patients with chronic whiplash will benefit from chiropractic treatment."
The authors interviewed "100 consecutive chiropractic referrals for chronic whiplash symptoms," seven of which were "lost to follow up." They were able to divide the remaining 93 patients into three symptom groups:
Group 1: patients with "neck pain radiating in a 'coat hanger' distribution, associated with restricted range of neck movement but with no neurological deficit";
Group 2: patients with "neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement";
Group 3: patients who described "severe neck pain but all of whom has a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes." These patients also "described an unusual complex of symptoms," including "blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain."
The patients underwent an average of 19.3 adjustments over the course of 4.1 months (mean). The patients were then surveyed and their improvement reported as follows:
Group 1
| 24% - | Asymptomatic |
| 24% - | Improved by Two Symptom Grades |
| 24% - | Improved by One Symptom Grade |
| 28% - | No Improvement |
Group 2
| 38% - | Asymptomatic |
| 43% - | Improved by Two Symptom Grades |
| 13% - | Improved by One Symptom Grade |
| 6% - | No Improvement |
Group 3
| 0% - | Asymptomatic |
| 9% - | Improved by Two Symptom Grades |
| 18%- | Improved by One Symptom Grade |
| 64%- | No Improvement |
| 9% - | Got Worse |
In their discussion, the authors made these observations:
"Woodward, et al.,2 found improvement in chronic symptoms in 26 of 28 patients (93%) following chiropractic treatment. Our results confirm the efficacy of chiropractic, with 69 of our 93 patients (74%) improving following treatment.
"Our study suggests that such a group of nonresponders does exist, represented by group 3. The defining characteristics of patients in this group were the full range of neck movement in association with neck pain, bizarre symptoms, female sex and ongoing litigation. The mean age of the group at 29.5 (16-43) was lower than that of the other two groups (mean 36.8, range 18-65).
"The results from this study provide further evidence that chiropractic is an effective treatment for chronic whiplash symptoms. However, our identification of a group of patients who fail to respond to such treatment, highlights the need for a careful history and physical examination before commencing treatment."
References
- Khan S, Cook J, Gargan M, Bannister G. A symptomatic classification of whiplash injury and the implications for treatment. Journal of Orthopaedic Medicine 1999;21(1):22-25.
- Woodward MN, Cook JCH, Gargan MF, Bannister GC. Chiropractic treatment of chronic whiplash injuries. Injury 1996;27:643-645.
